Severe aortic stenosis and myocardial function: diagnostic and prognostic usefulness of ultrasonic integrated backscatter analysis.

BACKGROUND: The aim of this study was to assess the myocardial reflectivity pattern in severe aortic valve stenosis through the use of integrated backscatter (IBS) analysis. Patients with aortic stenosis (AS) were carefully selected in the Department of Cardiology. METHODS AND RESULTS: Thirty-five subjects (AS: valve orifice < or =1 cm2; 12 female; mean age, 71.8+/-6.2 years) and 25 healthy subjects were studied. All subjects of the study had conventional 2D-Doppler echocardiography and IBS. Backscatter signal was sampled at the septum and posterior wall levels. Patients with AS were divided into 2 groups: 16 patients with initial signs of congestive heart failure and a depressed left ventricular systolic function (DSF) (ejection fraction [EF] range, 35% to 50%) and 19 asymptomatic patients with normal left ventricular systolic function (NSF) (EF >50%). Myocardial echo intensity (pericardium related) was significantly higher at the septum and posterior wall levels in DSF than in NSF and in control subjects. IBS variation, as an expression of variation of the signal, appeared to be significantly lower in AS with DSF than in NSF and in control subjects, at both the septum and posterior wall levels. Patients with DSF underwent aortic valve replacement, and, during surgical intervention, a septal myocardial biopsy was made for evaluation of myocardium/fibrosis ratio. Abnormally increased echo intensity was detected in left ventricular pressure overload by severe aortic stenosis and correlated with increase of myocardial collagen content (operating biopsy). CONCLUSIONS: One year after aortic valve replacement, we observed a significant reduction of left ventricular mass, and, only if pericardial indexed IBS value (reduction of interstitial fibrosis) decreased, it was possible to observe an improvement of EF and of IBS variation.

Myocardial function in severe aortic stenosis before and after aortic valve replacement: a Doppler tissue imaging study.

BACKGROUND: The aim of the study was to assess the value of Pulsed-wave Doppler tissue imaging (DTI) in assessing diastolic and systolic function in patients with severe aortic value stenosis. METHODS: Thirty-five patients with aortic stenosis (AS) (valve orifice < or = 1 cm 2 , mean age 71.8 +/- 6.2) and 35 comparable healthy subjects were studied. All subjects performed conventional 2-dimensional Doppler echocardiography and DTI at mitral annulus level. Patients with AS were divided into 2 groups: 16 patients who presented initial signs of HF and a depressed left ventricular systolic function (AS I) (EF: 35%-50%) and 19 patients were asymptomatic and had normal left ventricular systolic function (EF > 50%) (ASII). The 16 symptomatic AS patients underwent surgical aortic valve replacement and were examined after 1 year. RESULTS: DTI was able to detect abnormalities of systolic and diastolic function in AS: the significantly lower peak S velocity in AS I than in AS II and in controls, both at septum and lateral wall level; the significantly lower peak E velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significantly higher peak A velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significant lower E/A ratio in AS I than in AS II and in controls both at septum and lateral wall level. CONCLUSION: We found a significant inverse correlation between DTI lateral S velocity, DTI peak E velocity, lateral DTI E/A ratio, and AS peak and mean gradient. According to the results of this study we can affirm that DTI parameters surely had an important physiopathological impact in the knowledge of myocardial function in patients with severe aortic stenosis.

Aortic homograft improves hemodynamic performance and clinical outcome at mid-term follow-up.

BACKGROUND: Cryopreserved homograft is currently considered an excellent choice for the replacement of a diseased aortic valve in adults and it is the first choice for 1 with aortic endocarditis. The aim of this study was to analyze our single institution experience with the cryopreserved aortic homograft by a mid-term follow-up. METHODS: Between December 1996 and September 2003, 46 consecutive patients underwent aortic valve replacement using either aortic or pulmonary homograft. The risk profile was moderate-to-high, with a mean log EuroSCORE of 6.33+/-5.12. All patients were periodically evaluated at discharge, at 6 and 12 months, and yearly thereafter, to assess their clinical status and hemodynamic performance by comparing the ejection fraction, left ventricular mass index, mean gradient, effective orifice area index, and diastolic and systolic eccentricity indexes. RESULTS: The overall 30-day mortality was 4.3%. At univariate analysis, the significant determinants of in-hospital mortality were: aortic dissection (p < 0.001), urgent operation (p = 0.05) and a log EuroSCORE > 10 (p = 0.05). At multivariate analysis no independent predictors of in-hospital mortality were found. At 5 years of follow-up, the survival was 91.3+/-5.0%, the freedom from reoperation was 95.8+/-4.1%, the freedom from sudden death was 96.1+/-3.9%, and the freedom from readmission for congestive heart failure was 94.1+/-3.1%. In patients with either prevalent aortic valve stenosis or prevalent aortic valve insufficiency, a significant improvement in the preoperative ejection fraction during follow-up (49+/-4 vs 51+/-7%; F = 5.1, p = 0.04 and 50+/-10 vs 53+/-10%; F = 7.1, p = 0.01 respectively) and a significant reduction in the preoperative left ventricular mass index during follow-up (202+/-55 vs 143+/-28 g/m2; F = 7.5, p = 0.008 and 177+/-49 vs 138+/-24 g/m2; F = 8.8, p < 0.001) were recorded. CONCLUSIONS: Replacement of the diseased aortic valve with a cryopreserved homograft offers clear advantages in terms of excellent hemodynamics, resistance to infection, and a negligible incidence of postoperative regurgitation.

Interventricular hydatid cyst with atrioventricular block: a case report.

Hydatid cyst in the heart is rare, occurring in about 3% of human echinococcosis. A 21-year-old woman was admitted to hospital with a third degree atrioventricular block. Echocardiography showed a cystic mass with a diameter of 2.5 cm within the interventricular septum. Serologic testing for Echinococcus was clearly positive, and hence cardiac surgery was planned. Sterilization of the cystic cavity was achieved by injecting formaldehyde solution in the cavity before cystectomy. Definitive pacemaker implantation was necessary before discharge. Cardiac hydatid cysts constitute an indication for surgery which is necessary to prevent potentially lethal complications such as cystic rupture with embolic phenomena and anaphylactic shock.

Left atrial cardiac hemangioma: a report of two cases.

Cardiac hemangiomas are exceptionally rare tumors with an incidence of 1 to 3% of all detected benign heart neoplasms. We report 2 cases of left atrial hemangioma of which only one associated with clinical symptoms such as dyspnea and palpitations. Two years following surgical excision of the tumors, there was no echocardiographic evidence of recurrence.

Dysfunction of a 21-mm aortic bioprosthesis treated with percutaneous implantation of a CoreValve prosthesis.

Percutaneous aortic valve replacement is an emerging alternative for high surgical risk patients with native aortic valve stenosis. We describe for the first time a valve-in-valve procedure with a CoreValve prosthesis for the treatment of a severely stenotic degenerated aortic bioprosthesis.