Unanticipated Mild-to-Moderate Aortic Stenosis During Coronary Artery Bypass Graft Surgery: Scope of the Problem and Its Echocardiographic Evaluation

Journal of Cardiothoracic and Vascular Anesthesia

Volumn 23, Issue 6, 2009, Pages 869-877

  Mahmood, Feroze ^a   Fritsch, Matthew ^a   Maslow, Andrew ^b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b UNIVERSITY OF RHODE ISLAND   (United States)

Author keywords

continuity equation; coronary artery bypass graft surgery; Gorlin equation; mild to moderate aortic stenosis; planimetry; pressure recovery

Indexed keywords

AORTA STENOSIS; AORTA VALVE; CORONARY ARTERY BYPASS GRAFT; DECISION MAKING; DISEASE SEVERITY; DOPPLER ECHOCARDIOGRAPHY; ECHOCARDIOGRAPHY; EVALUATION; HUMAN; INCIDENCE; MEASUREMENT; PEROPERATIVE ECHOGRAPHY; PRESSURE GRADIENT; PREVALENCE; PRIORITY JOURNAL; REVIEW;

ALGORITHMS; AORTIC VALVE; AORTIC VALVE STENOSIS; CORONARY ARTERY BYPASS; ECHOCARDIOGRAPHY, DOPPLER; HUMANS; MONITORING, INTRAOPERATIVE;

EID: 70450233630     PISSN: 10530770     EISSN: None     Source Type: Journal    
DOI: 10.1053/j.jvca.2009.03.018     Document Type: Review

References (96)

