• Klíčová slova
• AORTIC VALVE STENOSIS *, CHILD *, MITRAL VALVE INSUFFICIENCY *,
• MeSH
• aortální stenóza * MeSH
• dítě MeSH
• lidé MeSH
• mitrální insuficience * MeSH
• supravalvulární stenóza aorty * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty). METHODS: Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair. RESULTS: The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007). CONCLUSIONS: Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.

• Klíčová slova
• Aortic insufficiency, Bicuspid, External ring annuloplasty, Valve repair,
• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   MeSH
• aortální aneurysma * MeSH
• aortální chlopeň diagnostické zobrazování   chirurgie   MeSH
• aortální insuficience * chirurgie   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• srdeční chlopně umělé * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The following case report describes an unusual example of aortic valve damage caused by iatrogenic stent-graft rupture (disconnection of the proximal uncovered part of a stent-graft) during delivery of a proximal extension, resulting in the displacement of a stent-graft wire to the aortic root. The wire was extracted under cardiopulmonary bypass, using circulatory arrest, and the damaged aortic valve replaced by a mechanical valve.

• MeSH
• aneurysma hrudní aorty diagnostické zobrazování   chirurgie   MeSH
• aortální chlopeň zranění   MeSH
• aortální insuficience etiologie   MeSH
• cévní protézy škodlivé účinky   MeSH
• chirurgická náhrada chlopně MeSH
• dospělí MeSH
• lidé MeSH
• nepravé aneurysma diagnostické zobrazování   etiologie   MeSH
• počítačová rentgenová tomografie MeSH
• selhání zařízení MeSH
• stenty škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Aortic valve stenosis is the most frequent cardiac valve pathology in the western world. Surgical aortic valve replacement is the gold standard for the treatment of significant degenerative aortic valve diseases. CASE PRESENTATION: This case report highlights an unexpected abnormal iatrogenic shortening of the aorto-mitral continuity and its deformity, during traditional AVR using sutured stented aortic prosthesis as the first choice, which caused significant mitral valve regurgitation. The suture-less prosthesis was a rescue choice to restore the geometry and eliminate the deformation of the aorto-mitral continuity. CONCLUSIONS: Aortic valve replacement using suture-less prosthesis could be a valuable optional choice for lowering the risk of deformation of the aortic annulus and aorto-mitral continuity. It might provide better outcomes in combined procedures.

• Klíčová slova
• Aortic valve replacement, Aorto-mitral continuity, Mitral regurgitation, Suture-less prosthesis,
• MeSH
• aortální chlopeň chirurgie   MeSH
• aortální insuficience * komplikace   chirurgie   MeSH
• aortální stenóza * chirurgie   MeSH
• chirurgická náhrada chlopně * škodlivé účinky   metody   MeSH
• lidé MeSH
• mitrální insuficience * etiologie   chirurgie   MeSH
• srdeční chlopně umělé * škodlivé účinky   MeSH
• sutura škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• aortální insuficience * patofyziologie   MeSH
• hemodynamika MeSH
• modely nemocí na zvířatech MeSH
• psi MeSH
• zvířata MeSH
• Check Tag
• psi MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

We investigated the effect of captopril on the growth of the left ventricle in an experimental model of aortic insufficiency. Four groups of rabbits were studied 28 days after experimental intervention: 1. control, 2. control with captopril (10 mg/kg/day), 3. aortic insufficiency, 4. aortic insufficiency with captopril (10 mg/kg/day). Aortic insufficiency induced hypertrophic growth of the left ventricle demonstrated by increased weight and ribonucleic acid (RNA) concentration. Administration of captopril only slightly attenuated the weight increase of the left ventricle and the increase in concentration of left ventricular RNA. However, captopril reduced the concentration of left ventricular deoxyribonucleic acid (DNA) both in the control and even more in the group with aortic insufficiency. The chronic haemodynamic overload enhanced mitochondrial respiration in the left ventricle which was not influenced by captopril. We conclude that captopril in the dose 10 mg/kg/day did not prevent hypertrophy of the left ventricle but reduced left ventricular DNA concentration.

