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Different second generation devices for transcatheter aortic valve implantation (TAVI) are available on market.A detailed characterization of the aortic valve anatomy by computerized tomography (CT) may guide the selection of a suitable aortic valve prosthesis. This is a single center, prospective

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 51-year-old man with aortic valve prosthesis and dual-chamber pacemaker was admitted for evaluation of recurrent fever and chills. The level of C-reactive protein was elevated, and blood cultures were

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 40-year-old man was brought to our hospital because of resuscitated cardiac arrest. On the transthoracic echocardiography (TTE) an almost-complete dehiscence of a mechanical aortic valve that caused massive acute aortic

Radiofrequency (RF) catheter ablation of left-sided accessory pathways is really a great challenge in patients with prosthetic heart valves so that it is in general delayed or even avoided in such patients due to concerns of the higher perceived risks of mechanical complications and difficulty of

The color Doppler echocardiographic studies and aortic angiograms of all patients who had these procedures performed within 2 weeks of each other between October 1984 and August 1985 were reviewed to determine whether any parameters of the regurgitant jet visualized by color Doppler study predicted the severity of aortic insufficiency as assessed by angiographic grading. Patients with an aortic valve prosthesis were excluded. Twenty-nine patients had aortic insufficiency and had adequate color Doppler studies for analysis. The mean time between color Doppler examination and angiography was 2.3 days (range 0 to 12). The maximal length and area of the regurgitant jet were poorly predictive of the angiographic grade of aortic insufficiency. The short-axis area of the regurgitant jet from the parasternal short-axis view at the level of the high left ventricular outflow tract relative to the short-axis area of the left ventricular outflow tract at the same location best predicted angiographic grade, correctly classifying 23 of 24 patients. However, the jet could be seen from this view in only 24 of the 29 patients. The height of the regurgitant jet relative to left ventricular outflow tract height measured from the parasternal long-axis view just beneath the aortic valve correctly classified 23 of the 29 patients. Mitral stenosis or valve prosthesis, which was present in 10 patients, did not interfere with the diagnosis or quantitation of aortic insufficiency by these methods. The thickness of the regurgitant stream at its origin relative to the size of the left ventricular outflow tract is a better predictor of the severity of aortic insufficiency as judged by angiographic grading than is the area of the regurgitant jet or the depth to which the jet extends in the left ventricle.

BackgroundTranscatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients.ObjectivesThe NOTION (Nordic Aortic Valve Intervention Trial) randomized clinical trial compared TAVR with surgical aortic valve replacement (SAVR) in an all-comers patient cohort.MethodsPatients ≥70 years old with severe aortic valve stenosis and no significant coronary artery disease were randomized 1:1 to TAVR using a self-expanding bioprosthesis versus SAVR. The primary outcome was the composite rate of death from any cause, stroke, or myocardial infarction (MI) at 1 year.ResultsA total of 280 patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and 81.8% were considered low-risk patients. In the intention-to-treat population, no significant difference in the primary endpoint was found (13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in the as-treated population. No difference in the rate of cardiovascular death or prosthesis reintervention was found. Compared with SAVR-treated patients, TAVR-treated patients had more conduction abnormalities requiring pacemaker implantation, larger improvement in effective orifice area, more total aortic valve regurgitation, and higher New York Heart Association functional class at 1 year. SAVR-treated patients had more major or life-threatening bleeding, cardiogenic shock, acute kidney injury (stage II or III), and new-onset or worsening atrial fibrillation at 30 days than did TAVR-treated patients.ConclusionsIn the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve Intervention Trial [NOTION]; NCT01057173)

Two patients underwent aortic valve replacement with a porcine bioprosthesis. A few weeks later, both developed severe hemolytic anemia that could not be controlled medically and led to additional valve replacement. In each case, perforation of the bioprosthetic cusps was detected. This type of lesion was probably responsible for this unusual complication in patients with an aortic bioprosthesis.