1. Pohle K., Otte M., Maffert R., et al. Association of cardiovascular risk factors to aortic valve calcification as quantified by electron beam computed tomography. Mayo Clin Proc 79 (2004) 1242-1246
2. Stewart B.F., Siscovick D., Lind B.K., et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 29 (1997) 630-634
3. Lindroos M., Kupari M., Heikkila J., et al. Prevalence of aortic valve abnormalities in the elderly: An echocardiographic study of a random population sample. J Am Coll Cardiol 21 (1993) 1220-1225
4. Cosmi J.E., Kort S., Tunick P.A., et al. The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening. Arch Intern Med 162 (2002) 2345-2347
5. Otto C.M., Lind B.K., Kitzman D.W., et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341 (1999) 142-147
6. Karagounis A., Valencia O., Chandrasekaran V., et al. Management of patients undergoing coronary artery bypass graft surgery with mild to moderate aortic stenosis. J Heart Valve Dis 13 (2004) 369-373
7. Horstkotte D., and Loogen F. The natural history of aortic valve stenosis. Eur Heart J 9 suppl E (1988) 57-64
8. Otto C.M., Burwash I.G., Legget M.E., et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 95 (1997) 2262-2270
9. Rosenhek R., Klaar U., Schemper M., et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J 25 (2004) 199-205
10. Rosenhek R., Binder T., Porenta G., et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 343 (2000) 611-617
11. Otto C.M. Aortic stenosis. Clinical evaluation and optimal timing of surgery. Cardiol Clin 16 (1988) 353-373
12. Pereira J.J., Balaban K., Lauer M.S., et al. Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery. Am J Med 118 (2005) 735-742
13. Tam J.W., Masters R.G., Burwash I.G., et al. Management of patients with mild aortic stenosis undergoing coronary artery bypass grafting. Ann Thorac Surg 65 (1998) 1215-1219
14. Ha J.W., Choi S.H., Chang B.C., et al. Is prophylactic aortic valve replacement indicated during mitral valve surgery for mild to moderate aortic valve disease?. Ann Thorac Surg 74 (2002) 1115-1119
15. Alexander K.P., Anstrom K.J., Muhlbaier L.H., et al. Outcomes of cardiac surgery in patients > or = 80 years: Results from the National Cardiovascular Network. J Am Coll Cardiol 35 (2000) 731-738
16. Ferguson Jr. T.B., Hammill B.G., Peterson E.D., et al. A decade of change-Risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: A report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg 73 (2002) 480-489
17. Cohn L.H., Collins Jr. J.J., Rizzo R.J., et al. Twenty-year follow-up of the Hancock modified orifice porcine aortic valve. Ann Thorac Surg 66 (1998) S30-S34
18. Davis K.B., Chaitman B., Ryan T., et al. Comparison of 15-year survival for men and women after initial medical or surgical treatment for coronary artery disease: A CASS registry study. Coronary Artery Surgery Study. J Am Coll Cardiol 25 (1995) 1000-1009
19. Rahimtoola S.H., Bennett A.J., Grunkemeier G.L., et al. Survival at 15 to 18 years after coronary bypass surgery for angina in women. Circulation 88 (1993) II71-II78
20. Peterseim D.S., Cen Y.Y., Cheruvu S., et al. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. J Thorac Cardiovasc Surg 117 (1999) 890-897
21. Rahimtoola S.H. Should patients with asymptomatic mild or moderate aortic stenosis undergoing coronary artery bypass surgery also have valve replacement for their aortic stenosis?. Heart 85 (2001) 337-341
22. Palta S., Pai A.M., Gill K.S., et al. New insights into the progression of aortic stenosis: Implications for secondary prevention. Circulation 101 (2000) 2497-2502
23. Daniel W.G., Pearlman A.S., Hausmann D., et al. Initial experience and potential applications of multiplane transesophageal echocardiography. Am J Cardiol 71 (1993) 358-361
24. Hoffmann R., Flachskampf F.A., and Hanrath P. Planimetry of orifice area in aortic stenosis using multiplane transesophageal echocardiography. J Am Coll Cardiol 22 (1993) 529-534
25. Tribouilloy C., Shen W.F., Peltier M., et al. Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: Comparison with monoplane transesophageal approach. Am Heart J 128 (1994) 526-532
26. Hofmann T., Kasper W., Meinertz T., et al. Determination of aortic valve orifice area in aortic valve stenosis by two-dimensional transesophageal echocardiography. Am J Cardiol 59 (1987) 330-335
