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Cerebral embolism following transcatheter aortic valve implantation: comparison of transfemoral and transapical approaches.

https://arctichealth.org/en/permalink/ahliterature138367
Source
J Am Coll Cardiol. 2011 Jan 4;57(1):18-28
Publication Type
Article
Date
Jan-4-2011
Author
Josep Rodés-Cabau
Eric Dumont
Robert H Boone
Eric Larose
Rodrigo Bagur
Ronen Gurvitch
Fernand Bédard
Daniel Doyle
Robert De Larochellière
Cleonie Jayasuria
Jacques Villeneuve
Alier Marrero
Mélanie Côté
Philippe Pibarot
John G Webb
Author Affiliation
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. josep.rodes@criucpq.ulaval.ca
Source
J Am Coll Cardiol. 2011 Jan 4;57(1):18-28
Date
Jan-4-2011
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Aorta, Thoracic
Aortic Valve Stenosis - diagnosis - surgery
British Columbia - epidemiology
Cardiac Catheterization - adverse effects
Diffusion Magnetic Resonance Imaging
Echocardiography, Transesophageal
Female
Femoral Artery
Follow-Up Studies
Heart Valve Prosthesis Implantation - adverse effects - methods
Humans
Incidence
Intracranial Embolism - diagnosis - epidemiology - etiology
Male
Prospective Studies
Quebec - epidemiology
Risk factors
Tomography, X-Ray Computed
Abstract
The objective of this study was to compare the incidence of cerebral embolism (CE) as evaluated by diffusion-weighted magnetic resonance imaging (DW-MRI) following transapical (TA) transcatheter aortic valve implantation (TAVI) versus transfemoral (TF) TAVI.
The TA-TAVI approach avoids both the manipulation of large catheters in the aortic arch/ascending aorta and the retrograde crossing of the aortic valve, and this avoidance might lead to a lower rate of CE.
This was a prospective multicenter study including 60 patients who underwent cerebral DW-MRI the day before and within the 6 days following TAVI (TF approach: 29 patients; TA approach: 31 patients). Neurologic and cognitive function assessments were performed at DW-MRI time points.
The TAVI procedure was performed with the Edwards valve and was successful in all cases but one (98%). A total of 41 patients (68%) had 251 new cerebral ischemic lesions at the DW-MRI performed 4 ± 1 days after the procedure, 19 patients in the TF group (66%) and 22 patients in the TA group (71%; p = 0.78). Most patients (76%) with new ischemic lesions had multiple lesions (median number of lesions per patient: 3, range 1 to 31). There were no differences in lesion number and size between the TF and TA groups. No baseline or procedural factors were found to be predictors of new ischemic lesions. The occurrence of CE was not associated with a measurable impairment in cognitive function, but 2 patients (3.3%) had a clinically apparent stroke within the 24 h following the procedure (1 patient in each group).
TAVI is associated with a high rate of silent cerebral ischemic lesions as evaluated by DW-MRI, with no differences between the TF and TA approaches. These results provide important novel insight into the mechanisms of CE associated with TAVI and support the need for further research to both reduce the incidence of CE during these procedures and better determine their clinical relevance.
Notes
Comment In: Nat Rev Cardiol. 2011 Mar;8(3):12021475318
PubMed ID
21185496 View in PubMed
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First-in-man transfemoral transcatheter aortic valve replacement with the 29 mm Edwards SAPIEN XT valve.

