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Ignacio Plaza - One of the best experts on this subject based on the ideXlab platform.
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Long-term Follow-up After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
Revista espanola de cardiologia (English ed.), 2015Co-Authors: Pablo Salinas, Raúl Moreno, Luis Calvo, Ángel Sánchez-recalde, Santiago Jiménez-valero, Guillermo Galeote, Teresa López-fernández, Ulises Ramírez, Luis Riera, Ignacio PlazaAbstract:Abstract Introduction and objectives Transcatheter aortic Valve implantation is used as an alternative to surgical Valve replacement in patients with severe aortic stenosis who are considered high-surgical-risk or inoperable. Two of the main areas of uncertainty in this field are Valve durability and long-term survival. Methods This prospective single-center registry study from a tertiary hospital included all consecutive patients who underwent percutaneous aortic Valve implantation between 2008 and 2012. Clinical follow-up lasted a minimum of 2.5 years and a maximum of 6.5 years. Valve Academic Research Consortium-2 definitions were used. Results Seventy-nine patients were included, with an immediate success rate of 94.9%. The median survival was 47.6 months (95% confidence intervals, 37.4-57.9 months), ie, 4 years. One quarter of deaths occurred in the first month, and most were of cardiovascular cause. After the first month, most deaths were due to noncardiovascular causes. The mean values of Valve gradients did not increase during follow-up. The cumulative rate of Prosthetic Valve Dysfunction was 15.3%, with no cases of repeat Valve replacement. Conclusions Half of the patients with aortic stenosis who underwent transcatheter aortic Valve implantation were alive 4 years after the procedure. There was a 15.3% Prosthetic Valve Dysfunction rate in cumulative follow-up, with no cases of repeat Valve replacement.
Hasan Kaya - One of the best experts on this subject based on the ideXlab platform.
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sixty four section cardiac computed tomography in mechanical Prosthetic heart Valve Dysfunction thrombus or pannus
Circulation-cardiovascular Imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background—Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results—Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical Prosthetic Valve Dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. PeriProsthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P 90) is associated with reduced lysis rates. (Circ Cardiovasc Imaging. 2015;8:e003246. DOI: 10.1161/CIRCIMAGING.115.003246.)
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sixty four section cardiac computed tomography in mechanical Prosthetic heart Valve Dysfunction thrombus or pannus
Circulation-cardiovascular Imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background— Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results— Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical Prosthetic Valve Dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. PeriProsthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P <0.001). Area under the receiver operating characteristic curve was 0.96 (95% confidence interval: 0.91–0.99; P <0.001), and a cutoff point of HU≥145 provided high sensitivity (87.5%) and specificity (95.5%) in discriminating pannus from thrombus. Complete lysis was more common for masses with HU<90 compared with those with HU 90 to 145 (100% versus 42.1%; P =0.007). Conclusions— Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with Prosthetic Valve Dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates.
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Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction
Circulation. Cardiovascular imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background—Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidet...
Pablo Salinas - One of the best experts on this subject based on the ideXlab platform.
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Long-term Follow-up After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
Revista espanola de cardiologia (English ed.), 2015Co-Authors: Pablo Salinas, Raúl Moreno, Luis Calvo, Ángel Sánchez-recalde, Santiago Jiménez-valero, Guillermo Galeote, Teresa López-fernández, Ulises Ramírez, Luis Riera, Ignacio PlazaAbstract:Abstract Introduction and objectives Transcatheter aortic Valve implantation is used as an alternative to surgical Valve replacement in patients with severe aortic stenosis who are considered high-surgical-risk or inoperable. Two of the main areas of uncertainty in this field are Valve durability and long-term survival. Methods This prospective single-center registry study from a tertiary hospital included all consecutive patients who underwent percutaneous aortic Valve implantation between 2008 and 2012. Clinical follow-up lasted a minimum of 2.5 years and a maximum of 6.5 years. Valve Academic Research Consortium-2 definitions were used. Results Seventy-nine patients were included, with an immediate success rate of 94.9%. The median survival was 47.6 months (95% confidence intervals, 37.4-57.9 months), ie, 4 years. One quarter of deaths occurred in the first month, and most were of cardiovascular cause. After the first month, most deaths were due to noncardiovascular causes. The mean values of Valve gradients did not increase during follow-up. The cumulative rate of Prosthetic Valve Dysfunction was 15.3%, with no cases of repeat Valve replacement. Conclusions Half of the patients with aortic stenosis who underwent transcatheter aortic Valve implantation were alive 4 years after the procedure. There was a 15.3% Prosthetic Valve Dysfunction rate in cumulative follow-up, with no cases of repeat Valve replacement.
Sabahattin Gündüz - One of the best experts on this subject based on the ideXlab platform.
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Histopathological and Immunohistochemical Evaluation of Pannus Tissue in Patients with Prosthetic Valve Dysfunction.
