Abstract
Given the inoperability of many patients undergoing transcatheter aortic valve replacement (TAVR), numerous other cardiac pathologies are often present. These can be represented a myriad of conditions that may alter the planned approach to TAVR. The evaluation of these conditions include traditional techniques such as echocardiography but often require advanced imaging methods including multidetector computed tomography and magnetic resonance imaging. This chapter delineates the diagnostic approach to three commonly encountered pathologies in patients with critical aortic stenosis, including mitral regurgitation, prior myocardial infarction, asymmetric septal hypertrophy. Further we describe the current practice and highlight the needs for specific research pertaining to this concomitant cardiac pathologies in patients undergoing TAVR.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Gurvitch R, Tay EL, Wijesinghe N, Ye J, Nietlispach F, Wood DA, Lichtenstein S, Cheung A, Webb JG. Transcatheter aortic valve implantation: lessons from the learning curve of the first 270 high-risk patients. Catheter Cardiovasc Interv. 2011;78:977–84.
Kodali SK, O’Neill WW, Moses JW, Williams M, Smith CR, Tuzcu M, Svensson LG, Kapadia S, Hanzel G, Kirtane AJ, Leon MB. Early and late (one year) outcomes following transcatheter aortic valve implantation in patients with severe aortic stenosis (from the United States REVIVAL trial). Am J Cardiol. 2011;107:1058–64.
Come PC, Riley MF, Ferguson JF, Morgan JP, McKay RG. Prediction of severity of aortic stenosis: accuracy of multiple noninvasive parameters. Am J Med. 1988;85:29–37.
Unger P, Dedobbeleer C, Van Camp G, Plein D, Cosyns B, Lancellotti P. Mitral regurgitation in patients with aortic stenosis undergoing valve replacement. Heart. 2010;96:9–14.
Hekimian G, Detaint D, Messika-Zeitoun D, Attias D, Iung B, Himbert D, Brochet E, Vahanian A. Mitral regurgitation in patients referred for transcatheter aortic valve implantation using the Edwards Sapien prosthesis: mechanisms and early postprocedural changes. J Am Soc Echocardiogr. 2012;25:160–5.
Barreiro CJ, Patel ND, Fitton TP, Williams JA, Bonde PN, Chan V, Alejo DE, Gott VL, Baumgartner WA. Aortic valve replacement and concomitant mitral valve regurgitation in the elderly: impact on survival and functional outcome. Circulation. 2005;112:I443–7.
Arom KV, Nicoloff DM, Kersten TE, Northrup 3rd WF, Lindsay WG, Emery RW. Ten-year follow-up study of patients who had double valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1989;98:1008–15; discussion 1015–16.
Mueller XM, Tevaearai HT, Stumpe F, Fischer AP, Hurni M, Ruchat P, von Segesser LK. Long-term results of mitral-aortic valve operations. J Thorac Cardiovasc Surg. 1998;115:1298–309.
Sutton M, Plappert T, Spiegel A, Raichlen J, Douglas P, Reichek N, Edmunds L. Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study. Circulation. 1987;76:77–89.
Moazami N, Diodato MD, Moon MR, Lawton JS, Pasque MK, Herren RL, Guthrie TJ, Damiano RJ. Does functional mitral regurgitation improve with isolated aortic valve replacement? J Card Surg. 2004;19:444–8.
Tassan-Mangina S, Metz D, Nazeyllas P, Torossian F, Pop C, Bertrand J, Baehrel B, Elaerts J. Factors determining early improvement in mitral regurgitation after aortic valve replacement for aortic valve stenosis: a transthoracic and transesophageal prospective study. Clin Cardiol. 2003;26:127–31.
Adams PB, Otto CM. Lack of improvement in coexisting mitral regurgitation after relief of valvular aortic stenosis. Am J Cardiol. 1990;66:105–7.
Brasch AV, Khan SS, DeRobertis MA, Kong JH, Chiu J, Siegel RJ. Change in mitral regurgitation severity after aortic valve replacement for aortic stenosis. Am J Cardiol. 2000;85:1271–4.
Vanden Eynden F, Bouchard D, El-Hamamsy I, Butnaru A, Demers P, Carrier M, Perrault LP, Tardif JC, Pellerin M. Effect of aortic valve replacement for aortic stenosis on severity of mitral regurgitation. Ann Thorac Surg. 2007;83:1279–84.