https://arctichealth.org/en/permalink/ahliterature123007
Source
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):664-70
Publication Type
Article
Date
Oct-1-2013
Author
Melanie Freeman
Josep Rodés-Cabau
Marina Urena
Robert DeLarochelliere
Eric Dumont
Jean-Bernard Masson
Alexander B Willson
Ronald K Binder
Stefan Toggweiler
Jonathon Leipsic
David A Wood
John G Webb
Author Affiliation
Department of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Source
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):664-70
Date
Oct-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve - radiography - ultrasonography
Aortic Valve Stenosis - diagnosis - therapy
Bioprosthesis
Canada
Cardiac Catheterization - adverse effects - instrumentation
Cardiac Catheters
Echocardiography, Transesophageal
Equipment Design
Feasibility Studies
Femoral Artery
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation - methods
Humans
Male
Multidetector Computed Tomography
Patient Selection
Predictive value of tests
Prosthesis Design
Treatment Outcome
Abstract
To demonstrate the feasibility of transfemoral transcatheter aortic valve replacement (TAVR) with the 29 mm Edwards SAPIEN XT valve and Novaflex™ + delivery system through a 20F expandable sheath (eSheath™, Edwards Lifesciences, USA). In addition, to describe the use of the Novaflex + delivery system and expandable sheath.
TAVR has undergone significant advances in device technology resulting in smaller profile sheaths and delivery systems, allowing transfemoral delivery of a 29 mm valve.
Twelve patients underwent transfemoral TAVR with the 29 mm Edwards SAPIEN XT valve and Novaflex + delivery system through a 20F expandable sheath. Baseline clinical and procedural characteristics are evaluated. In-hospital and 30-day outcomes are reported according to Valve Academic Research Consortium criteria.
All patients were male with a mean aortic annulus diameter of 25.0 ± 1.1 mm and 25.9 ± 1.2 mm, on transesophageal echocardiography and multidetector computerized tomography, respectively. Mean iliofemoral minimal luminal diameter (MLD) was 8.0 ± 0.8 mm. Successful deployment of the valve occurred in 11 out of 12 patients. Valve embolization occurred in one patient. Aortic valve area increased from 0.7 ± 0.2 to 2.0 ± 0.5 cm(2) (P
Notes
Comment In: Catheter Cardiovasc Interv. 2013 Oct 1;82(4):671-224078425
PubMed ID
22744829 View in PubMed
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Multidetector CT predictors of prosthesis-patient mismatch in transcatheter aortic valve replacement.

https://arctichealth.org/en/permalink/ahliterature106547
Source
J Cardiovasc Comput Tomogr. 2013 Jul-Aug;7(4):248-55
Publication Type
Article
Author
Melanie Freeman
John G Webb
Alexander B Willson
Miriam Wheeler
Philipp Blanke
Robert R Moss
Christopher R Thompson
Brad Munt
Bjarne L Norgaard
Tae-Hyun Yang
James K Min
Steen Poulsen
Nicolaj C Hansson
Ronald K Binder
Stefan Toggweiler
Cameron Hague
David A Wood
Philippe Pibarot
Jonathon Leipsic
Author Affiliation
Divisions of Cardiology and Cardiac Imaging, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Source
J Cardiovasc Comput Tomogr. 2013 Jul-Aug;7(4):248-55
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve - radiography - ultrasonography
Aortic Valve Stenosis - radiography - therapy - ultrasonography
Area Under Curve
British Columbia
Cardiac Catheterization - adverse effects - instrumentation
Chi-Square Distribution
Denmark
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation - methods
Humans
Imaging, Three-Dimensional
Logistic Models
Male
Multidetector Computed Tomography
Odds Ratio
Predictive value of tests
Prosthesis Design
ROC Curve
Radiographic Image Interpretation, Computer-Assisted
Risk factors
Treatment Outcome
Abstract
Prosthesis-patient mismatch (PPM) is a predictor of mortality after aortic valve replacement (AVR).
We examined whether accurate 3-dimensional annular sizing with multidetector CT (MDCT) is predictive of PPM after transcatheter AVR (TAVR).
One hundred twenty-eight patients underwent MDCT then TAVR. Moderate PPM was defined as an indexed effective orifice area =0.85 cm²/m² and severe =0.65 cm²/m². MDCT annular measurements (area, short and long axis) were compared with the size of the selected transcatheter heart valve (THV) to obtain (1) the difference between prosthesis size and CT-measured mean annular diameter and (2) the percentage of undersizing or oversizing (calculated as 100 × [MDCT annular area--THV nominal area]/THV nominal area). In addition, the MDCT annular area was indexed to body surface area. These measures were evaluated as potential PPM predictors.
We found that 42.2% of patients had moderate PPM and 9.4% had severe PPM. Procedural characteristics and in-hospital outcomes were similar between patients with or without PPM. THV undersizing of the mean aortic annulus diameter was not predictive of PPM (odds ratio [OR], 0.84; 95% CI, 0.65-1.07; P = .16; area under the receiver-operating characteristic curve [AUC], 0.58). THV undersizing of annular area was not predictive of PPM (OR, 0.96; 95% CI, 0.80-1.16; P = .69; AUC, 0.52). Indexed MDCT annular area was, however, predictive of PPM (OR, 0.24; 95% CI, 0.10-0.59; P
PubMed ID
24148778 View in PubMed
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Multislice computed tomography for prediction of optimal angiographic deployment projections during transcatheter aortic valve implantation.