The Journal of heart valve disease, 2016Co-Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Mahmut Yesin, Macit Kalçık, Mehmet Ali Astarcıoğlu, Sabahattin Gündüz, Ali Emrah Oğuz, Şermin Çoban Kökten, Ayşe Nimet Karadayı, Altug TuncerAbstract:BACKGROUND Prosthetic Valve Dysfunction due to pannus formation is a rare but serious complication. Currently, limited data are available concerning the pathogenesis and immunohistochemical properties of pannus. The study aim was to investigate the morphological, histopathological and immunohistochemical characteristics of pannus formation in patients with Prosthetic Valve Dysfunction. METHODS A total of 35 patients (10 males, 25 females; mean age 44 ± 16 years) who had undergone re-do Valve surgery due to Prosthetic Valve obstruction was enrolled in the study. Immunohistochemical studies were aimed at evaluating the expression of alphasmooth muscle actin (α-SMA) and desmin in myofibroblasts and smooth muscle cells; epithelial membrane antigen (EMA) in epithelial cells; and CD34, Factor VIII and vascular endothelial growth factor (VEGF) in endothelial cells. Matrix metalloproteinases (MMPs) -2 and -9, and transforming growth factor-beta (TGF-β) were used to demonstrate cytokine release from macrophages, leukocytes, fibroblasts and myofibroblasts. RESULTS Pannus appeared as a tough and thick tissue hyperplasia which began from outside the suture ring in the periannular region and extended to the inflow and outflow surfaces of the Prosthetic Valves. Histopathological analysis showed the pannus tissue to consist of chronic inflammatory cells (lymphocytes, plasma cells, macrophages and foreign body giant cells), spindle cells such as myofibroblasts, capillary blood vessels and endothelial cells laying down the lumens. Calcification was present in the pannus tissue of 19 explanted prostheses. Immunohistochemical studies revealed positive α-SMA expression in all patients, whereas 60.5% of patients were positive for desmin, 50% for EMA, 42.1% for VEGF, 39.5% for TBF-β, 42.1% for MMP-2, 86.8% for CD34, and 97.4% for Factor VIII. MMP-9 was negative in all patients. CONCLUSIONS Pannus tissue appears to be formed as the result of a neointimal response in periannular regions of Prosthetic Valves that consist of periannular tissue migration, myofibroblast and extracellular matrix proliferation with vascular components. It is a chronic active process in which mediators such as TGF-β, VEGF and MMP-2 play roles in both matrix formation and degradation.
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sixty four section cardiac computed tomography in mechanical Prosthetic heart Valve Dysfunction thrombus or pannus
Circulation-cardiovascular Imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background— Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results— Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical Prosthetic Valve Dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. PeriProsthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P <0.001). Area under the receiver operating characteristic curve was 0.96 (95% confidence interval: 0.91–0.99; P <0.001), and a cutoff point of HU≥145 provided high sensitivity (87.5%) and specificity (95.5%) in discriminating pannus from thrombus. Complete lysis was more common for masses with HU<90 compared with those with HU 90 to 145 (100% versus 42.1%; P =0.007). Conclusions— Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with Prosthetic Valve Dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates.
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sixty four section cardiac computed tomography in mechanical Prosthetic heart Valve Dysfunction thrombus or pannus
Circulation-cardiovascular Imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background—Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results—Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical Prosthetic Valve Dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. PeriProsthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P 90) is associated with reduced lysis rates. (Circ Cardiovasc Imaging. 2015;8:e003246. DOI: 10.1161/CIRCIMAGING.115.003246.)
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Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction
Circulation. Cardiovascular imaging, 2015Co-Authors: Sabahattin Gündüz, Süleyman Karakoyun, Macit Kalçık, Mehmet Ali Astarcıoğlu, Mehmet Özkan, Ozan Mustafa Gürsoy, Ahmet Çağrı Aykan, Murat Biteker, Tayyar Gökdeniz, Hasan KayaAbstract:Background—Distinguishing pannus and thrombus in patients with Prosthetic Valve Dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidet...
Ulises Ramírez - One of the best experts on this subject based on the ideXlab platform.
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Long-term Follow-up After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
Revista espanola de cardiologia (English ed.), 2015Co-Authors: Pablo Salinas, Raúl Moreno, Luis Calvo, Ángel Sánchez-recalde, Santiago Jiménez-valero, Guillermo Galeote, Teresa López-fernández, Ulises Ramírez, Luis Riera, Ignacio PlazaAbstract:Abstract Introduction and objectives Transcatheter aortic Valve implantation is used as an alternative to surgical Valve replacement in patients with severe aortic stenosis who are considered high-surgical-risk or inoperable. Two of the main areas of uncertainty in this field are Valve durability and long-term survival. Methods This prospective single-center registry study from a tertiary hospital included all consecutive patients who underwent percutaneous aortic Valve implantation between 2008 and 2012. Clinical follow-up lasted a minimum of 2.5 years and a maximum of 6.5 years. Valve Academic Research Consortium-2 definitions were used. Results Seventy-nine patients were included, with an immediate success rate of 94.9%. The median survival was 47.6 months (95% confidence intervals, 37.4-57.9 months), ie, 4 years. One quarter of deaths occurred in the first month, and most were of cardiovascular cause. After the first month, most deaths were due to noncardiovascular causes. The mean values of Valve gradients did not increase during follow-up. The cumulative rate of Prosthetic Valve Dysfunction was 15.3%, with no cases of repeat Valve replacement. Conclusions Half of the patients with aortic stenosis who underwent transcatheter aortic Valve implantation were alive 4 years after the procedure. There was a 15.3% Prosthetic Valve Dysfunction rate in cumulative follow-up, with no cases of repeat Valve replacement.
