The aortic valve: structure, complications and implications for transcatheter aortic valve replacement

Abstract

The aortic valve operates in a complex haemodynamic environment, opening and closing over 100,000 times a day. When complications arise, such as aortic stenosis, prognosis can be very poor, leading to death within the first few years. Surgical valve replacement is currently the standard treatment for aortic stenosis. A thorough understanding of the anatomy and function of the native valve is imperative when developing a prosthetic replacement that can withstand the complex demands of the heart. This review focuses on the anatomy, structure and disease of the aortic valve and the implications for a transcatheter aortic valve replacement (TAVR). Current complications with TAVR, such as major vascular bleeding, conduction disturbances and patient-prosthesis mismatch (PPM), can be overcome by reducing the delivery profile and through the use of more accurate imaging technologies to work towards a fully functional and durable prosthesis.

Aortic regurgitation: epidemiologic, etiologic, and pathophysiologic characteristics

“…Корень аорты включает АК, основание передней створки митрального клапана (МК) и дает начало коронарным артериям. Помимо своей основной анатомической функции, корень аорты участвует в процессах взаимодействия створок АК с синусами Вальсальвы и регуляции динамики кровотока в течение всего сердечного цикла [5,6]. Корень аорты включает АК от его месторасположения в отверстии ЛЖ до соединения с восходящей аортой [7,8].…”

Evaluation of Aortic Valve Pressure Gradients for Increasing Severities of Rheumatic and Calcific Stenosis Using Empirical and Numerical Approaches

“…The aortic valve is situated in a complex haemodynamic environment between the left ventricle (LV) and the aorta, the largest artery in the human body. The aortic valve rapidly opens during systole and closes during diastole approximately 100,000 times per day to regulate blood flow and pressure throughout the body, an essential element to sustain human life [1]. Valvular heart disease (VHD) describes the pathological condition where heart valves are affected by abnormalities caused by congenital malformation, degeneration, or infection [2].…”

“…Aortic stenosis (AS) is the valve pathology described by the narrowing of the valve opening area. It is the VHD where physical medical intervention is most often required in Europe and North America [1,3]. The prevalence of VHD increases with age where degenerative VHDs are more prevalent in industrial countries and rheumatic heart disease leading in developing countries.…”

Current and novel echocardiographic assessment of left ventricular systolic function in aortic stenosis—A comprehensive review

“…The prevalence of this type of valvular heart disease has been shown to be directly related to age affecting around 2%–5% of the population of those over 65 years of age, increasing to nearly 10% of the population for those over the age of 80 years of age 2,3 . Lipid accumulation, gradual fibrosis, and the deposition of focal calcium within the aortic valve leaflet matrix over time have been shown to cause a reduction in leaflet mobility and valve area with concomitant increases in myocardial stress and workload induced by higher left ventricular afterload 4 . AS is a gradual pathological process described as having an asymptomatic latency period where compensatory left ventricular hypertrophy develops to preserve left ventricular systolic function and cardiac output while coping with increases in myocardial wall stress 5 .…”

“… 2 , 3 Lipid accumulation, gradual fibrosis, and the deposition of focal calcium within the aortic valve leaflet matrix over time have been shown to cause a reduction in leaflet mobility and valve area with concomitant increases in myocardial stress and workload induced by higher left ventricular afterload. 4 AS is a gradual pathological process described as having an asymptomatic latency period where compensatory left ventricular hypertrophy develops to preserve left ventricular systolic function and cardiac output while coping with increases in myocardial wall stress. 5 The risk of AS related mortality has been shown to significantly increase following the development of symptoms such as pre‐syncope, syncope, angina, and heart failure.…”