https://arctichealth.org/en/permalink/ahliterature139208
Source
JACC Cardiovasc Interv. 2010 Nov;3(11):1157-65
Publication Type
Article
Date
Nov-2010
Author
Ronen Gurvitch
David A Wood
Jonathon Leipsic
Edgar Tay
Mark Johnson
Jian Ye
Fabian Nietlispach
Namal Wijesinghe
Anson Cheung
John G Webb
Author Affiliation
St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
JACC Cardiovasc Interv. 2010 Nov;3(11):1157-65
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve Stenosis - radiography - therapy
British Columbia
Cardiac Catheterization - instrumentation
Chi-Square Distribution
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - instrumentation - methods
Humans
Male
Predictive value of tests
Radiographic Image Interpretation, Computer-Assisted
Tomography, X-Ray Computed
Treatment Outcome
Abstract
This study assessed whether multislice computed tomography (MSCT) could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI).
Accurate device positioning during TAVI depends on valve deployment in angiographic projections perpendicular to the native valve plane, but these may be difficult to determine.
Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple angiographic projections accurately representing the native valve plane in multiple axes were determined. The accuracy of all predicted projections was determined post-procedure using angiography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction.
Correct final deployment projections were more frequent in the MSCT-guided compared with non-MSCT-guided group: excellent or satisfactory projections (90% vs. 65%, p = 0.06). The MSCT angle prediction was accurate but dependent on optimal images (optimal images: 93% of predicted angles were excellent or satisfactory, suboptimal images: 73% of predicted angles were poor). A "line of perpendicularity" could be generated with optimal projections across the right-to-left anterior oblique plane by adding the correct cranial or caudal angulation.
Pre-procedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or "line of perpendicularity" can be generated. Understanding and applying these principles improves the accuracy of valve deployment and may improve outcomes.
PubMed ID
21087752 View in PubMed
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Outcome of patients after transcatheter aortic valve embolization.

https://arctichealth.org/en/permalink/ahliterature136732
Source
JACC Cardiovasc Interv. 2011 Feb;4(2):228-34
Publication Type
Article
Date
Feb-2011
Author
Edgar L W Tay
Ronen Gurvitch
Namal Wijeysinghe
Fabian Nietlispach
Jonathon Leipsic
David A Wood
Gerald Yong
Anson Cheung
Jian Ye
Samuel V Lichtenstein
Ronald Carere
Christopher Thompson
John G Webb
Author Affiliation
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
JACC Cardiovasc Interv. 2011 Feb;4(2):228-34
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve Stenosis - diagnosis - physiopathology - therapy
British Columbia
Cardiac Catheterization - adverse effects - instrumentation
Echocardiography
Electrocardiography
Embolism - diagnosis - etiology - physiopathology - therapy
Female
Foreign-Body Migration - diagnosis - etiology - physiopathology - therapy
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation
Hemodynamics
Humans
Male
Prospective Studies
Prosthesis Design
Radiography, Interventional
Severity of Illness Index
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Western Australia
Abstract
This study aims to assess the mid- to long-term follow-up of patients after valve embolization at the time of transcatheter aortic valve implantation (TAVI).
Transcatheter heart valve (THV) embolization is a rare but serious complication during TAVI. Although various techniques have been developed to manage acute complications and reduce periprocedural morbidity/mortality, long-term clinical and hemodynamic consequences after these events are unknown.
Patients who developed THV embolization after TAVI were prospectively assessed. Clinical and echocardiographic characteristics were recorded at baseline and after successful TAVI/surgical aortic valve replacement. The THV migration and strut fractures/degeneration were assessed by computed tomography.
A total of 7 patients had THV embolization, all of which occurred immediately after valve deployment. The embolized THV was repositioned in the aortic arch proximal to the left subclavian artery (n = 2), immediately distal to the left subclavian artery (n = 2), and in the abdominal aorta (n = 3). A second THV was implanted successfully at the same sitting in 4 patients and at the time of a second procedure in 2 patients. Elective conventional aortic valve replacement was performed in 1 patient. Median follow-up was 1,085 days. One patient died during follow-up from an unrelated cause. The remaining 6 survivors were in New York Heart Association functional class I or II at final follow-up. Mid-term computed tomography follow-up (n = 4,591 to 1,548 days) showed that the leaflets of the embolized THV remain open in all phases of the cardiac cycle. There was also no strut fracture or migration of these valves.
Clinical outcomes remain good when THV embolization is managed effectively. There are no apparent hemodynamic consequences of a second valve placed in the series. These embolized valves remain in a stable position with no evidence of strut fractures at mid-term follow-up.
PubMed ID
21349463 View in PubMed
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Structural integrity of balloon-expandable stents after transcatheter aortic valve replacement: assessment by multidetector computed tomography.