• MeSH
• aortální insuficience komplikace   MeSH
• energetický metabolismus účinky léků   MeSH
• fosforylace MeSH
• hypertrofie levé komory srdeční etiologie   metabolismus   prevence a kontrola   MeSH
• inhibitory ACE farmakologie   MeSH
• kaptopril farmakologie   MeSH
• králíci MeSH
• myokard metabolismus   MeSH
• RNA metabolismus   MeSH
• tělesná hmotnost účinky léků   MeSH
• velikost orgánu účinky léků   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• inhibitory ACE MeSH
• kaptopril MeSH
• RNA MeSH

OBJECTIVES: Class I triggers for severe and chronic aortic regurgitation surgery mainly rely on symptoms or systolic dysfunction, resulting in a negative outcome despite surgical correction. Therefore, US and European guidelines now advocate for earlier surgery. We sought to determine whether earlier surgery leads to improved postoperative survival. METHODS: We evaluated the postoperative survival of patients who underwent surgery for severe aortic regurgitation in the international multicenter registry for aortic valve surgery, Aortic Valve Insufficiency and Ascending Aorta Aneurysm International Registry, over a median follow-up of 37 months. RESULTS: Among 1899 patients (aged 49 ± 15 years, 85% were male), 83% and 84% had class I indication according to the American Heart Association and European Society of Cardiology, respectively, and most were offered repair surgery (92%). Twelve patients (0.6%) died after surgery, and 68 patients died within 10 years after the procedure. Heart failure symptoms (hazard ratio, 2.60 [1.20-5.66], P = .016) and either left ventricular end-systolic diameter greater than 50 mm or left ventricular end-systolic diameter index greater than 25 mm/m2 (hazard ratio, 1.64 [1.05-2.55], P = .030) predicted survival independently over and above age, gender, and bicuspid phenotype. Therefore, patients who underwent surgery based on any class I trigger had worse adjusted survival. However, patients who underwent surgery while meeting early imaging triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or left ventricular ejection fraction 50% to 55%) had no significant outcome penalty. CONCLUSIONS: In this international registry of severe aortic regurgitation, surgery when meeting class I triggers led to postoperative outcome penalty compared with earlier triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or ventricular ejection fraction 50%-55%). This observation, which applies to expert centers where aortic valve repair is feasible, should encourage the global use of repair techniques and the conduction of randomized trials.

• Klíčová slova
• aortic regurgitation, guidelines, surgery, survival,
• MeSH
• aneurysma vzestupné aorty MeSH
• aortální aneurysma chirurgie   mortalita   diagnostické zobrazování   MeSH
• aortální chlopeň chirurgie   diagnostické zobrazování   patofyziologie   MeSH
• aortální insuficience * chirurgie   mortalita   diagnostické zobrazování   patofyziologie   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně škodlivé účinky   mortalita   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• registrace * MeSH
• rizikové faktory MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH

Angiotensin converting enzyme (ACE) inhibition has been reported to induce regression of hypertrophy in several models of hemodynamic pressure overload. The aim of the present study was to determine whether the ACE inhibitor captopril can reduce hypertrophy of the left ventricle induced by a chronic volume overload and modify collagen composition of the hypertrophied myocardium. Rabbits with four months lasting aortic insufficiency were divided into two groups: treated with captopril (20 mg/kg/day) for five weeks and treated with placebo. The respective control groups were represented by sham-operated animals. Aortic insufficiency induced a decrease of diastolic pressure, an increase of systolic and pulse pressure, hypertrophy of the left and right ventricle, and an increase of hydroxyproline content in the left ventricle without a change of hydroxyproline concentrations in either ventricle. Captopril treatment further enhanced pulse pressure by decreasing diastolic blood pressure. Hypertrophy of the left ventricle, hydroxyproline content and concentration in both ventricles were unaffected by captopril treatment. It is concluded that ACE inhibition did not reverse the left ventricular hypertrophy developed as a result of overload induced by aortic insufficiency. We suggest that mechanisms different from activation of the renin-angiotensin system may play a decisive role in the maintenance of hypertrophy in this particular model of volume hemodynamic overload.

