This book describes the different aspects of aortic valve including comprehensive discussion of the state-of-the-art diagnostic imaging options, disease risk stratification, selection of candidates for valve repair or percutaneous intervention, and most recent therapeutic options. The growing prevalence of valvular heart disease represents a major challenge in terms of short- and long-term management and surveillance. Aortic valve diseases, including aortic stenosis and regurgitation, are among the most frequent of these, while the number of cases of aortic root disease is also on the rise. Aortic valve disease treatment options include valve surgery, valve repair, minimally invasive valve surgery, and percutaneous approaches and all are covered in this volume.
Perspective in Aortic Valve Disease is a highly illustrated, case oriented reference aimed at cardiology fellows in training, while also helpful to surgeons, cardiologists, imagers, interventionalists, as well as other clinicians and students involved in the diagnosis and treatment of aortic valve and root diseases.
Author(s): Giovanni Concistrè
Series: Cardiology Research and Clinical Developments
Edition: 1
Publisher: Nova Science Pub Inc
Year: 2021
Language: English
Commentary: decrypted from 24121BC2DAB466293C098A7968B85F38 source file
Pages: 426
City: Massa
Tags: Aortic Valve Disease
Contents
Foreword
Preface
Chapter 1
Surgical Anatomy and Pathology of Aortic Valve: Morphogenesis, Normal and Pathological Anatomy
Abstract
Introduction
Aortic Valve Morphogenesis
Structural Components
The Aortic Root
Anatomical Landmarks and Uniform Terminology
Definition of the Aortic Root
The Sinotubular Junction
The Valsalva Sinuses
The Aortic Valve Structure (Semilunar Leaflets and Commissures)
The Interleaflet Triangles
The Ventriculo-Aortic Junction
Functional Anatomy
Aortic Stenosis
Aortic Regurgitation
Morphofunctional Classification of Aortic Regurgitation
The Bicuspid Valve
Morphology of BAV
Genetics of BAV
Aortic Stenosis in BAV
Aortic Regurgitation in BAV
Aortopathy and Aortic Dissection in BAV
References
Chapter 2
Epidemiology and Clinical Approach
to Aortic Valve Disease
Abstract
Abbreviations
Introduction
Epidemiology and Etiologies
Clinical Approach to Aortic Valve Disease
Aortic Stenosis
Symptoms
Signs
Diagnosis and Evaluation
Clinical Features of Advanced AS
Aortic Regurgitation
Acute Aortic Regurgitation
Symptoms and Signs
Diagnosis and Evaluation
Chronic Aortic Regurgitation
Symptoms
Signs
Diagnosis and Evaluation
Staging and Serial Monitoring
Conclusion
References
Chapter 3
Non-Invasive Imaging of Aortic Valve – Ultrasounds: Trans-Thoracic, Trans-Esophageal and Stress Echocardiography
Abstract
Introduction
Trans-Thoracic Echocardiography
Anatomic Assessment of the Aortic Valve in Physiology and Pathology
Doppler-Based Assessment of Aortic Stenosis
Doppler-Based Assessment of Aortic Regurgitation
Trans-Esophageal Echocardiography
Aortic Stenosis
Aortic Regurgitation
Thoracic Aorta and Aortic Arch
3D-Transesophageal Assessment
TEE as a Key Tool before and after Percutaneous and Surgical Procedures
Stress Echocardiography
Stress Echocardiography in Aortic Stenosis
Low-Flow Low-Gradient Aortic Stenosis
Stress Echocardiography in Aortic Regurgitation
Conclusion
References
Chapter 4
Advanced Imaging and Functional Tools for Aortic Valve Assessment: Cardiovascular Magnetic Resonance and Cardiac Computed Tomography Angiography
Abstract
Aortic Valve Morphology
Normal Anatomy
Aortic Valve Variants
Aortic Valve Stenosis
Aortic Valve Regurgitation
Combined Aortic Valve Disease
Aortic Valve Masses And Pseudomasses
Ventricular Remodelling and Dysfunction
Myocardial Tissue Characterization
Aortic Remodelling and Dilation
Planning Surgical Interventions
Planning Percutaneous Interventions
Post-Procedural Imaging
Aortic Valve Complications
Aortic Complications
Ventricular Remodelling
Technical Limitations
Conclusion
References
Chapter 5
Degenerative Aortic Valve Disease
Abstract
Abbreviations
Introduction
Pathophysiology
Degenerative Aortic Valve Disease and Atherosclerosis
Calcification
Genetic Factors
Role of Imaging
Pharmacological Strategies
Lipid-Lowering Drugs
Drugs Acting on the Renin-Angiotensin-Aldosterone System
Modulators of Valve Calcification
Other Pharmacological Strategies
Interventional Therapies
Tissue Engineering
Conclusion
References
Chapter 6
