Exercise hemodynamics in small (≤21 mm) aortic valve prostheses assessed by Doppler echocardiography

Wiseth, Rune; Levang, Olaf W.; Tangen, Geir; Rein, Kjell Arne; Skjærpe, Terje; Hatle, Liv

doi:10.1016/0002-8703(93)90066-i

Cited by 44 publications

(22 citation statements)

References 26 publications

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“…Our findings are consistent with these observations. Wiseth and colleagues 21 assessed DOBUTAMINE STRESS TEST Çam the present study are higher than those previously reported, which may be due to the following reasons:…”

Section: çAm Dobutamine Stress Testcontrasting

confidence: 76%

“…[15][16][17][18][19][20] It was suggested that a complete hemodynamic evaluation of prosthetic valves should include assessment of exercise hemodynamics. [21][22][23] In order to evaluate the exercise hemodynamics of prosthetic valves, bicycle or treadmill exercise tests were performed and Doppler gradients were recorded immediately after exercise while the patients were in the supine position. [21][22] The use of dobutamine stress echocardiography for this purpose has been reported only by Izzat and colleagues 8,9 who applied the technique in evaluation of the hemodynamic performance of St. Jude Medical and Carbomedics 21-mm prostheses and in comparing small Carbomedics aortic valve prostheses (19 mm and 21 mm).…”

Section: Discussionmentioning

confidence: 99%

“…33 A similar finding has been reported recently by Wiseth and colleagues. 21 The gradients observed in y = -6.1x + 9.7 p < 0.0001 r = 0.81 Figure 5. Linear regression analysis showed a significant correlation between exercise duration and valvular size.…”

Section: çAm Dobutamine Stress Testmentioning

confidence: 97%

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Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves

Çam¹,

Gerçekoğlu

Çelık³

et al. 1998

Asian Cardiovasc Thorac Ann

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Dobutamine stress testing and Doppler echocardiography were used to assess hemodynamics in 27 patients aged 16 to 54 years with various sizes and types of aortic valve prosthesis. All patients underwent a symptom-limited treadmill exercise test within two days of the dobutamine test. There was no significant difference in ejection fractions and transvalvular gradients at rest and during dobutamine stress between St. Jude Medical, Medtronic-Hall, and Carbomedics valves. Exercise duration did not differ significantly among the different types of valve. When patients were classified by their underlying lesion, those with aortic stenosis and those with aortic insufficiency had similar ejection fractions and transvalvular gradients at rest and during dobutamine stress. The mean and peak transvalvular gradients at rest and during dobutamine stress were significantly different in patients with different valve sizes but the extent of the increase in gradients during stress was not significant. Linear regression analysis revealed that both peak and mean gradients during dobutamine stress could be predicted by the resting gradients. There was a negative correlation between valve size and gradients at rest and during stress, while there was a significant correlation between exercise duration and valve size. Dobutamine stress echocardiography was useful for studying hemodynamics in patients with aortic valve prostheses and the findings show that valvular size was the main determinant of exercise capacity.

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Section: çAm Dobutamine Stress Testcontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves

Çam¹,

Gerçekoğlu

Çelık³

et al. 1998

Asian Cardiovasc Thorac Ann

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“…This might indicate that the smallest valve sizes represent a hazard to the life of the patients because of an anticipated higher transvalvular gradient. This, however, is less likely because hemodynamic studies with the MH prosthesis have shown small and hemodynamically acceptable gradients even in the smallest valve sizes, [22][23][24][25][26][27] which may represent an alternative to root enlargement. 26,28 The interpretations of our findings are, however, rather complex because patients with the smallest valve sizes tended to be older and included more female patients than those with the largest valve sizes.…”

Section: Valve Sizementioning

confidence: 99%

Twenty-Five–Year Experience With the Medtronic-Hall Valve Prosthesis in the Aortic Position

2007

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“…In contrary, small prostheses may be threatening in especially early and late periods of life and during exercise by creating an obstruction through the left ventricle outlet [11]- [16]. It was demonstrated that both prosthetic and bioprosthetic valves are narrower than the natural valves, and although function normally, they may lead to some degree of a gradient [17] [18]. These gradient values further increase in the cases with a small annulus by using valves with a small size [19].…”

Section: Discussionmentioning

confidence: 99%

Surgical Method for Facilitation of Aortic Valve Replacement: Intraoperative Application of External Pressure for Increasing the Transverse Axis of Aortic Annulus

Bozok¹,

Kestelli²,

Şahin³

et al. 2015

WJCS

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Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming * Corresponding author. Ş. Bozok et al. 109prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.

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Exercise hemodynamics in small (≤21 mm) aortic valve prostheses assessed by Doppler echocardiography

Cited by 44 publications

References 26 publications

Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves

Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves

Twenty-Five–Year Experience With the Medtronic-Hall Valve Prosthesis in the Aortic Position

Surgical Method for Facilitation of Aortic Valve Replacement: Intraoperative Application of External Pressure for Increasing the Transverse Axis of Aortic Annulus

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