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Chi tiết tài liệu

Aortic Stenosis: Case-Based Diagnosis and Therapy.

Tác giả: Abbas, Amr E.

Chủ đề:

Chủ đề: Medicine; Aortic Stenosis; Diagnosis; Therapy

Nhà xuất bản: Springer

Năm xuất bản: 2015

Loại tài liệu: Book

Mô tả vật lý: 283 p.

Định danh: 978-1-4471-5242-2

Ngôn ngữ: en

Đọc trực tuyến

Tải tài liệu

With the advent of less invasive treatments for aortic stenosis including percutaneous and apical replacement, more patients are being offered this technology. As such, determining the true severity of aortic stenosis is becoming paramount. Many clinical scenarios occur where the area and gradient estimates of severity do not match. This book will present case by case examples of different patients with a wide variety of aortic stenosis. It will assist cardiologists in identifying patients with true aortic stenosis who may benefit from valve replacement. It will also highlight the role and advent of new technology as the role of CTA, MRI, and 3D echo for diagnosis and TAVR and mini surgery for treatment. The audience will range from clinical cardiologists, imaging cardiologists and interventionalists alike.

Cover
Aortic StenosisCase-Based Diagnosis and Therapy
Preface
Contents
Contributors
1: General Considerations and Etiologies of Aortic Stenosis
- Historical Perspective
- Introduction
- The Aortic Valve and Root Apparatus
- Prevalance and Epidemiology of Aortic Stenosis
- Causes of Aortic Stenosis
  - Calcific Aortic Valve Stenosis
  - Congenital Aortic Valve Stenosis
  - Valvular Aortic Stenosis
  - Para-valvular Aortic Stenosis
    - Supra Valvular Aortic Stenosis
    - Sub Valvular Aortic Stenosis
  - Rheumatic Aortic Valve Stenosis
- Natural History of Aortic Valve Stenosis
- Morbidity and Mortality
- Conclusions
- References
2: Clinical Assessment of the Severity of Aortic Stenosis
- Introduction
- Pathophysiology
  - Increased Afterload: Effects on LV Compliance and Contractility
  - Outflow Obstruction: Effects on Cardiac Output
  - Prolonged LV Ejection Time: Compensation and Insight into Severity of Obstruction
- Historical Features of Aortic Stenosis
  - Angina
  - Dyspnea
  - Frailty Assessment
  - Gastrointestinal Bleeding
  - Infective Endocarditis
  - Syncope
- Physical Exam
  - Pulse Waveform
  - Auscultation
  - Precordial Examination
  - Differentiating Aortic Stenosis from Other Murmurs
- Specific Clinical Scenarios
  - Exercise and AS
  - Low Flow, Low Gradient AS
- References
- Summary
3: Physiological Basis for Area and Gradient Assessment: Hemodynamic Principles of Aortic Stenosis
- Introduction
- Physiological Considerations of Transvalvular Pressure Gradient (∆P) and Aortic Valve Area (AVA) in Aortic Stenosis
  - Bernoulli Equation
- Assessing the Severity of Aortic Stenosis
  - Aortic Valve Gradient Calculations
    - Maximum Achievable Pressure Gradient (∆Pmax)
    - Determinants of Transvalvular Gradients (∆P) and Prec
      - Para Valvular Determinants
      - Aortic Determinants
      - Vascular Determinants
      - Determinants of Pressure Recovery and Concordance Between Doppler and Catheter Measures of Gradient
    - Net Pressure Gradient (∆Pnet)
    - Pressure Recovery (Prec)
  - Aortic Valve Area Calculations
    - Coefficient of Orifice Contraction and Its Determinants
    - Effective Versus Geometric Orifice Area
    - Effect of Flow on Aortic Valve Area
    - Measurements of Aortic Valve Area