D’Onofrio A, Gasparetto V, Napodano M, Bianco R, Tarantini G, Renier V, Isabella G, Gerosa G. Impact of preoperative mitral valve regurgitation on outcomes after transcatheter aortic valve implantation. Eur J Cardiothorac Surg. 2012;41:1271–6.
Durst R, Avelar E, McCarty D, Poh KK, Friera LF, Llano MF, Chu J, Anumandla AK, Rodriguez LL, Mack MJ, et al. Outcome and improvement predictors of mitral regurgitation after transcatheter aortic valve implantation. J Heart Valve Dis. 2011;20:272–81.
Cilingiroglu M, Hakeem A. Fate of mitral regurgitation following transcatheter aortic valve implantation: the achilles heel of core valve? Catheter Cardiovasc Interv. 2011;78:645–6.
Chin D. Echocardiography for transcatheter aortic valve implantation. Eur J Echocardiogr. 2009;10:i21–9.
Yong Z, Van Dijk K, Koch K, Vis M, et al. Effect of transcatheter aortic valve implantation with the Medtronic-CoreValve bioprosthesis on mitral valve area and pressure gradient. Eur J Echocardiogr. 2010;11 Suppl 2:ii9–11.
Rudolph V, Schirmer J, Franzen O, Schluter M, Seiffert M, Treede H, Reichenspurner H, Blankenberg S, Baldus S. Bivalvular transcatheter treatment of high-surgical-risk patients with coexisting severe aortic stenosis and significant mitral regurgitation. Int J Cardiol. 2013;167(3):716–20.
Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med. 1999;341:142–7.
Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29:630–4.
Ortlepp JR, Schmitz F, Bozoglu T, Hanrath P, Hoffmann R. Cardiovascular risk factors in patients with aortic stenosis predict prevalence of coronary artery disease but not of aortic stenosis: an angiographic pair matched case-control study. Heart. 2003;89:1019–22.
Teo KK, Corsi DJ, Tam JW, Dumesnil JG, Chan KL. Lipid lowering on progression of mild to moderate aortic stenosis: meta-analysis of the randomized placebo-controlled clinical trials on 2344 patients. Can J Cardiol. 2011;27:800–8.
Nowicki ER, Birkmeyer NJ, Weintraub RW, Leavitt BJ, Sanders JH, Dacey LJ, Clough RA, Quinn RD, Charlesworth DC, Sisto DA, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg. 2004;77:1966–77.
Tjang YS, van Hees Y, Korfer R, Grobbee DE, van der Heijden GJ. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg. 2007;32:469–74.
Florath I, Rosendahl UP, Mortasawi A, Bauer SF, Dalladaku F, Ennker IC, Ennker JC. Current determinants of operative mortality in 1400 patients requiring aortic valve replacement. Ann Thorac Surg. 2003;76:75–83.
Dewey TM, Brown DL, Herbert MA, Culica D, Smith CR, Leon MB, Svensson LG, Tuzcu M, Webb JG, Cribier A, Mack MJ. Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg. 2010;89:758–67; discussion 767.
Webb JG, Altwegg L, Boone RH, Cheung A, Ye J, Lichtenstein S, Lee M, Masson JB, Thompson C, Moss R, et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009;119:3009–16.
Drews T, Pasic M, Buz S, Unbehaun A, Dreysse S, Kukucka M, Mladenow A, Hetzer R. Transapical aortic valve implantation after previous heart surgery. Eur J Cardiothorac Surg. 2011;39:625–30.
Ducrocq G, Al-Attar N, Himbert D, Messika-Zeitoun D, Iung B, Descoutures F, Nataf P, Vahanian A. Early and mid-term outcomes in patients undergoing transcatheter aortic valve implantation after previous coronary artery bypass grafting. Eur J Cardiothorac Surg. 2012;41:499–504.
Pasic M, Dreysse S, Unbehaun A, Buz S, Drews T, Klein C, D’Ancona G, Hetzer R. Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg. 2012;14:463–8.
Hess OM, Ritter M, Schneider J, Grimm J, Turina M, Krayenbuehl HP. Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. Circulation. 1984;69:855–65.
Di Tommaso L, Stassano P, Mannacio V, Russolillo V, Monaco M, Pinna G, Vosa C. Asymmetric septal hypertrophy in patients with severe aortic stenosis: the usefulness of associated septal myomectomy. J Thorac Cardiovasc Surg. 2012;145:171–5.
