scholarly journals Aortic valve replacement due to granulomatosis with polyangiitis: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Gilles Uijtterhaegen ◽  
Laura De Donder ◽  
Eline Ameloot ◽  
Kristof Lefebvre ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Granulomatosis With Polyangiitis ◽  
Surrounding Tissue ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Severe Aortic Regurgitation

Abstract Background Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA. Case summary We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up. Discussion Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease.

Abstract 12999: Correcting the Current: Modeling the Hemodynamic Impact of Transcatheter Aortic Valve Replacement in Multiple Valvular Heart Disease Precipitating Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael I Brener ◽  
Amisha Patel ◽  
Torsten Vahl ◽  
Nadira Hamid ◽  
Melana Yuzefpolskaya ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Cardiogenic Shock ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Circulatory Support ◽  
Ventricular Performance ◽  
Transcatheter Aortic Valve

Introduction: Multiple valvular heart disease (mVHD) caused by mixed stenotic and regurgitant lesions involving at least two valves is a common condition which is poorly understood and challenging to manage. Herein, we simulate the hemodynamics of a patient with mVHD before and after transcatheter aortic valve replacement (TAVR) to better understand the physiology of this complex disease. Case: A 67-year-old man with celiac enteropathy presented to a local hospital with dyspnea, hypotension, and oliguria. Echocardiography revealed a dilated left ventricle (end-diastolic diameter [LVEDD] 6.7 cm) with an ejection fraction (EF) of 20% and multiple severe valvulopathies, including aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Right heart catheterization revealed a low cardiac index (1.76 L/min/m 2 ) and a high wedge pressure (36 mmHg) with V-waves exceeding 50 mmHg. The patient’s severe AR precluded mechanical circulatory support, so TAVR was emergently performed in the setting of worsening cardiogenic shock (CS) with a 29 mm self-expanding bioprosthesis via transfemoral access. Valve deployment was successfully guided by fluoroscopy and transthoracic echocardiography alone. CS resolved in the subsequent 48 hours, and at 3-month follow-up, his LV EF returned to 55% and LVEDD decreased to 4.4 cm. LV pressure-volume loops pre- and post-TAVR were generated using a cardiovascular physiology simulator (Fig. 1). TAVR’s correction of the patient’s severe AS and AR produced immediate energetic benefits, with pressure-volume area declining 13% and cardiac power output increasing 2.24-fold. Conclusions: This challenging case and the accompanying pressure-volume analysis affirms the feasibility of emergent TAVR in highly selected patients, the procedure’s ability to immediately improve ventricular performance, and the LV’s capacity to remodel when operating under more physiologic loading conditions.

scholarly journals Aortic Valve Replacement with Bovine Pericardium in Patients with Aortic Valve Regurgitation

2019 ◽  
Vol 60 (6) ◽  
pp. 1344-1349 ◽  
Author(s):  
Weiyong Sheng ◽  
Guochang Zhao ◽  
Yangyang Chao ◽  
Fuqiang Sun ◽  
Zhouyang Jiao ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bovine Pericardium ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation

scholarly journals SO088BURDEN OF VALVULAR HEART DISEASE IN HAEMODIALYSIS RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohamed Elewa ◽  
Anu Jayanti
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Heart Association ◽  
Mitral Valve Stenosis ◽  
Annual Data ◽  
Cross Sectional ◽  
Dialysis Vintage

Abstract Background and Aims Valvular heart disease (VHD) is highly prevalent in maintenance haemodialysis patients. This high prevalence is associated with poor outcomes and higher mortality [Samad et al., Journal of the American Heart Association, 6 (10), (2017)]. Previous large studies found VHD prevalence between 14% and 16% among prevalent haemodialysis patients [2018 USRDS Annual Data Report | Vol 2] [Hickson et al., Journal of the American College of Cardiology, 67(10), (2016)]. KDIGO consensus group identified several evidence gaps where research is necessary in order to improve our understanding of diagnosis and management of VHD in this population [Marwick et al., Kidney international, 96 (4), (2019)]. The aim of our study is to assess the burden of VHD in a large cohort of haemodialysis recipients in one center in the United Kingdom (UK). Method This is a retrospective cross-sectional evaluation of valvular heart disease in prevalent haemodialysis patients. Prevalent haemodialysis recipients were defined as patients established on haemodialysis for ≥ 3 months. Echocardiographic data was collected for all patients. Patients were considered to have VHD if they had significant aortic (AVD) or mitral valve disease (MVD) based on standard echocardiographic criteria. These valvular diseases are classified as mild, moderate or severe. Here, we report some descriptive statistics from our data. Results The study group includes 544 prevalent haemodialysis patients. Mean age was 62 years (SD 15.28), 40% females and 60% were males. Median dialysis vintage was 1.9 years (IQR 1, 3.2) [Range: 0.2, 10.2]. 14 % of patients received home-based hemodialysis and 86% received in-center dialysis. 30% of patients were actively awaiting a transplant. A total of 1155 echocardiography studies were reviewed. Of the 425 patients who had an echocardiogram; 34% (n=143) had evidence of VHD as defined above. Significant AVD was identified in 18% of patients (n=78). The dominant lesion was aortic regurgitation in 11%, and aortic stenosis in 7% of patients. 20% of patients (n=85) had significant MVD with mitral valve stenosis in 0.7% of patients (n=3) and mitral regurgitation in 18% of patients. 5% of patients had cardiothoracic intervention (n=21) for valvular heart disease, which included aortic valve replacement (n=9), transcatheter aortic valve implantation (TAVI) (n=9), and mitral valve replacement (n=3). Conclusion We found that at least one third (34%) of patients in this cohort had significant VHD- higher than the previously published figures. The numbers are likely to be higher, if echocardiogram information was available for all patients in the study. Timely echocardiographic studies and follow-up imaging for those with established disease are essential to identify patients with significant VHD, in order to establish impact of disease on both dialysis delivery and patient symptoms.

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