      - Catheterization
      - Echocardiography
      - Doppler versus Catheter-Derived Measures of Aortic Valve Area
- Other Measures to Assess Aortic Stenosis Severity
  - Aortic Valve Resistance
  - Dimensionless Index
  - Energy Loss Coefficient and Index
  - AV Calcification and AV Calcium Score
  - Projected Aortic Valve Area
- Measures of Left Ventricular Hemodynamic Burden
  - Hemodynamic Models
  - Brain Natriuretic Peptide (BNP)
  - Effect on the Right Ventricle
  - Structural Models
- Conclusions
- References
4: Different Classifications of Aortic Stenosis
- Underlying Pathology
  - Valvular
  - Paravalvular AS
- Severity of AS
- Stages of Aortic Stenosis
  - Stage A, at Risk
  - Stage B, Progressive
  - Stage C, Asymptomatic Severe Aortic Stenosis
  - Stage D, Symptomatic Severe AS
- Area/Gradient Match or Concordance
  - Area/Gradient Match or Concordance
  - Area/Gradient Mismatch or Discordance
  - Reverse Area/Gradient Mismatch or Discordance
- Ejection Fraction and Flow
  - Low Ejection Fraction, Low Flow/Low Gradient Severe Aortic Stenosis
  - Normal Ejection Fraction Severe Aortic Stenosis
- References
5: Invasive Evaluation of Aortic Stenosis
- Introduction
- Invasive Measures of Trans-aortic Valve Gradients
  - General Considerations in Invasive Pressure Gradient Assessment
- Invasive Measures of Aortic Valve Areas
  - Gorlin Equation
  - Aortic Valve Resistance
  - General Considerations in Invasive Aortic Valve Area Assessment
  - The Hakki Equation
- Invasive Pharmacological Challenges for Assessment and Stratification of Severe Aortic Stenosis
  - Dobutamine
  - Nitroprusside
- Invasive Evaluation of Dynamic Outflow Tract Obstruction
  - General Considerations in Patients with HOCM
  - Combined Aortic Stenosis and Aortic Regurgitation
- Conclusions
- References
6: Echocardiographic Evaluation of Aortic Valve Stenosis
- Case Presentation
  - EKG
  - Patient Summary
  - Transthoracic Echocardiography (TTE)
- Introduction
- Echocardiography and the Normal Aortic Valve
- Pathophysiology of Aortic Stenosis and Echocardiography
- Echocardiography and the Stenotic Aortic Valve
- Two-Dimensional Echocardiographic Evaluation of Aortic Stenosis
  - Aortic Valve
  - Left Ventricular Outflow Tract
  - Doppler Assessment of Aortic Stenosis
  - Left Atrium
  - Left Ventricle
  - Mitral Insufficiency
  - Proper Doppler Flow Measurement
  - Continuity Equation and Effective Orifice Area
  - Pulmonary Hypertension
  - Additional Echocardiographic Measurements of Aortic Stenosis Severity
  - Three-Dimensional Imaging and Aortic Stenosis
- Conclusions
- References
7: Complimentary Role of CT/MRI in the Assessment of Aortic Stenosis
- Introduction
- Cardiac Magnetic Resonance Imaging in Aortic Stenosis
  - MRI Modalities Utilized in Patients with Aortic Stenosis (Tables 7.1a and 7.1b)
  - Indications
    - Aortic Morphology
    - Discrepant Diagnostic Data on Severity of Aortic Stenosis and Morphology of the Aortic Valve
    - Assessment of Paravalvular Obstruction, Associated Aortic Regurgitation, and Congenital Anomalies
    - Assessment of Ventricular Function
- Cardiac Computed Tomography in Aortic Stenosis
  - Indications
    - Assessment of Coronary Anatomy and Coronary Artery Disease
    - Pre SAVR and Pre-TAVR Evaluation by CT Aortography
    - Aortic Morphology
    - Assessment of Paravalvular Obstruction and Congenital Anomalies
    - Assessment of Ventricular Function
