Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

Kiyota, Yuka; Corte, Alessandro Della; Vieira, Vanessa Montiero; Habchi, Karam M.; Huang, Chuan-Chin; Ratta, Ester E Della; Sundt, Thoralf M.; Shekar, Prem; Muehlschlegel, Jochen D.; Body, Simon C.

doi:10.1136/openhrt-2016-000545

Cited by 43 publications

(33 citation statements)

References 31 publications

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“…There is moderate heritability of BAV, but the vast majority of affected patients do not possess other syndromic features and have indeterminate inheritance (Prakash et al, 2014 ). Unlike the majority of congenital cardiac disease, BAV is most frequently diagnosed in adulthood, notably, with the onset of aortic valvular dysfunction, ascending aortic dilation (AAD; Michelena et al, 2008 , 2011 ; McKellar et al, 2010 ) or endocarditis (Kiyota et al, 2017 ). More than 50%, and perhaps as high as 75%, of patients with BAV undergo aortic valve replacement during their lifetime (Michelena et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Pathogenic Mechanisms of Bicuspid Aortic Valve Aortopathy

2017

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Bicuspid aortic valve (BAV) is the most common congenital valvular defect and is associated with ascending aortic dilation (AAD) in a quarter of patients. AAD has been ascribed both to the hemodynamic consequences of normally functioning and abnormal BAV morphology, and to the effect of rare and common genetic variation upon function of the ascending aortic media. AAD manifests in two overall and sometimes overlapping phenotypes: that of aortic root aneurysm, similar to the AAD of Marfan syndrome; and that of tubular AAD, similar to the AAD seen with tricuspid aortic valves (TAVs). These aortic phenotypes appear to be independent of BAV phenotype, have different embryologic origins and have unique etiologic factors, notably, regarding the role of hemodynamic changes inherent to the BAV phenotype. Further, in contrast to Marfan syndrome, the AAD seen with BAV is infrequently present as a strongly inherited syndromic phenotype; rather, it appears to be a less-penetrant, milder phenotype. Both reduced levels of normally functioning transcriptional proteins and structurally abnormal proteins have been observed in aneurysmal aortic media. We provide evidence that aortic root AAD has a stronger genetic etiology, sometimes related to identified common non-coding fibrillin-1 (FBN1) variants and other aortic wall protein variants in patients with BAV. In patients with BAV having tubular AAD, we propose a stronger hemodynamic influence, but with pathology still based on a functional deficit of the aortic media, of genetic or epigenetic etiology. Although it is an attractive hypothesis to ascribe common mechanisms to BAV and AAD, thus far the genetic etiologies of AAD have not been associated to the genetic etiologies of BAV, notably, not including BAV variants in NOTCH1 and GATA4.

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Section: Introductionmentioning

confidence: 99%

Pathogenic Mechanisms of Bicuspid Aortic Valve Aortopathy

2017

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“…The bicuspid aortic valve was the most common congenital heart disease in our study population and was significantly higher in the ARA group. Kiyota et al [23] has shown that the bicuspid aortic valve is associated with an increased incidence of IE and ARA as compared with the trileaflet valve.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study

et al. 2020

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Background Aortic root abscess (ARA) is a major complication of infective endocarditis that is associated with increased morbidity and mortality. Limited data are present about patient characteristics and outcomes in this lethal disease. We aimed to study the clinical and echocardiographic characteristics of patients with ARA compared to patients with left-sided infective endocarditis without ARA. We included patients with a definite diagnosis of left-sided infective endocarditis according to modified Duke’s criteria. The patients were classified into two groups according to the presence of ARA (ARA and NO-ARA groups). All the patients were studied regarding their demographic data, clinical characteristics, laboratory and imaging data, and complications. Results We included 285 patients with left-sided infective endocarditis. The incidence of ARA was 21.4% (61 patients). Underlying heart disease, mechanical prosthesis, bicuspid aortic valve, and prior IE were significantly higher in ARA. The level of CRP was higher in ARA (p = 0.03). ARA group showed more aortic valve vegetations (73.8% vs. 37.1%, p < 0.001), more aortic paravalvular leakage (26.7% vs. 4.5%, p < 0.001), and less mitral valve vegetations (21.3% vs. 68.8%, p < 0.001). Logistic regression analysis showed that the odds of ARA increased in the following conditions: aortic paravalvular leak (OR 3.9, 95% CI 1.2–13, p = 0.03), mechanical prosthesis (OR 3.6, 95% CI 1.5–8.7, p = 0.005), aortic valve vegetations (OR 3.0, 95% CI 1.2–8.0, p = 0.02), and undetected organism (OR 2.3, 95% CI 1.1–4.6, p = 0.02), while the odds of ARA decreased with mitral valve vegetations (OR 0.2, 95% CI 0.08–0.5, p = 0.001). We did not find a difference between both groups regarding the incidence of major complications, including in-hospital mortality. Conclusion In our study, ARA occurred in one fifth of patients with left-sided IE. Patients with mechanical prosthesis, aortic paravalvular leakage, aortic vegetations, and undetected organisms had higher odds of ARA, while patients with mitral vegetations had lower odds of ARA.

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“…Malformed stenotic or regurgitant valves may be subacutely infected during episodes of bacteremia, likely via initial adhesion and subsequent colonization of the surface area. Less commonly, subacute bacterial endocarditis can affect the healthy heart valve (6)(7)(8).…”

Section: Review Articlementioning

confidence: 99%

Current surgical strategies and techniques of aortic valve diseases in children

2018

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While the long-term outcome of surgical aortic valvotomy (SAV) appears to be better than that of balloon aortic valvuloplasty (BAV) as the primary procedure of aortic valve stenosis, the surgical strategies and techniques of treating aortic valve disease in children in other situations remain controversial. Valve repair should be first considered while replacement is still unavoidable in some cases, and new repair techniques developed by innovative surgeons are gradually becoming adopted. Some complex repair procedures such as cusp extension, leaflet replacement/reconstruction have provided satisfactory outcomes. The Ozaki technique replaces aortic valve leaflets with glutaraldehyde-treated autologous pericardium instead of replacing the valve entirely. Special instruments have been developed to make the Ozaki technique more reproducible and standardized. Neonates and infants undergoing aortic valve replacement (AVR) are a high-risk group, where repair should be the primary consideration rather than replacement. Several systematic reviews reveal that all currently available aortic valve substitutes such as pulmonary autograft, mechanical prosthesis, homograft and bioprosthesis are associated with suboptimal results in children, but pulmonary autograft appeared to be superior with high freedom from reintervention and better hemodynamic performance. The strategy for treatment of aortic valve disease should be specifically analyzed based on the brief of being beneficial for children.

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Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

Cited by 43 publications

References 31 publications

Pathogenic Mechanisms of Bicuspid Aortic Valve Aortopathy

Pathogenic Mechanisms of Bicuspid Aortic Valve Aortopathy

Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study

Current surgical strategies and techniques of aortic valve diseases in children

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