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Related Concept Videos

Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Heart Valves01:16

Heart Valves

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The human heart is a complex organ with an intricate system of valves that regulate blood flow. There are two main types of valves: atrioventricular (AV) valves and semilunar valves.
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
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Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Related Experiment Video

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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Exercise Hemodynamics After Aortic Valve Replacement for Severe Aortic Stenosis.

Rasmus Carter-Storch1, Jordi S Dahl2, Nicolaj L Christensen2

  • 1Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense Patient Data Explorative Network, Odense, Denmark.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|August 26, 2018
PubMed
Summary

One-third of patients experience elevated left ventricular filling pressure after aortic valve replacement, particularly those with coronary artery disease or myocardial fibrosis. This persistent diastolic dysfunction after AVR highlights the need for further investigation into associated factors.

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Aortic stenosisDiastolic dysfunctionExercise testingMyocardial fibrosis

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Cardiac Imaging

Background:

  • Severe aortic stenosis (AS) often coexists with diastolic dysfunction.
  • Aortic valve replacement (AVR) can lead to left ventricular (LV) reverse remodeling.
  • Diastolic dysfunction may persist even after successful AVR.

Purpose of the Study:

  • To determine the incidence of elevated LV filling pressure at rest and during exercise post-AVR in severe AS patients.
  • To identify factors associated with persistent elevated LV filling pressure.
  • To explore the relationship between elevated LV filling pressure and LV/left atrial remodeling and myocardial fibrosis.

Main Methods:

  • Thirty-seven patients with severe AS underwent AVR.
  • Pre-AVR assessments included echocardiography, cardiac CT, and MRI; LV biopsy for collagen fraction.
  • One year post-AVR, right heart catheterization with exercise was performed to measure pulmonary capillary wedge pressure (PCWP).

Main Results:

  • 32% of patients had elevated exercise PCWP (≥28 mm Hg) one year post-AVR.
  • Elevated exercise PCWP was associated with concomitant coronary artery bypass graft surgery and lower preoperative stroke volume index.
  • Higher baseline LV ejection fraction and coronary calcium scores were observed in patients with elevated PCWP; LV interstitial volume fraction correlated with PCWP in isolated AVR patients.

Conclusions:

  • Elevated LV filling pressure during exercise persists in one-third of patients post-AVR for severe AS.
  • This elevated pressure is primarily linked to coexisting ischemic heart disease or diffuse myocardial fibrosis.
  • The findings suggest that preoperative AS severity and LV remodeling are not the primary drivers of persistent elevated filling pressures post-AVR.