    - Discrepant Diagnostic Data on Severity of Aortic Stenosis and Aortic Valve Morphology
- Multimodality Imaging for Aortic Stenosis: Clinical Application and Case Examples
  - Normal Flow-High Gradient (NF/HG) Severe AS, Normal Ejection Fraction Symptomatic Severe AS
  - Area/Gradient Mismatch: Low Flow/Low Gradient Severe Aortic Stenosis with Reduced Ejection Fraction
  - Indeterminate Severity Aortic Stenosis, Preserved Ejection Fraction
    - Catheterization
    - Clinical
    - TTE
    - MRI
    - TEE
    - Dobutamine Stress Echo
    - Energy Loss Index (ELI)
    - Other Data
  - Reverse Area Gradient Mismatch and the Bicuspid Aortic Valve
    - Clinical
    - MRI
    - TEE
    - TTE
    - Catheterization
  - Paravalvular Obstruction: Sub-aortic Stenosis
    - Clinical
    - TTE
    - TEE
- Conclusion
- References
8: Area and Gradient Mismatch: The Discordance of a Small Valve Area and Low Gradients
- Errors of Assumption
- Errors of Measurement
- Introduction
- Low Flow Area-Gradient Mismatch
  - Low Flow/Low Gradient AS with Depressed LVEF (Low LVEF Area-Gradient Mismatch)
  - Low Flow/Low Gradient AS with Preserved LVEF (Normal LVEF Area-Gradient Mismatch)
- Clinical Implications
- Conclusion
- References
9: Reverse Area and Gradient Mismatch: The Discordance of a Large Valve Area and High Gradients
- Introduction
- Reverse Area/Gradient Mismatch
  - Causes of Reverse Area-Gradient Mismatch in Native Valves
    - Errors of Measurement and/or Assumption
    - High Flow States
    - Eccentric Jet
    - Pressure Recovery
    - Aortic Valve Geometry
    - Increased LVOT Diameter
  - Causes of Reverse Area-Gradient Mismatch in Prosthetic Aortic Valves
    - Localized High Gradient in Central Orifice of Bileaflet Mechanical Valves
    - Prosthesis-Patient Mismatch (PPM)
  - Paravalvular Obstruction: Sub or Supra-valvular Aortic Obstruction
    - Subaortic Membrane
    - Hypertrophic Obstructive Cardiomyopathy
    - Supra-aortic Obstruction
    - Mitral Valve Prosthesis
- Conclusion
- References
10: Prosthetic Aortic Valves and Diagnostic Challenges
- Prosthetic Aortic Valves and Diagnostic Challenges
- Valve Design and Types
  - Bioprosthetic Valves
  - Mechanical Valves
- Causes of Prosthetic Valve Aortic Stenosis
- Hemodynamics and Anticipated Gradients of Prosthetic Valves
- Algorithmic Approach to Evaluate Prosthetic Aortic Valve Function
- ASE: PV Algorithm Case Illustration
  - Errors in Measurement
- Importance of Qualitative Indices in the Assessment of Prosthetic Valve Stenosis
- Valve Prosthesis: Patient Mismatch (VP-PM)
- Role of Cardiac CT and Cardiac MRI for Assessment of Prosthetic Valve Complications
  - Cardiac CT
  - Cardiac MRI
- References
11: Risk Prediction Models, Guidelines, Special Populations, and Outcomes
- Introduction
- Risk Prediction Models
  - Background
  - Development and Limitations
  - Comparing Different Surgical Risk Models for Aortic Valve Replacement
  - Surgical Risk Models
- The Heart Valve Team, Heart Valve Center of Excellence
- Novel Guidelines and Aortic Valve Replacement
- Special Populations with Severe Aortic Stenosis
  - Pregnancy and Aortic Stenosis
    - Management of Aortic Stenosis During Pregnancy
- Perioperative Risk Assessment in Patients with Severe Aortic Stenosis Undergoing Noncardiac Surgery
- Aortic Stenosis in Association with Other Valvular Diseases
  - Aortic Stenosis with Aortic Regurgitation
  - AS with Moderate or Severe Mitral Stenosis (MS)