• MeSH
• antihypertenziva farmakologie   MeSH
• aortální insuficience komplikace   patofyziologie   MeSH
• činčila MeSH
• hydroxyprolin metabolismus   MeSH
• hypertrofie levé komory srdeční farmakoterapie   etiologie   patofyziologie   MeSH
• inhibitory ACE farmakologie   MeSH
• kaptopril farmakologie   MeSH
• králíci MeSH
• krevní tlak fyziologie   MeSH
• remodelace komor fyziologie   MeSH
• velikost orgánu účinky léků   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antihypertenziva MeSH
• hydroxyprolin MeSH
• inhibitory ACE MeSH
• kaptopril MeSH

OBJECTIVES: This study assessed the safety and efficacy of an internal geometric annuloplasty ring in a regulatory trial of aortic valve reconstruction (ClinicalTrials.gov Identifier: NCT01400841). METHODS: Sixty-five patients with predominant moderate-to-severe trileaflet aortic insufficiency (AI) underwent aortic valve repair with an average age of 63 ± 13 years (mean ± SD). All had initial implantation of an internal aortic annuloplasty ring to correct annular dilatation and facilitate leaflet reconstruction. Leaflet plication was performed for prolapse in 80% of patients, and more complex leaflet procedures, usually employing autologous pericardium, were required in 22%. Ascending aortic and/or root aneurysms were replaced in 62%. RESULTS: Follow-up was for a maximum of 3 years and a mean of 2 years. No in-hospital operative mortalities, major complications or early or late valve-related events occurred. The annular diameter before repair was 26.5 ± 2.3 mm, and the average ring diameter used was 21.5 ± 1.6 mm. The preoperative AI grade (0-4) was 2.9 ± 0.8 and improved after repair to 0.6 ± 0.7 (P < 0.0001), as did the NYHA class. The mean valve gradient was 8.6 ± 4.3 mmHg, and at 3 years, the Kaplan-Meier survival rate was 95%, with no valve-related mortality. Over the 3 years, aortic valve replacement was required in 7 patients (10.8%) for reasons usually related to surgical technique. Most repair failures occurred early, and results stabilized after 6 months. No structural complications of the rings were observed. CONCLUSIONS: Geometric ring annuloplasty was a safe and effective adjunct to aortic valve repair. Initial correction of annular dilatation seemed to facilitate overall reconstruction. Because most early repair failures were technical, increasing experience with geometric ring annuloplasty for aortic valve reconstruction has the potential to standardize and improve outcomes.

• Klíčová slova
• Aortic annuloplasty, Aortic insufficiency, Aortic valve repair,
• MeSH
• anuloplastika srdeční chlopně škodlivé účinky   přístrojové vybavení   metody   mortalita   MeSH
• aortální chlopeň chirurgie   MeSH
• aortální insuficience chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• reoperace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

The authors studied the diagnostic possibilities of contrast echocardiography in tricuspid (TVI), mitral (MVI) and aortic (AVI) insufficiency. In 29 patients with TVI the contrast medium was injected into the cubital vein, in 12 patients with MVI and in 13 patients with AVI it was injected into the left ventricle and the aorta respectively at catheterization. Four diagnostic echocontrast criteria of TVI were deduced, three of which have a high specificity and sensitivity. Diagnosis of MVI and AVI is possible only with the use of selective contrast echocardiography, which provides direct signs of regurgitation through the affected valve, is highly specific and sufficiently sensitive.

• MeSH
• aortální insuficience diagnóza   MeSH
• dítě MeSH
• dospělí MeSH
• echokardiografie metody   MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální insuficience diagnóza   MeSH
• mladiství MeSH
• nemoci srdečních chlopní diagnóza   MeSH
• trikuspidální insuficience diagnóza   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kontrastní látky MeSH