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Paul W M Fedak - One of the best experts on this subject based on the ideXlab platform.
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abstract 12518 Bicuspid Aortic Valve disease increases viscous energy loss circumferential wall shear stress and pressure drop in the ascending aorta
Circulation, 2019Co-Authors: Patrick J Geeraert, Paul W M Fedak, Jacqueline Flewitt, Michael R Bristow, Bobak Heydari, C Lydell, Andrew G Howarth, Ali Fatehi, James A White, Julio GarciaAbstract:Introduction: We use 4D-Flow MRI to investigate the effects of Bicuspid Aortic Valve (BAV) disease on downstream pressure drop (PD), wall shear stress (WSS), and viscous energy loss (EL) in the asc...
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Evolving Surgical Approaches to Bicuspid Aortic Valve Associated Aortopathy
Frontiers Media S.A., 2019Co-Authors: Ali Fatehi Hassanabad, Subodh Verma, Paul W M Fedak, Christopher M. FeindelAbstract:Bicuspid Aortic Valve (BAV) is the most common congenital cardiac pathology which results from the fusion of two adjacent Aortic Valve cusps. It is associated with dilatation of the aorta, known as Bicuspid Valve-associated aortopathy or Bicuspid aortopathy. Bicuspid aortopathy is progressive and is linked with adverse clinical events. Hence, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. Over the past two decades resection strategies and surgical interventions have mainly been directed by surgeon and institution preferences. These practices have ranged from conservative to aggressive approaches based on Aortic size and growth criteria. This strategy, however, may not best reflect the risks of important Aortic events. A new set of guidelines was proposed for the treatment of Bicuspid aortopathy. Herein, we will highlight the most recent findings pertinent to Bicuspid aortopathy and its management in the context of a case presentation
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy full online only version
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy executive summary
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is a common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current document is an executive summary of "The American Association for Thoracic Surgery Guidelines on Bicuspid Aortic Valve-Related Aortopathy." All major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research are contained within these guidelines. The current executive summary serves as a condensed version of the guidelines to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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should the ascending aorta be replaced more frequently in patients with Bicuspid Aortic Valve disease
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Joan Ivanov, Michael A Borger, Mark A Preston, Paul W M Fedak, Piroze DavierwalaAbstract:Objective The optimal diameter at which replacement of the ascending aorta should be performed in patients with Bicuspid Aortic Valve disease is not known. Methods We reviewed all patients with Bicuspid Aortic Valves undergoing Aortic Valve replacement at our institution from 1979 through 1993 (n = 201). Patients undergoing concomitant replacement of the ascending aorta were excluded. Results Follow-up was obtained on 98% of patients and was 10.3 ± 3.8 (mean ± SD) years. The average patient age was 56 ± 15 years, and 76% were male. The ascending aorta was normal ( 5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patients required reoperation, predominantly for Aortic Valve prosthesis failure. Twenty-two patients had long-term complications related to the ascending aorta: 18 required an operative procedure to replace the ascending aorta (for Aortic aneurysm), 1 had Aortic dissection, and 3 experienced sudden cardiac death. Fifteen-year freedom from ascending aorta–related complications was 86%, 81%, and 43% in patients with an Aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4.5 to 4.9 cm, respectively ( P Conclusions Patients undergoing operations for Bicuspid Aortic Valve disease should be considered for concomitant replacement of the ascending aorta if the diameter is 4.5 cm or greater.
Michael D Hope - One of the best experts on this subject based on the ideXlab platform.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy full online only version
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy executive summary
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is a common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current document is an executive summary of "The American Association for Thoracic Surgery Guidelines on Bicuspid Aortic Valve-Related Aortopathy." All major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research are contained within these guidelines. The current executive summary serves as a condensed version of the guidelines to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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Bicuspid Aortic Valve four dimensional mr evaluation of ascending Aortic systolic flow patterns
Radiology, 2010Co-Authors: Michael D Hope, Thomas A Hope, Alison K Meadows, Karen G Ordovas, Thomas H Urbania, Marcus T Alley, Charles B HigginsAbstract:By using four-dimensional flow MR imaging, we have provided evidence that markedly abnormal helical flow is evident in the ascending thoracic aorta of patients with a Bicuspid Aortic Valve, including those without aneurysm or Aortic stenosis.
