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Drug-induced aortic valve stenosis: An under recognized entity

Pierre-Vladimir Ennezat 1 Patrick Bruneval 2 Daniel Czitrom 3 Jean-Pierre Gueffet 4 Nicolas Piriou 5 Jean Noel Trochu Odile Patra Benedicte Blanchard-Lemoine Xavier Halna Fretay Pierre Nazeyrollas 6 Bernard Assoun Yannick Jobic 7 Eric Brochet 8 Emmanuel Bogino Raymond Roudaut 9 Caroline Augier 10 Lorraine Greffe Helene Petit-Eisenmann 11, 12, 13 Camille Dambrin 14 Olivier Chavanon 15 Louis Guillou 16 Dominique Grisoli 17 Pierre Morera Carlo Banfi 18 Jean Paul Remadi Olivier Fabre Andre Vincentelli 18 Sylvie Lantuejoul 19 Jean-Fortune Ikoli Marie-Christine Copin 18 Marie-Christine Malergue 20, 21, 22 Sylvestre Marechaux 23, 24 Christophe Tribouilloy 24
Abstract : Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS. Methods: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient > 15 mm Hg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria. Results: Twenty-five (19 females, mean age 62 years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32+/-13 mm Hg. Aortic regurgitation was >= mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis, aortic valvular endocardium was markedly thickened by dense non-inflammatory fibrosis, a characteristic feature of DI-VHD. Conclusion: The association between AS and typical mitral DI-VHD after valvulopathic drug exposure may not be fortuitous. Aortic regurgitation was usually associated to AS and preceded AS in most cases but may be lacking. Pathology demonstrated the potential role of valvulopathic drugs in the development of AS. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03580779
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Soumis le : vendredi 18 février 2022 - 17:19:14
Dernière modification le : mercredi 27 avril 2022 - 04:55:39

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Pierre-Vladimir Ennezat, Patrick Bruneval, Daniel Czitrom, Jean-Pierre Gueffet, Nicolas Piriou, et al.. Drug-induced aortic valve stenosis: An under recognized entity. INTERNATIONAL JOURNAL OF CARDIOLOGY, 2016, 220, pp.429-434. ⟨10.1016/j.ijcard.2016.06.112⟩. ⟨hal-03580779⟩

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