Siegenthaler W. Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart: Georg Thieme Verlag; 2007.
Villari B, Campbell SE, Hess OM, Mall G, Vassalli G, Weber KT, Krayenbuehl HP. Influence of collagen network on left ventricular systolic and diastolic function in aortic valve disease. J Am Coll Cardiol. 1993;22:1477–84.
Krayenbuehl HP, Hess OM, Monrad ES, Schneider J, Mall G, Turina M. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation. 1989;79:744–55.
Bach DS. Subvalvular left ventricular outflow obstruction for patients undergoing aortic valve replacement for aortic stenosis: echocardiographic recognition and identification of patients at risk. J Am Soc Echocardiogr. 2005;18:1155–62.
Tuseth N, Cramariuc D, Rieck AE, Wachtell K, Gerdts E. Asymmetric septal hypertrophy – a marker of hypertension in aortic stenosis (a SEAS substudy). Blood Press. 2010;19:140–4.
Verdecchia P, Porcellati C, Zampi I, Schillaci G, Gatteschi C, Battistelli M, Bartoccini C, Borgioni C, Ciucci A. Asymmetric left ventricular remodeling due to isolated septal thickening in patients with systemic hypertension and normal left ventricular masses. Am J Cardiol. 1994;73:247–52.
Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004;292:2350–6.
Raj MV, Srinivas V, Graham IM, Evans DW. Coexistence of asymmetric septal hypertrophy and aortic valve disease in adults. Thorax. 1979;34:91–5.
Pellikka PA, Sarano ME, Nishimura RA, Malouf JF, Bailey KR, Scott CG, Barnes ME, Tajik AJ. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005;111:3290–5.
Mehta RH, Bruckman D, Das S, Tsai T, Russman P, Karavite D, Monaghan H, Sonnad S, Shea MJ, Eagle KA, Deeb GM. Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery. J Thorac Cardiovasc Surg. 2001;122:919–28.
Jilaihawi H, Kar S, Doctor N, Fontana G, Makkar R. Contemporary application of cardiovascular hemodynamics: transcatheter aortic valve interventions. Cardiol Clin. 2011;29:211–22.
Suh WM, Witzke CF, Palacios IF. Suicide left ventricle following transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2010;76:616–20.
Kayalar N, Schaff HV, Daly RC, Dearani JA, Park SJ. Concomitant septal myomectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg. 2010;89:459–64.
Finkelstein A, Keren G, Banai S. Treatment of severe valvular aortic stenosis and subvalvular discrete subaortic stenosis and septal hypertrophy with Percutaneous CoreValve Aortic Valve Implantation. Catheter Cardiovasc Interv. 2010;75:801–3.
Moreno R, Calvo L, Garcia E, Dobarro D. Severe septal hypertrophy: is it necessarily a contraindication for the transcatheter implantation of an Edwards-Sapien prosthesis? Rev Esp Cardiol. 2010;63:241–2.
Dworakowski R, Wendler O. The transapical route for TAVR. Cardiac Interventions Today: Transcatheter Valve Update. 2011:62–5.
Raman SV. The hypertensive heart. An integrated understanding informed by imaging. J Am Coll Cardiol. 2010;55:91–6.
Desai MY, Ommen SR, McKenna WJ, Lever HM, Elliott PM. Imaging phenotype versus genotype in hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2011;4:156–68.
Herrmann S, Stork S, Niemann M, Lange V, Strotmann JM, Frantz S, Beer M, Gattenlohner S, Voelker W, Ertl G, Weidemann F. Low-gradient aortic valve stenosis myocardial fibrosis and its influence on function and outcome. J Am Coll Cardiol. 2011;58:402–12.
La Manna A, Sanfilippo A, Capodanno D, Salemi A, Polizzi G, Deste W, Cincotta G, Cadoni A, Marchese A, Figuera M, et al. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson. 2011;13:82.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this chapter
Cite this chapter
Siddiqui, Y., Moore, S., Ghosh, S., Raman, S.V. (2014). Common Cardiac Pathologies Associated with Aortic Stenosis. In: Min, J., Berman, D., Leipsic, J. (eds) Multimodality Imaging for Transcatheter Aortic Valve Replacement. Springer, London. https://doi.org/10.1007/978-1-4471-2798-7_17
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2798-7_17
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2797-0
Online ISBN: 978-1-4471-2798-7
eBook Packages: MedicineMedicine (R0)