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Related Concept Videos

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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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 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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Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

499
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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Related Experiment Video

Updated: Feb 24, 2026

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Right-Sided Extravalvular Damage: An Overlooked Driver of Risk Model Failure in Low-Flow, Low-Gradient Aortic

Yash Prakash1, Akarsh Sharma1, Lakshay Chopra2

  • 1Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

Journal of the Society for Cardiovascular Angiography & Interventions
|February 23, 2026
PubMed
Summary

Right-sided extravalvular damage markers improve mortality prediction after TAVR in low-flow, low-gradient aortic stenosis (AS). These markers refine the STS-PROM score, especially for moderate-risk patients, enhancing patient selection for TAVR.

Keywords:
low-flow low-gradient aortic stenosispatient selectionright-sided extravalvular damagerisk predictiontranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • The Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score is used for procedural risk in aortic stenosis (AS).
  • STS-PROM tends to overestimate long-term mortality post-transcatheter aortic valve replacement (TAVR).

Purpose of the Study:

  • To evaluate if right-sided extravalvular damage markers improve STS-PROM performance in predicting 1-year mortality post-TAVR.
  • Focus on patients with low-flow, low-gradient AS.

Main Methods:

  • Retrospective analysis of 410 patients undergoing TAVR for low-flow, low-gradient AS.
  • Stratification into STS-PROM risk groups (low, moderate, high).
  • Assessed an enhanced model including STS-PROM and right-sided extravalvular damage markers (pulmonary hypertension, tricuspid regurgitation, RV dysfunction).

Main Results:

  • Right-sided extravalvular damage independently associated with increased 1-year mortality (OR 2.45).
  • Enhanced model showed improved fit (Δχ² = 8.68, P < .01) and discrimination (IDI = 0.02, P = .01).
  • Improved survivor classification (non-event NRI = 0.10, P < .01), with greatest gain in moderate-risk patients.

Conclusions:

  • Right-sided extravalvular damage markers provide prognostic value in low-flow, low-gradient AS.
  • These markers correct STS-PROM overestimation of post-TAVR mortality.
  • Added value is most significant in moderate-risk patients, potentially improving TAVR selection.