  - Aortic Stenosis in Association with Basal Septal Hypertrophy
  - AS in Association with Mitral Regurgitation (MR)
- Aortic Stenosis in Bicuspid Aortic Valve (BAV)
- Asymptomatic Severe AS
- Evaluation of Coronary Artery Disease Prior to AVR
- Appendix: VARC-2 Definitions
- Conclusions
- The Valve Academic Research Consortium (VARC) Consensus Document
- References
12: Surgical Management of Aortic Valve Stenosis
- Aortic Valve Surgery
  - Mechanical Aortic Valve Replacement
  - Auto-graft Aortic Valve Replacement (Ross Procedure)
  - Bioprosthetic Aortic Valve Replacement
    - Comparison Between Mechanical and Bioprosthetic Aortic Valve
    - Comparison Between Stented and Stentless Bioprosthetic Aortic Valves
  - Aortic Valve Decalcification
  - Transcatheter Aortic Valve Replacement
- Historical Perspective and Background
- Introduction
- Approaches for Surgical Aortic Valve Replacement
  - Traditional Full Sternotomy Approach
    - Surgical Technique
  - Minimally Invasive Aortic Valve Replacement (MIAVR)
  - Right Thoracotomy Approach
    - Surgical Technique
  - Hemisternotomy Approach
    - Surgical Technique
  - Robotic Aortic Valve Replacement
  - Sutureless Aortic Valve Replacement
- Types and Choice of the Prosthetic Aortic Valve
- References
13: Balloon Aortic Valvuloplasty
- Historical Considerations
- Introduction
- Patho-anatomic Mechanism of Balloon Aortic Valvuloplasty (BAV)
- Technique
- Immediate Hemodynamic Results
- Acute Complications
- Long-Term Followup
- Mechanisms of Clinical Improvement
- Miscellaneous Applications
- References
- Summary
14: Imaging for Transcatheter Aortic Valve Replacement
- Introduction
- Pre-procedural Planning
  - Two-Dimensional Transthoracic Echocardiography (2D-TTE)
    - Aortic Regurgitation
    - Left and Right Ventricular Function
    - Mitral Regurgitation
    - Paradoxical Low Flow Low Gradient Aortic Stenosis
    - Severity of Aortic Stenosis
    - THV Sizing
  - Aorto-ilio-femoral Angiography
  - Cardiac Catheterization
  - Two-Dimensional Transesophageal Echocardiography (2D-TEE)
  - Three-Dimensional Transesophageal Echocardiography (3D-TEE)
  - Multi-slice Computed Tomography
    - THV Sizing
    - Aortic Apparatus Calcification
    - MSCT Vasculature Assessment
    - Optimal Fluoroscopic Projection
- Procedural Planning
  - Fluoroscopy and Angiography
  - Rotational Angiography
  - Valve-in-Valve Fluoroscopy
  - Transesophageal Echocardiography
- Post Procedural Imaging
  - Transthoracic Echocardiography
- Case Presentations and Imaging Considerations
  - Case 1: Aortic Stenosis Echocardiography
  - Case 2: Dobutamine Stress Echocardiography
  - Case 3: TTE vs. MSCT
  - Case 4: 3mensio Workup
  - Case 5: THV Sizing Dilemma
  - Case 6: MSCT Pitfalls
  - Case 7: Bicuspid Aortic Valve
  - Case 8: Vasculature Reconstruction
  - Case 9: Edwards and CoreValve Fluoroscopy
- Future Perspective
- Conclusion
- References
15: Transcatheter Aortic Valve Replacement
- Introduction
- Commercially Approved Transcatheter Heart Valves in the United States
- Clinical Outcomes
  - Survival
  - Functional Outcomes
  - Valve Function and Durability
- Complications
  - Neurological Events
  - Access Site Complications and Bleeding
  - Paravalvular Aortic Regurgitation
  - Acute Kidney Injury
  - Conduction Disturbances and Atrial Fibrillation
  - Annular Rupture
  - Coronary Occlusion
- Patient Selection
- New Devices
- New Patient Populations
- Conclusions
- References
Index