https://arctichealth.org/en/permalink/ahliterature124089
Source
JACC Cardiovasc Interv. 2012 May;5(5):525-32
Publication Type
Article
Date
May-2012
Author
Alexander B Willson
John G Webb
Ronen Gurvitch
David A Wood
Stefan Toggweiler
Ronald Binder
Melanie Freeman
Mark Madden
Cameron Hague
Jonathon Leipsic
Author Affiliation
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
JACC Cardiovasc Interv. 2012 May;5(5):525-32
Date
May-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Analysis of Variance
Aortic Valve Stenosis - therapy
British Columbia
Cardiac Catheterization - adverse effects - instrumentation
Echocardiography
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation
Humans
Male
Multidetector Computed Tomography
Predictive value of tests
Prosthesis Design
Prosthesis Failure
Stents
Time Factors
Treatment Outcome
Abstract
This study sought to evaluate the structural integrity of balloon-expandable stents used in transcatheter aortic valve replacement.
Underexpansion, deformation, or fracture of stent frames may affect transcatheter heart valve (THV) function and durability.
Patients >1 year after transcatheter aortic valve replacement underwent multidetector computed tomography. Geometry of the stent frame was assessed for circularity; eccentricity; minimum and maximum external diameter; and expansion at the inflow, mid-stent, and outflow levels, as well as for stent fracture. THV noncircularity was defined as stent eccentricity >10% (1 - minimum diameter/maximum diameter) and THV underexpansion when expansion
PubMed ID
22625191 View in PubMed
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Three-dimensional multidetector computed tomography versus conventional 2-dimensional transesophageal echocardiography for annular sizing in transcatheter aortic valve replacement: Influence on postprocedural paravalvular aortic regurgitation.

https://arctichealth.org/en/permalink/ahliterature272809
Source
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):977-86
Publication Type
Article
Date
Nov-15-2013
Author
Nicolaj C Hansson
Leif Thuesen
Vibeke E Hjortdal
Jonathon Leipsic
Henning R Andersen
Steen H Poulsen
John G Webb
Evald H Christiansen
Lars E Rasmussen
Lars R Krusell
Kim Terp
Kaj E Klaaborg
Mariann Tang
Jens F Lassen
Hans E Bøtker
Bjarne L Nørgaard
Source
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):977-86
Date
Nov-15-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve - radiography - ultrasonography
Aortic Valve Insufficiency - epidemiology - prevention & control
Aortic Valve Stenosis - radiography - therapy - ultrasonography
Cardiac Catheterization - adverse effects - instrumentation
Denmark - epidemiology
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation
Humans
Imaging, Three-Dimensional
Incidence
Male
Multidetector Computed Tomography
Predictive value of tests
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Treatment Outcome
Abstract
In transcatheter aortic valve replacement (TAVR), the influence of aortic annular assessment with either multidetector computed tomography (MDCT) or conventional transesophageal echocardiography (TEE) on the incidence of postprocedural paravalvular aortic regurgitation (PAR) was evaluated.
PAR remains a major limitation in TAVR. Appropriate selection of transcatheter heart valve (THV) size is crucial to prevent PAR.
Outcomes following TAVR with a balloon-expandable THV were compared in two retrospective cohorts identified according to whether THV size selection was based on TEE (study group 1, n = 80) or MDCT (study group 2, n = 58).
The two study groups were comparable with regard to baseline clinical, risk score, and echocardiographic characteristics. The incidence of moderate/severe PAR was lower in study group 2 than in group 1, 8.6% versus 28.8% (P
PubMed ID
23703899 View in PubMed
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Transcatheter aortic valve replacement with a new self-expanding transcatheter heart valve and motorized delivery system.

