Hypertrophy of nodules of arantius and aortic insufficiency: Pathophysiology and repair

Incremental Value of Three‐Dimensional Transesophageal Echocardiography over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Lambl's Excrescences and Nodules of Arantius on the Aortic Valve

“…Based on its anatomic morphology, NA can be more easily confused with a cardiac mass such as a thrombus, vegetation, or tumor. In addition, as stated before, fibrosis and hypertrophy of NA have been described as a cause of isolated AR in patients with a history of rheumatic heart disease . Commonly, postinflammatory AR is characterized by fibrosis extending from the cuspid lines of insertion resulting in retraction of the cusps.…”

“…Commonly, postinflammatory AR is characterized by fibrosis extending from the cuspid lines of insertion resulting in retraction of the cusps. The patients described in the Shapira et al . study revealed a different pattern of fibrosis confined only to the lines of apposition.…”

“…In addition, as stated before, fibrosis and hypertrophy of NA have been described as a cause of isolated AR in patients with a history of rheumatic heart disease. 10 Commonly, postinflammatory AR is characterized by fibrosis extending from the cuspid lines of insertion resulting in retraction of the cusps. The patients described in the Shapira et al 10 study revealed a different pattern of fibrosis confined only to the lines of apposition.…”

“…Their physiological role remains elusive although it has been hypothesized they have a stress‐decreasing effect on the cusps coapting surfaces, minimizing the wear and tear effect on the overall structure . Their role in valvular pathology has also been debated in the literature, specifically their hypertrophy and the subsequent development of aortic regurgitation (AR) . Shapira et al .…”

“…9 Their role in valvular pathology has also been debated in the literature, specifically their hypertrophy and the subsequent development of aortic regurgitation (AR). 10 Shapira et al 10 described 11 cases of conservative aortic repair by surgically excising the hypertrophied tissue off the free edge of the cusps with restoration of cuspid flexibility and apposition. On the other hand, their structural utility has been highlighted in heart failure patients with concomitant AR who undergo left ventricular assist device (LVAD) placement for bridge and destination therapies.…”