Valvular Heart Disease

Abstract

Abstract-Aortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV).Acute AR typically causes severe pulmonary edema and hypotension and is a surgical emergency. Chronic severe AR causes combined LV volume and pressure overload. It is accompanied by systolic hypertension and wide pulse pressure, which account for peripheral physical findings, such as bounding pulses. The afterload excess caused by systolic hypertension leads to progressive LV dilation and systolic dysfunction. The most important diagnostic test for AR is echocardiography. It provides the ability to determine the cause of AR and to assess the severity of AR and its effect on LV size, function, and hemodynamics. Many patients with chronic severe AR may remain clinically compensated for years with normal LV function and no symptoms. These patients do not require surgery but can be followed carefully for the onset of symptoms or LV dilation/dysfunction. Surgery should be considered before the LV ejection fraction falls below 55% or the LV end-diastolic dimension reaches 55 mm. Symptomatic patients should undergo surgery unless there are excessive comorbidities or other contraindications. The primary role of medical therapy with vasodilators is to delay the need for surgery in asymptomatic patients with normal LV function or to treat patients in whom surgery is not an option. The goal of vasodilator therapy is to achieve a significant decrease in systolic arterial pressure. Future therapies may focus on molecular mechanisms to prevent adverse LV remodeling and fibrosis. Key Words: aorta Ⅲ echocardiography Ⅲ valves Ⅲ ventricles A ortic regurgitation (AR) is characterized by diastolic reflux of blood from the aorta into the left ventricle (LV) due to malcoaptation of the aortic cusps. Its clinical presentation is variable and depends on a complex interplay of a number of factors, including acuity of onset, aortic and LV compliance, hemodynamic conditions, and severity of the lesion. Although chronic AR is generally well tolerated for many years, acute AR may lead to rapid cardiac decompensation and, if untreated, to early death. 1 This review focuses on the clinical manifestations of AR, evaluation of its severity and hemodynamic consequences, and its treatment. PrevalenceThe prevalence of chronic AR and incidence of acute AR are not precisely known. Singh et al 2 reported the prevalence of chronic AR detected by color Doppler echocardiography in a large unselected adult population (the Framingham Offspring Study). The overall prevalence AR in men was 13% and in women 8.5%. However, most of the AR in this population was trace or mild in severity; moderate or severe AR was rare (Table 1). Multiple logistic regression analysis revealed age and male gender to be predictors of AR. Interestingly, hypertension did not predict AR on multivariate analysis, confirming results of earlier studies that hypertension is associated with modest increases in aortic root size but not AR when age is included in the...

Predictive value of heart-type fatty acid-binding protein for left ventricular remodelling and clinical outcome of hypertensive patients with mild-to-moderate aortic valve diseases

“…15 Hypertensive patients with mild-to-moderate AR had an increased prevalence of eccentric left ventricular hypertrophy. 6 These results indicate that hypertensive patients concomitant with mild-tomoderate AR are high-risk population that may predispose to heart failure; however, to our knowledge, there were no recent reports regarding the prognosis of these patients population.…”

Risks and opportunities to prevent acute renal failure in patients after cardiac surgery

“…Зависимость между ударным объемом и ОПН велика, при снижении объема поступаю-щей крови развивается ишемия нефронов. Для преду-преждения последней необходимо длительно наблюдать пациентов с начальными изменениями клапанов сердца и оперировать их на границе, когда есть минимальные показания к операции, но еще нет развития дисфункции миокарда [2]. Длительность ИК в большинстве исследований рас-сматривают как предиктор развития ОПН после операции на сердце [15,20].…”

Surgery for Aortic Regurgitation due to Dehiscence of Aortic Valve Commissure

“…1) This patient had a history of blunt trauma to the shoulder about a month before the first symptom. However, thoracic trauma is commonly due to more severe injury such as traffic accidents.…”