https://arctichealth.org/en/permalink/ahliterature115344
Source
JACC Cardiovasc Interv. 2013 Mar;6(3):301-7
Publication Type
Article
Date
Mar-2013
Author
Ronald K Binder
Ulrich Schäfer
Karl-Heinz Kuck
David A Wood
Robert Moss
Jonathon Leipsic
Stefan Toggweiler
Melanie Freeman
Avi J Ostry
Christian Frerker
Alexander B Willson
John G Webb
Author Affiliation
St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
JACC Cardiovasc Interv. 2013 Mar;6(3):301-7
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Valve Insufficiency - etiology
Aortic Valve Stenosis - diagnosis - physiopathology - therapy
Balloon Valvuloplasty
British Columbia
Cardiac Catheterization - adverse effects - instrumentation
Echocardiography, Transesophageal
Feasibility Studies
Female
Germany
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation - methods
Hemodynamics
Humans
Male
Multidetector Computed Tomography
Predictive value of tests
Prosthesis Design
Risk factors
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
The aim of this study was to demonstrate feasibility and short- and midterm clinical outcomes with a new self-expanding transcatheter heart valve and motorized delivery system.
Refining transcatheter aortic valve replacement with newly designed bioprostheses and delivery systems is anticipated to facilitate the procedure, reduce the risk of complications, improve outcomes, and widen applicability.
The CENTERA valve (Edwards Lifesciences, Irvine, California) was implanted in 15 patients with symptomatic severe aortic stenosis via femoral or axillary arterial percutaneous access. Patients underwent transesophageal echocardiography during and transthoracic echocardiography and multidetector computed tomography before and after valve implantation. Clinical and echocardiographic follow-up was obtained at 30 days and for the initial 10 patients after 1 year.
All 15 device implants were successful. Aortic valve area increased from 0.7 ± 0.1 cm(2) to 1.6 ± 0.4 cm(2) post-procedure (p
PubMed ID
23517843 View in PubMed
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Transcatheter aortic valve replacement with the SAPIEN 3: a new balloon-expandable transcatheter heart valve.

https://arctichealth.org/en/permalink/ahliterature115345
Source
JACC Cardiovasc Interv. 2013 Mar;6(3):293-300
Publication Type
Article
Date
Mar-2013
Author
Ronald K Binder
Josep Rodés-Cabau
David A Wood
Michael Mok
Jonathon Leipsic
Robert De Larochellière
Stefan Toggweiler
Eric Dumont
Melanie Freeman
Alexander B Willson
John G Webb
Author Affiliation
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
JACC Cardiovasc Interv. 2013 Mar;6(3):293-300
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Algorithms
Aortic Valve Insufficiency - etiology
Aortic Valve Stenosis - diagnosis - therapy
Balloon Valvuloplasty
British Columbia
Cardiac Catheterization - adverse effects - instrumentation
Echocardiography
Feasibility Studies
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects - instrumentation - methods
Humans
Male
Multidetector Computed Tomography
Predictive value of tests
Prosthesis Design
Quebec
Radiographic Image Interpretation, Computer-Assisted
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
The aim of this study was to demonstrate the first-in-human feasibility and short-term clinical outcomes with a new balloon-expandable transcatheter heart valve (THV).
The SAPIEN 3 (S3) THV incorporates a paravalvular sealing system, an active 3-dimensional coaxial positioning catheter, and is compatible with a 14-F expandable sheath.
The S3 THV was implanted in 15 patients with symptomatic severe aortic stenosis via femoral arterial access. Multidetector computed tomography before and after valve implantation allowed assessment of a novel annular area sizing algorithm. Clinical and echocardiographic data were obtained at baseline, discharge, and 30 days.
All 15 device implants were successful. Multidetector computed tomography estimated an aortic annular area of 4.9 ± 0.4 cm(2), predicting 9.7 ± 6.9% THV oversizing. Post-transcatheter aortic valve replacement multidetector computed tomography showed consistently symmetrical and circular THVs. Aortic valve area increased from 0.7 ± 0.2 cm(2) to 1.5 ± 0.2 cm(2) (p
PubMed ID
23517842 View in PubMed
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9 records – page 1 of 1.