Posts Tagged ‘Valvular’
Article by Suzanne Benz
The new Structural Heart Disease Program at Brigham and Women’s Hospital provides highly specialized, multidisciplinary evaluation and care for patients with advanced and complex valvular and structural heart disease.
Comprised of a renowned team of specialists in cardiovascular medicine and surgery, including cardiology, interventional cardiology, cardiac surgery, cardiovascular imaging, and cardiac anesthesia, the Program enables patients to be evaluated by multiple specialists in one visit. These specialists collaborate closely in the development of a treatment plan – often using multiple modalities – designed to deliver the best outcome for each patient.
Groundbreaking Clinical TrialsThe team of experts in the Program participates in leading clinical trials and is currently enrolling patients in the PARTNER trial, a national, multi-center, randomized trial for patients with aortic stenosis who are at high risk for conventional surgery.
The team recently completed the first percutaneous aortic valve replacement as part of this trial, placing a 26mm SAPIEN prosthesis via the transfemoral route, with vascular access and closure done entirely percutaneously. In the future, patients will be treated using either a percutaneous or transapical approach. New trials for patients with mitral regurgitation are expected within the year.
Advanced Treatment OptionsThe team of specialists in the Program collaborates to offer a range of advanced procedures, including:• Percutaneous valve replacement;• Aortic and mitral valvuloplasty;• Catheter-based closure of periprosthetic valvular leaks in high risk or inoperable patients;• “Hybrid” approaches to combined coronary and valvular heart disease.
Brigham and Women’s Hospital’s neuroscience center offers neurology services with the care & compassion you would expect from an organization that has been consistently ranked as one of America’s best hospitals on the U.S. News & World Report® Honor Roll, and one of the top neurology & neurosurgery providers in the country. For close to 175 years, Brigham and Women’s Hospital has been the most trusted name in women’s health. Our women health center has been the site for important advances in women’s health. Our team works to improve the health of women and transform their care. For more information about BWH, please visit http://www.brighamandwomens.org/ .
About the Author
BBrigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, is consistently ranked as one of the nation’s leading hospitals. With a state-of-the-art cardiovascular center & orthopedic center of excellence, BWH is committed to excellence in patient care with expertise specialty of medicine and surgery.
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Article by Subramani
Valvular involvement by disease causes stenosis, insufficiency (regurgitation), or both. Stenosis is the failure of a volve to open completely, thereby impeding forward flow Insufficiency, regurgitation, or incompetence, in contrast results from failure of a valve to close completely, thereby allowing reversed flow. These abnormalities can be either pure, when only stenosis or regurgitation is present or mixed when both stenosis and regurgitation coexist in the same valve, but one of these defects usually predominates. Dysfunction may affect a single valve (isolated disease) or multiple valves (combined disease). Functional regurgation results when a valve becomes incompetent owing to ventricular dilation, which causes the right or left ventricular papillary muscles to be pulled down and outward thereby preventing coaptation of otherwise intact leaflets during systole. Abnormalities of flow often produce abnormal heart sounds known as murmurs.
Valvular dysfunction can vary in degree from slight and physiologically unimportant to severe and rapidly fatal. The clinical consequences depend on the valve involved the rate and quality of compensatory mechanisms. For example, sudden destruction of an aortic valve cusp by infection (as in infective endocarditis) may cause rapidly fatal caardiac failure owing to massive regurgitation. In contrast, rheumatic mitral stenosis usually develops over years and its clinical effects may be remarkably well tolerated. Depending on degree, duration, and cause, valvular stenosis or insufficiency often produces secondary changes in the heart, blood vessels, and other organs, both proximal and distal to the valvular lesion. Most important are the myocardial hypertrophy and pulmonary and systemic changes. Moreover a patch of endocardial thickening often occurs at the point where a jet lesion impinges such as the focal endocardial fibrosis in the left atrium secondary to a regurgitant jet of mitral insufficiency.
Valvular abnormalities may be caused by congenital disorders or by a variety of acquired disease. Most frequent are acquired stenoses of the mitral and aortic valves which account for approximately two thirds of all valve lesions. Valvular insufficiency may result from either intrinsic disease of the valve cups or damage to or distortion of the supporting structures (e.g.,) the aorta, mitral annulus, tendinous cords, papillary muscles, ventricular free wall) without primary changes in the cusps. It may appear acutely with infective endocarditis or chronically with leaflet scarring and retraction. In contrast, valvular stenosis almost always is due to a primary cuspal abnormality and is virtually always a chronic process.
In contrast to the many potential causes of valvular insufficiency, only a relatively few mechanisms commonly produce acquired valvular stenosis. The most frequent chronic causes of the major functional valvular lesions are as follows:
Mitral stenosis-rheumatic heart diseaseMitral insufficiency-myxomatous degeneration (mitral valve prolapse)Aortic stenosis – calcification of anatomically normal and congenitally bicupspid aortic valvesAortic insufficiency -dialation of the ascending aorta related to hypertension and aging.
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