Functional Anatomy of Aortic Regurgitation

Abstract

Background-For patients with aortic regurgitation (AR), aortic valve sparing or repair surgery is an attractive alternative to valve replacement. In this setting, accurate preoperative delineation of aortic valve pathology and potential repairability is of paramount importance. The aim of the present study was to assess the diagnostic value of preoperative transesophageal echocardiography (TEE) in defining the mechanisms of AR, as identified by surgical inspection, and in predicting repairability, by using the final surgical approach as reference. Methods and Results-One

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

“…48 • Quantification of aortic regurgitation should follow an integrated approach considering all qualitative, semi-quantitative and quantitative parameters 2,6 (Table 4).…”

“…6,48,49 In experienced centres, valve-sparing root replacement and valve repair, when feasible, yield good long-term results with low rates of valve-related events as well as better quality of life. [62][63][64][65] The choice of the surgical procedure should be adapted to the experience of the team, the presence of an aortic root aneurysm, characteristics of the cusps, life expectancy and desired anticoagulation status.…”

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

“…La ecocardiografía (ETT/ETE) es la prueba más importante para describir la anatomía valvular, cuantificar la insuficiencia aórtica, evaluar sus mecanismos, definir la morfología de la aorta y determinar la viabilidad de una intervención quirúrgica de conservación o de reparación valvular 48,49 . Los aspectos más importantes de esta evaluación son:…”

Mechanobiology of myofibroblast adhesion in fibrotic cardiac disease

“…Myxomatous remodeling is characterized by increased expression of TGF-β1 (TGFB1), matrix metalloproteinases (MMPs) and several ECM components, and results in valve billowing and regurgitating blood flow (Aupperle and Disatian, 2012;Geirsson et al, 2012;Hagler et al, 2013). Calcific aortic valve disease (CAVD), a stenotic disease that often necessitates valve replacement, is characterized by increased expression of TGF-β1 and collagen -especially collagen-1 -and the development of calcified nodules, resulting in a stiff, partially occluded, stenotic valve (le Polain de Waroux et al, 2007;Mohler et al, 2001). These pathologic alterations to the mechanical properties of the tissue are primarily mediated by VICs, a heterogenous population of fibroblast-like cells that differentiate into active MyoFBs in response to fibrotic signaling factors and mechanical cues ( Fig.…”