27. Stoddard M.F., Arce J., Liddell N.E., et al. Two-dimensional transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis. Am Heart J 122 (1991) 1415-1422
28. Bernard Y., Meneveau N., Vuillemenot A., et al. Planimetry of aortic valve area using multiplane transoesophageal echocardiography is not a reliable method for assessing severity of aortic stenosis. Heart 78 (1997) 68-73
29. Cormier B., Iung B., Porte J.M., et al. Value of multiplane transesophageal echocardiography in determining aortic valve area in aortic stenosis. Am J Cardiol 77 (1996) 882-885
30. Arsenault M., Masani N., Magni G., et al. Variation of anatomic valve area during ejection in patients with valvular aortic stenosis evaluated by two-dimensional echocardiographic planimetry: Comparison with traditional Doppler data. J Am Coll Cardiol 32 (1998) 1931-1937
31. Baumgartner H. Hemodynamic assessment of aortic stenosis: Are there still lessons to learn?. J Am Coll Cardiol 47 (2006) 138-140
32. Kadem L., Rieu R., Dumesnil J.G., et al. Flow-dependent changes in Doppler-derived aortic valve effective orifice area are real and not due to artifact. J Am Coll Cardiol 47 (2006) 131-137
33. Badano L., Cassottano P., Bertoli D., et al. Changes in effective aortic valve area during ejection in adults with aortic stenosis. Am J Cardiol 78 (1996) 1023-1028
34. Bermejo J., Garcia-Fernandez M.A., Torrecilla E.G., et al. Effects of dobutamine on Doppler echocardiographic indexes of aortic stenosis. J Am Coll Cardiol 28 (1996) 1206-1213
35. Kim C.J., Berglund H., Nishioka T., et al. Correspondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization. Am Heart J 132 (1996) 1163-1172
36. Tardif J.C., Miller D.S., Pandian N.G., et al. Effects of variations in flow on aortic valve area in aortic stenosis based on in vivo planimetry of aortic valve area by multiplane transesophageal echocardiography. Am J Cardiol 76 (1995) 193-198
37. Tardif J.C., Rodrigues A.G., Hardy J.F., et al. Simultaneous determination of aortic valve area by the Gorlin formula and by transesophageal echocardiography under different transvalvular flow conditions. Evidence that anatomic aortic valve area does not change with variations in flow in aortic stenosis. J Am Coll Cardiol 29 (1997) 1296-1302
38. Shively B.K., Charlton G.A., Crawford M.H., et al. Flow dependence of valve area in aortic stenosis: relation to valve morphology. J Am Coll Cardiol 31 (1998) 654-660
39. Garcia D., and Kadem L. What do you mean by aortic valve area: Geometric orifice area, effective orifice area, or Gorlin area?. J Heart Valve Dis 15 (2006) 601-608
40. Garcia D., Pibarot P., Landry C., et al. Estimation of aortic valve effective orifice area by Doppler echocardiography: Effects of valve inflow shape and flow rate. J Am Soc Echocardiogr 17 (2004) 756-765
41. Gilon D., Cape E.G., Handschumacher M.D., et al. Effect of three-dimensional valve shape on the hemodynamics of aortic stenosis: Three-dimensional echocardiographic stereolithography and patient studies. J Am Coll Cardiol 40 (2002) 1479-1486
42. Blumberg F.C., Pfeifer M., Holmer S.R., et al. Transgastric Doppler echocardiographic assessment of the severity of aortic stenosis using multiplane transesophageal echocardiography. Am J Cardiol 79 (1997) 1273-1275
43. Blumberg F.C., Pfeifer M., Holmer S.R., et al. Quantification of aortic stenosis in mechanically ventilated patients using multiplane transesophageal Doppler echocardiography. Chest 114 (1998) 94-97
44. Stoddard M.F., Hammons R.T., and Longaker R.A. Doppler transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis. Am Heart J 132 (1996) 337-342
45. Currie P.J., Hagler D.J., Seward J.B., et al. Instantaneous pressure gradient: A simultaneous Doppler and dual catheter correlative study. J Am Coll Cardiol 7 (1986) 800-806
46. Currie P.J., Seward J.B., Reeder G.S., et al. Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: A simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation 71 (1985) 1162-1169
47. Hatle L., Brubakk A., Tromsdal A., et al. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 40 (1978) 131-140
48. Simpson I.A., Houston A.B., Sheldon C.D., et al. Clinical value of Doppler echocardiography in the assessment of adults with aortic stenosis. Br Heart J 53 (1985) 636-639
49. Smith M.D., Dawson P.L., Elion J.L., et al. Correlation of continuous wave Doppler velocities with cardiac catheterization gradients: An experimental model of aortic stenosis. J Am Coll Cardiol 6 (1985) 1306-1314