Aortic Valve Endocarditis: Epidemiology, Treatment and Outcomes
Abstract
Introduction
Classification
Epidemiology
Physiopathology
Microbiology
Symptoms
Diagnosis
Treatment
Surgery
Indication
Techniques
Results
Prosthetic Valve Endocarditis
Our Experience at the Lancisi Cardiovascular Center
Conclusion
References
Chapter 7
Neoplastic Disorders Involving the Aortic Valve
Abstract
Abbreviations
Introduction
Benign Tumors of the Aortic Valve
Papillary Fibroelastoma
Clinical Features
Imaging
Macroscopic Features
Microscopic Features
Myxoma
Clinical Features
Imaging
Macroscopic Features
Microscopic Features
Fibroma
Clinical Features
Imaging
Macroscopic Features
Microscopic Features
Hemangioma
Imaging
Macroscopic Features
Microscopic Features
Inflammatory Myofibroblastic Tumor
Primary Malignant Tumors of the Aortic Valve
Sarcoma
Non-Hodgkin Lymphoma
Cardiac Metastases
Non-Neoplastic Lesions (Pseudotumors) of the Aortic Valve
Endocarditis
Rheumatoid Nodules
Conclusion
References
Chapter 8
Aortic Root Involvement in Congenital Heart Defects: Special Surgical Topics
Abstract
Truncus Arteriosus and Truncal Valve Regurgitation
Introduction
Anatomy and Classification
Truncal Valve
Methods
Surgical Repair of Truncal Valve Regurgitation
Discussion
Outcomes of Truncal Valve Surgery and Current Perspestives
Ventricular Septal Defect and Aortic Valve Regurgitation
Introduction
Description
Epidemiology
Methods
Etiology, Pathophysiology and Clinical Description
Anatomical Factor
Hemodynamic Factor
Diagnosis
Surgical Management
Discussion
Outcome and Perspectives
Aortico-Left Ventricular Tunnel (ALVT)
Introduction
Description and Anatomical Considerations
Etiology
Pathophysiology and Clinical Description
Diagnosis
Methods
Principles of Surgical Management
The Two-Patch Technique
Associated Anomalies
Discussion
Outcome and Current Perspectives
References
Chapter 9
Adult Bicuspid Aortic Valve
Abstract
Introduction
Phenotypes of Bicuspid Aortic Valve
Embryogenesis and Hemodynamic Effects of Different Morphotypes
Different Inherent Risks?
Bicuspid Aortic Valve Stenosis
BAV is a Relevant Cause of Aortic Valve Stenosis
Invasive Treatment of BAV Stenosis
Bicuspid Aortic Valve Regurgitation
The Regurgitant BAV
Principles of BAV Repair
Endocarditis of the BAV
Indications for Prophylaxis, Risks and Treatments
BAV Aortopathy
Pathogenetic Hypotheses
Indications to Treatment: Wavering Guidelines
The Risk of Aortic Dissection
References
Chapter 10
Management of Aortic Valve Disease in LVADs
Abstract
Introduction
De Novo Aortic Regurgitation
Hemodynamic Effect
Treatment Strategies for De Novo Ai
Assessment and Indication for Treatment of Aortic Regurgitation at the Time of LVAD Implantation
Strategies for AV Repair at Time of LVAD Implantation
Conclusion
References
Chapter 11
Multidisciplinary Approach to the Treatment of Aortic Valve Disease: The Role of the Heart Team
Abstract
Introduction
Developments in Aortic Valve Surgery
Advantages of a Multidisciplinary Approach in Aortic Valve Disease
The Heart Team in Valvular Heart Disease
Conclusion
References
Chapter 12
Pharmacological Treatment of Aortic Valve Disease
Abstract
Introduction
Novel Pharmacological Targets for Calcific Aortic Valve Disease
Lipid-Lowering Approaches
Failure of Statins
Lipoprotein(a) Reduction
PCSK9 Inhibition
Aortic Valve Adverse Remodeling Therapeutic Targets
Purinergic Receptor 2Y2 Activation
Phosphate Inorganic Transporter 1 Inhibition
Peroxisome Proliferator-Activated Receptor-Gamma Activation
Dipeptidyl Peptidase 4 Inhibition
5-Hydroxytryptamine Receptor 2B Inhibition
Cadherin 11 Inhibition
Cathepsin S Inhibition
Multi-Omic Approach
Conclusion
Rational for Medical Treatment in Aortic Aortic Regurgitation
Vasodilators
Acute AR
Chronic AR
Short-Term Effects of Vasodilators
Long-Term Effects of Vasodilators
Limitations
↑-Adrenoceptor Antagonists
Other Treatment in AR and Systemic Prevention of Endocarditis
Evidence-Based Management of AR: Place of Medical Therapy
Future Prospects
Conclusion
References
Chapter 13
Surgical Treatment of Aortic Valve Disease: Indications, Risk Stratification and Outcomes
Abstract
Introduction
Indications
Risk Stratification
Outcomes
Early or Peri-Operative Mortatlity
Early Complications
Neurologic Complications
Heart Block and Permanent Pacemaker Implantation
Long-Term Survival
Late Complications
Thromboembolism, Anticoagulation, and Bleeding Complications
