The Natural History and Rate of Progression of Aortic Stenosis

Lester, Steven J.; Heilbron, Brett; Gin, Ken; Dodek, Arthur; Jue, John

doi:10.1378/chest.113.4.1109

Cited by 88 publications

(47 citation statements)

References 43 publications

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“…48 Angina pectoris is associated with significant increase in the risk of sudden death in AS patients. 49 This fact is even more important if one considers that people with diabetes do not necessarily have to have symptoms despite the existence of angina pectoris. With this regard, the fact that there was a clear tendency towards increased mortality in diabetics in our study is in favour of this, although statistical significance was not achieved, most probably due to the low number of diabetic patients.…”

Section: Clinical Implication Of Coronary Microvascular Dysfunction Imentioning

confidence: 99%

Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries

Banović

Brković

Nedeljkovic

et al. 2016

Diabetes and Vascular Disease Research

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Background and aim: Coronary flow reserve is impaired in asymptomatic patients with aortic stenosis and has a prognostic value. We investigated whether the type II diabetes mellitus additionally impairs microvascular circulation assessed by coronary flow reserve in patients with asymptomatic severe aortic stenosis, normal left ventricular ejection fraction and nonobstructed coronary arteries. Methods: A total of 128 patients, mean age of 66.35 ± 10.51 (58.6% males), with severe aortic stenosis and normal left ventricular ejection fraction were enrolled in this study. Patients with diabetes mellitus, those who were treated for diabetes mellitus or had documentation confirming the diagnosis of diabetes mellitus, were considered. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter), standard transthoracic Doppler-echocardiographic study and adenosine stress transthoracic echocardiography for coronary flow reserve measurement. Results: Diabetes mellitus was present in 26 patients (20.31%). There was no significant difference in aortic stenosis severity between diabetic and non-diabetic patients [aortic valve area (0.81 ± 0.18 vs 0.85 ± 0.15 cm 2 ) and V max (4.20 ± 0.57 vs 4.21 ± 0.48 m/s)]. Mean coronary flow reserve in diabetic patients was 1.98 ± 0.48, while mean coronary flow reserve in non-diabetic patients was 2.64 ± 0.54 (p < 0.01). Diabetes mellitus was independent predictor of coronary flow reserve [B = −0.636, 95% confidence interval (−0.916 to −0.368), p < 0.001]. Conclusion: Diabetes mellitus additionally impairs coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.

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Section: Clinical Implication Of Coronary Microvascular Dysfunction Imentioning

confidence: 99%

Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries

Banović

Brković

Nedeljkovic

et al. 2016

Diabetes and Vascular Disease Research

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“…1 its etiology may be congenital or acquired. Both forms of stenosis result in a valve with calcified, restricted leaflets.…”

Section: éLéments Cliniques : Une Fois Le Consentement Du Comité D'étmentioning

confidence: 99%

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Ree

Bowering

Schwarz

2008

Can J Anesth/J Can Anesth

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Purpose: To describe both the evolution and the main associated complications in the anesthetic management of the initial 40 patients at our centre who underwent percutaneous retrograde aortic valve replacement, a novel technique utilizing a catheterguided femoral artery approach. Clinical features:With institutional Research Ethics Board approval, we retrospectively reviewed the medical records of the first 40 patients who underwent percutaneous retrograde aortic valve replacement between January 2005 and March 2006. Information obtained included patient characteristics, anesthetic management, details of the procedure, and complications. All procedures were scheduled to be performed in the cardiac catheterization laboratory. The first four patients received monitored anesthesia care, and the subsequent 36 underwent general anesthesia. There were no anesthesia-related adverse events. The prosthetic valve was placed successfully in 33/40 patients (83%). Median anesthetic time was 3.5 hr (range, 1.25-7.25 hr). Thirty-two/40 patients required vasopressor support. The most common, serious procedural complications were myocardial ischemia and arrhythmia following rapid ventricular pacing, hemorrhage from vascular injury secondary to the placement and removal of the large-bore sheath in the ilio-femoral artery, aortic rupture, and prosthetic valve maldeployment; 30-day mortality was 13% (n = 5/40). Conclusions:Percutaneous retrograde aortic valve replacement is a novel procedure that presents the anesthesiologist with unique challenges. Careful preoperative assessment, intraoperative monitoring appropriate for a major vascular procedure, and meticulous management of hemodynamics are imperative for a successful outcome. Serious complications, including major hemorrhage from vascular injury as well as arrhythmia and myocardial ischemia following rapid ventricular pacing, must be anticipated and managed in an expeditious fashion.

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“…These symptoms do not need to appear with a specific time sequence (Lester et al ., 1998). The commencement of the symptoms predicts an increase in mortality in the evolution of the disease and constitutes as such an indication for surgical treatment.…”

Section: Introductionmentioning

confidence: 99%