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Thomas F. Lüscher
Bernard J. Gersh
(A) Normal tricuspid valve. (B) Functional tricuspid regurgitation: enlargement of the right ventricle results in displacement of the papillary muscles and tethering of the tricuspid leaflets. In addition there is dilatation of the tricuspid annulus.
Infective endocarditis in adults with congenital heart disease: Is it time to change our approach to prophylaxis based on new insights into risk prediction?
Eur. Heart J. (2011), 32 (15), 1835-1837; 10.1093/eurheartj/ehr037 - Click here to view abstract
Endocarditis in congenital heart disease. Left upper panel: schematic drawing of unrepaired tetralogy of Fallot. Right upper panel: repaired tetralogy with a VSD patch and transannular RVOT patch resulting in residual severe pulmonary regurgitation. Left lower panel: after reoperation with implantation of a homograft. Right lower panel: ultrasound image of a patient with repaired tetralogy and homograft endocarditis. The arrows indicate the vegetations on the homograft valve.
Ao, aorta; LV, left ventricle; PA, pulmonary artery; RV, right ventricle; RVOT, right ventricular outflow tract; VSD, ventricular septal defect.
Centre: severe calcific aortic stenosis causes pressure overload followed by left ventricular hypertrophy, collagen deposition, relative ischaemia, and diastolic dysfunction with pulmonary congestion. Left top: transfemoral TAVI with implantation of the Edwards Sapien prosthesis. Left bottom: transapical TAVI with implantation of the Edwards Sapien prosthesis. Right top: transfemoral TAVI with implantation of the Medtronic CoreValve prosthesis. Right bottom: transsubclavian TAVI with implantation of the Medtronic CoreValve prosthesis.
This conceptual framework for the natural history of calcific aortic valve disease illustrates the spectrum of disease from the 'at risk' patient to the patient with end-stage severe symptomatic aortic stenosis. Once aortic sclerosis is detectable, there is an increased risk of cardiovascular events, as shown by deviation of the survival curve (purple line) from the expected event-free survival (light blue line). At the onset of even mild symptoms, survival deviates even more from expected, with a dramatic decline in survival with severe symptomatic aortic stenosis. Aortic valve replacement (AVR) at the onset of early symptoms prevents these late adverse outcomes.
Fluid shear stress, the arterial modelling force! But how does it work?
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