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evaluation of Bicuspid Aortic Valve and Aortic coarctation with 4d flow magnetic resonance imaging
Circulation, 2008Co-Authors: Michael D Hope, Thomas A Hope, Alison K Meadows, Karen G Ordovas, Marcus T Alley, Gautham P Reddy, Charles B HigginsAbstract:Time-resolved, 3D, phase-contrast magnetic resonance imaging (4D flow) is an effective means of evaluating dynamic multidirectional blood flow in the thoracic aorta.1 We have used the technique for characterization of abnormal flow features in a 14-year-old boy with Aortic coarctation and Bicuspid Aortic Valve (BAV) but without evidence of Aortic stenosis or regurgitation. In addition to the expected flow disturbance in the region of the juxtaductal coarctation (Figure 1), we show an unusual flow feature in the ascending aorta that has not been previously reported in this clinical setting and that may be unique to BAV: 2 discrete nested helices of midsystolic blood flow in a nonaneurysmal aorta (Figure 2). Figure 1. Fourteen-year-old boy with BAV and Aortic coarctation. A, Three-dimensional contrast-enhanced magnetic resonance angiography that demonstrates a focal juxtaductal coarctation and prominent internal mammary and …
Michael A Borger - One of the best experts on this subject based on the ideXlab platform.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy executive summary
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is a common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current document is an executive summary of "The American Association for Thoracic Surgery Guidelines on Bicuspid Aortic Valve-Related Aortopathy." All major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research are contained within these guidelines. The current executive summary serves as a condensed version of the guidelines to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy full online only version
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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should the ascending aorta be replaced more frequently in patients with Bicuspid Aortic Valve disease
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Joan Ivanov, Michael A Borger, Mark A Preston, Paul W M Fedak, Piroze DavierwalaAbstract:Objective The optimal diameter at which replacement of the ascending aorta should be performed in patients with Bicuspid Aortic Valve disease is not known. Methods We reviewed all patients with Bicuspid Aortic Valves undergoing Aortic Valve replacement at our institution from 1979 through 1993 (n = 201). Patients undergoing concomitant replacement of the ascending aorta were excluded. Results Follow-up was obtained on 98% of patients and was 10.3 ± 3.8 (mean ± SD) years. The average patient age was 56 ± 15 years, and 76% were male. The ascending aorta was normal ( 5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patients required reoperation, predominantly for Aortic Valve prosthesis failure. Twenty-two patients had long-term complications related to the ascending aorta: 18 required an operative procedure to replace the ascending aorta (for Aortic aneurysm), 1 had Aortic dissection, and 3 experienced sudden cardiac death. Fifteen-year freedom from ascending aorta–related complications was 86%, 81%, and 43% in patients with an Aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4.5 to 4.9 cm, respectively ( P Conclusions Patients undergoing operations for Bicuspid Aortic Valve disease should be considered for concomitant replacement of the ascending aorta if the diameter is 4.5 cm or greater.
Michael W A Chu - One of the best experts on this subject based on the ideXlab platform.
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Bicuspid Aortic Valve disease and ascending Aortic aneurysms gaps in knowledge
Cardiology Research and Practice, 2012Co-Authors: Katie L Losenno, Robert L Goodman, Michael W A ChuAbstract:The Bicuspid Aortic Valve is the most common congenital cardiac anomaly in developed nations. The abnormal Bicuspid morphology of the Aortic Valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of Bicuspid Aortic Valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including Aortic coarctation, hypoplastic left heart structures, and ascending Aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of Bicuspid Aortic Valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending Aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the Aortic Valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of Bicuspid Aortic Valve disease with associated ascending Aortic aneurysms.
Samuel C. Siu - One of the best experts on this subject based on the ideXlab platform.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy full online only version
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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the american association for thoracic surgery consensus guidelines on Bicuspid Aortic Valve related aortopathy executive summary
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Michael A Borger, Samuel C. Siu, Subodh Verma, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Michael D HopeAbstract:Bicuspid Aortic Valve disease is a common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with Bicuspid Aortic Valve disease, with thoracic Aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of Bicuspid Aortic Valve-associated aortopathy, but none focused entirely on this disease process. The current document is an executive summary of "The American Association for Thoracic Surgery Guidelines on Bicuspid Aortic Valve-Related Aortopathy." All major aspects of Bicuspid Aortic Valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research are contained within these guidelines. The current executive summary serves as a condensed version of the guidelines to provide clinicians with a current and comprehensive review of Bicuspid Aortic Valve aortopathy and to guide the daily management of these complex patients.
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Aortic Dilatation in Patients with Bicuspid Aortic Valve
New England Journal of Medicine, 2014Co-Authors: Subodh Verma, Samuel C. SiuAbstract:Bicuspid Aortic Valve is the most common congenital heart defect in adults. Dilatation of the proximal aorta, or Bicuspid aortopathy, is present in approximately half these patients and can lead to complications, including aneurysm formation and Aortic dissection.
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Bicuspid Aortic Valve disease
Journal of the American College of Cardiology, 2010Co-Authors: Samuel C. Siu, Candice K SilversidesAbstract:Bicuspid Aortic Valve (BAV) disease is the most common congenital cardiac defect. While the BAV can be found in isolation, it is often associated with other congenital cardiac lesions. The most frequent associated finding is dilation of the proximal ascending aorta secondary to abnormalities of the Aortic media. Changes in the Aortic media are present independent of whether the Valve is functionally normal, stenotic, or incompetent. Although symptoms often manifest in adulthood, there is a wide spectrum of presentations ranging from severe disease detected in utero to asymptomatic disease in old age. Complications can include Aortic Valve stenosis or incompetence, endocarditis, Aortic aneurysm formation, and Aortic dissection. Despite the potential complications, 2 large contemporary series have demonstrated that life expectancy in adults with BAV disease is not shortened when compared with the general population. Because BAV is a disease of both the Valve and the aorta, surgical decision making is more complicated, and many undergoing Aortic Valve replacement will also need Aortic root surgery. With or without surgery, patients with BAV require continued surveillance. Recent studies have improved our understanding of the genetics, the pathobiology, and the clinical course of the disease, but questions are still unanswered. In the future, medical treatment strategies and timing of interventions will likely be refined. This review summarizes our current understanding of the pathology, genetics, and clinical aspects of BAV disease with a focus on BAV disease in adulthood.