50. Yoganathan A.P., Valdes-Cruz L.M., Schmidt-Dohna J., et al. Continuous-wave Doppler velocities and gradients across fixed tunnel obstructions: Studies in vitro and in vivo. Circulation 76 (1987) 657-666
51. Burwash I.G., Forbes A.D., Sadahiro M., et al. Echocardiographic volume flow and stenosis severity measures with changing flow rate in aortic stenosis. Am J Physiol 265 (1993) H1734-H1743
52. Otto C.M., Pearlman A.S., Comess K.A., et al. Determination of the stenotic aortic valve area in adults using Doppler echocardiography. J Am Coll Cardiol 7 (1986) 509-517
53. Otto C.M., Davis K.B., Holmes Jr. D.R., et al. Methodologic issues in clinical evaluation of stenosis severity in adults undergoing aortic or mitral balloon valvuloplasty. The NHLBI Balloon Valvuloplasty Registry. Am J Cardiol 69 (1992) 1607-1616
54. Otto C.M., and Pearlman A.S. Doppler echocardiography in adults with symptomatic aortic stenosis. Diagnostic utility and cost-effectiveness. Arch Intern Med 148 (1988) 2553-2560
55. Clark C. The fluid mechanics of aortic stenosis-II. Unsteady flow experiments. J Biomech 9 (1976) 567-573
56. Clark C. Energy losses in flow through stenosed valves. J Biomech 12 (1979) 737-746
57. Levine R.A., Cape E.G., and Yoganathan A.P. Pressure recovery distal to stenoses: Expanding clinical applications of engineering principles. J Am Coll Cardiol 21 (1993) 1026-1028
58. Bartunek J., De Bacquer D., Rodrigues A.C., et al. Accuracy of aortic stenosis severity assessment by Doppler echocardiography: Importance of image quality. Int J Card Imaging 11 (1995) 97-104
59. Garcia D., Dumesnil J.G., Durand L.G., et al. Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: Practical implications with regard to quantification of aortic stenosis severity. J Am Coll Cardiol 41 (2003) 435-442
60. Niederberger J., Schima H., Maurer G., et al. Importance of pressure recovery for the assessment of aortic stenosis by Doppler ultrasound. Role of aortic size, aortic valve area, and direction of the stenotic jet in vitro. Circulation 94 (1996) 1934-1940
61. Baumgartner H., Stefenelli T., Niederberger J., et al. "Overestimation" of catheter gradients by Doppler ultrasound in patients with aortic stenosis: A predictable manifestation of pressure recovery. J Am Coll Cardiol 33 (1999) 1655-1661
62. Schobel W.A., Voelker W., Haase K.K., et al. Extent, determinants and clinical importance of pressure recovery in patients with aortic valve stenosis. Eur Heart J 20 (1999) 1355-1363
63. Laskey W.K., and Kussmaul W.G. Pressure recovery in aortic valve stenosis. Circulation 89 (1994) 116-121
64. Voelker W., Reul H., Stelzer T., et al. Pressure recovery in aortic stenosis: An in vitro study in a pulsatile flow model. J Am Coll Cardiol 20 (1992) 1585-1593
65. Baumgartner H., Schima H., Tulzer G., et al. Effect of stenosis geometry on the Doppler-catheter gradient relation in vitro: A manifestation of pressure recovery. J Am Coll Cardiol 21 (1993) 1018-1025
66. Isaaz K., Gaillard O., Cerisier A., et al. How important is the impact of pressure recovery on routine evaluation of aortic stenosis?. A clinical study in 91 patients. J Heart Valve Dis 13 (2004) 347-356
67. VanAuker M.D., Hla A., Meisner J.S., and Strom J.A. Simultaneous Doppler/catheter measurements of pressure gradients in aortic valve disease: A correction to the Bernoulli equation based on velocity decay in the stenotic jet. J Heart Valve Dis 9 (2000) 291-298
68. Shavelle S.M., and Otto C.M. Aortic Stenosis: Echocardiographic Evaluation of Disease Severity, Disease Progression, and the Role of Echcocardiography in Clinical Decision Making. ed 2. (2002), Saunders, Philadelphia, PA
69. Dumesnil J.G., and Yoganathan A.P. Theoretical and practical differences between the Gorlin formula and the continuity equation for calculating aortic and mitral valve areas. Am J Cardiol 67 (1991) 1268-1272
70. Skjaerpe T., Hegrenaes L., and Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 72 (1985) 810-818
71. Teirstein P., Yeager M., Yock P.G., et al. Doppler echocardiographic measurement of aortic valve area in aortic stenosis: A noninvasive application of the Gorlin formula. J Am Coll Cardiol 8 (1986) 1059-1065
72. Zoghbi W.A., Farmer K.L., Soto J.G., et al. Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography. Circulation 73 (1986) 452-459