Prosthetic Valve Endocarditis
Structural Valve Deterioration and Freedom from Reoperation
Symptomatic Relief
Left Ventricular Remodeling
Prosthesis-Patient Mismatch
References
Chapter 14
Surgical Approach: Conventional and Minimally Invasive Treatments
Abstract
Introduction
Conventional Treatment
Cardiopulmonary Bypass and Myocardial Protection
Exposure of the Aortic Valve
Valve Excision, Debridement, and Sizing
Valve Implantation
Stented Prosthesis
Homograft Prosthesis
Stentless Prosthesis
Sutureless and Rapid Deployment Prostheses
Ross Procedure
Aortotomy Closure and De-airing
Minimally Invasive Treatment
Principles and Advantages
Preoperative Assessment and Preparation
Anesthesia
Ministernotomy: Surgical Technique
Right Anterior Minitoracothomy: Surgical Technique
Outcomes in Minimally Invasive Aortic Surgery
References
Chapter 15
Totally Endoscopic Aortic Valve Replacement (EAVR)
Abstract
Introduction
Minimally Invasive Concept
MICS and Endoscopic MICS
General Considerations
Patient Selection and Preoperative
Assessment for Eavr
Operating Theatre Setup and Patient Positioning
Surgical Access
Cardiopulmonary Bypass
Aortic Cross Clamping, Cardioplegia
and Ventricular Venting
Aortic Valve Access in Endoscopic Surgery
Surgical Technique
Aortotomy
Aortic Valve Replacement (AVR)
Aortorrhaphy
Deairing
Electrodes
Drainages
Conclusion
References
Chapter 16
REDO Surgery for Aortic Valve: Demographics and Operative Options
Abstract
Introduction
Surgical Approach
Resternotomy
Minimally Invasive Approach
Valve in Valve for Failed Aortic Bioprosthesis
Conclusion
References
Chapter 17
Aortic Prosthesis: Mechanical and Sutured Biological Valves
Abstract
Introduction
Biological Models
Hemodynamic Performance and Durability
References
Chapter 18
New Generation of Aortic Bioprosthesis: Sutureless and Rapid Deployment Valves
Abstract
Introduction
Methods
Sutureless Perceval S Bioprosthesis
Perceval Platform Technology
Implantation Technique
Sizing
Role of Oversizing
Results
Rapid Deployment Intuity Elite Valve
INTUITY Platform Technology
Implantation Technique
Sizing
Results
References
Chapter 19
Aortic Valve Repair
Abstract
Introduction
Anatomy of the Aortic Valve
Functional Classification of Aortic Regurgitation
General Principles of AV Repair
Aortic Valve Repair in Tricuspid AV
Valve-Sparing Aortic Root Replacement with the Reimplantation Technique
Cusp Prolapse Repair in Tricuspid AV
Central Leaflet Plication and Triangular Resection
Free Margin Resuspension
Cusp Fenestration Repair
Cusp Perforation
Aortic Valve Repair in Bicuspid AV
Anatomical Considerations
Surgical Techniques for BAV Repair
Cusp Repair in BAV
Annuloplasty and Aorta Management
Results of Aortic Valve Repair
Outcomes of Valve-Sparing Root Replacement with the Reimplantation Technique
Outcomes of Isolated Aortic Valve Repair
References
Chapter 20
Aortic Valve Sparing: Remodeling and Reimplantation
Abstract
Introduction
The Rational
Surgical Anatomy and Physiology of the Aortic Root
The Role of Imaging
The History of Remodeling
The History of Reimplantation
The Similarity of the Two Procedures after All Modifications… from Remodeling to Reimplantation (the “Ring”)
The Similarity of the Two Procedures after All Modifications… from Reimplantation to Remodeling (the “Space”)
Indications and Choice of the Strategy (Remodeling vs. Reimplantation)
Additional Leaflets Repair (Further Scientific Contribution)
Conclusion
References
Chapter 21
Transcatheter Therapy: Devices and Techniques
Abstract
Introduction
TAVI Devices
Valves Prostheses
Sapien (Edwards Lifesciences, Irvine, CA, USA)
Medtronic CoreValve (Medtronic Inc, MN, USA)
Portico (St. Jude Medical, CA, USA)
Acurate Neo (Boston Scientific Corporation, MA, USA)
Lotus (Boston Scientific Corporation, MA, USA)
Allegra (New Valve Technology, Switzerland)
Myval (Meril Lifesciences, Pvt. Ltd., India)
Techniques
Transfemoral Approach
Access Site Management
Temporary Pacemaker Implantation
Valve Implantation
Alternative Approaches
Subclavian/Transaxillary
Transaortic
Transcarotid
Transapical
Transcaval
Additional Techniques in Complex Clinical Scenarios
Low Coronaries: When and How to Protect Them
TAVI in the Setting of Acutely Decompansated Aortic Stenosis
The Role of Emergent BAV
The Role of Emergent TAVI
Conflict of Interest
References
About the Editor
Index
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