73. Carabello B.A. Advances in the hemodynamic assessment of stenotic cardiac valves. J Am Coll Cardiol 10 (1987) 912-919
74. Gorlin R., and Gorlin S.G. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J 41 (1951) 1-29
75. Burwash I.G., Thomas D.D., Sadahiro M., et al. Dependence of Gorlin formula and continuity equation valve areas on transvalvular volume flow rate in valvular aortic stenosis. Circulation 89 (1994) 827-835
76. Otto C.M., Pearlman A.S., Gardner C.L., et al. Experimental validation of Doppler echocardiographic measurement of volume flow through the stenotic aortic valve. Circulation 78 (1988) 435-441
77. Levine R.A., and Schwammenthal E. Stenosis is in the eye of the observer: Impact of pressure recovery on assessing aortic valve area. J Am Coll Cardiol 41 (2003) 443-445
78. Garcia D., Pibarot P., Dumesnil J.G., et al. Assessment of aortic valve stenosis severity: A new index based on the energy loss concept. Circulation 101 (2000) 765-771
79. Kume T., Okura H., Kawamoto T., et al. Clinical implication of energy loss coefficient in patients with severe aortic stenosis diagnosed by Doppler echocardiography. Circ J 72 (2008) 1265-1269
80. Chambers J., Bach D., Dumesnil J., et al. Crossing the aortic valve in severe aortic stenosis: No longer acceptable?. J Heart Valve Dis 13 (2004) 344-346
81. Burwash I.G., Dickinson A., Teskey R.J., et al. Aortic valve area discrepancy by Gorlin equation and Doppler echocardiography continuity equation: Relationship to flow in patients with valvular aortic stenosis. Can J Cardiol 16 (2000) 985-992
82. Anderson F.L., Tsagaris T.J., Tikoff G., et al. Hemodynamic effects of exercise in patients with aortic stenosis. Am J Med 46 (1969) 872-885
83. Bache R.J., Wang Y., and Jorgensen C.R. Hemodynamic effects of exercise in isolated valvular aortic stenosis. Circulation 44 (1971) 1003-1013
84. Casale P.N., Palacios I.F., Abascal V.M., et al. Effects of dobutamine on Gorlin and continuity equation valve areas and valve resistance in valvular aortic stenosis. Am J Cardiol 70 (1992) 1175-1179
85. Endrys J., Yousof A.M., and Stransky P. Assessment of the severity of aortic stenosis: Comparison of gradient and valve area. Pediatr Cardiol 6 (1986) 263-267
86. Cannon S.R., Richards K.L., and Crawford M. Hydraulic estimation of stenotic orifice area: A correction of the Gorlin formula. Circulation 71 (1985) 1170-1178
87. Segal J., Lerner D.J., Miller D.C., et al. When should Doppler-determined valve area be better than the Gorlin formula?: Variation in hydraulic constants in low flow states. J Am Coll Cardiol 9 (1987) 1294-1305
88. Sprigings D.C., Chambers J.B., Cochrane T., et al. Ventricular stroke work loss: Validation of a method of quantifying the severity of aortic stenosis and derivation of an orifice formula. J Am Coll Cardiol 16 (1990) 1608-1614
89. Chambers J.B., Sprigings D.C., Cochrane T., et al. Continuity equation and Gorlin formula compared with directly observed orifice area in native and prosthetic aortic valves. Br Heart J 67 (1992) 193-199
90. Danielsen R., Nordrehaug J.E., and Vik-Mo H. Factors affecting Doppler echocardiographic valve area assessment in aortic stenosis. Am J Cardiol 63 (1989) 1107-1111
91. Oh J.K., Taliercio C.P., Holmes Jr. D.R., et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: Prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol 11 (1988) 1227-1234
92. Bonow R.O., Carabello B., de Leon A.C., et al. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis 7 (1998) 672-707
93. Bonow R.O., Carabello B.A., Chatterjee K., et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease). Circulation 118 (2008) 523-551
94. Bonow R.O., Carabello B.A., Kanu C., et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Developed in collaboration with the Society of Cardiovascular Anesthesiologists: Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114 (2006) e84-e231
95. de la Fuente Galan L., San Roman Calvar J.A., Munoz San Jose J.C., et al. [Influence of the degree of aortic valve calcification on the estimate of valvular area using planimetry with transesophageal echocardiography]. Rev Esp Cardiol 49 (1996) 663-668
96. Maslow A.D., Mahmood F., Poppas A., et al. Intraoperative dobutamine stress echocardiography to assess aortic valve stenosis. J Cardiothorac Vasc Anesth 20 (2006) 862-866