Download Aortic Valve

Trileaflet Aortic Valve
Severe Aortic Regurgitation
Management strategy for patients with chronic severe aortic regurgitation. Preoperative coronary angiography should be
performed routinely as determined by age, symptoms, and coronary risk factors. Cardiac catheterization and angiography
may also be helpful when there is discordance between clinical findings and echocardiography. “Stable” refers to stable
echocardigraphic measurements. In some centers, serial follow-up may be performed with radionuclide ventriculography
(RVG) or magnetic resonance imaging (MRI) rather than echocardiography (Echo) to assess left ventricular (LV) volume
and systolic function. AVR indicates aortic valve replacement; DD, end-diastolic dimension; EF, ejection fraction; eval,
evaluation; and SD, end-systolic dimension.
Case #1

78 year old woman admitted to hospital in
heart failure. Found to have trileaflet Aortic
valve with severe aortic insufficiency and
reduced LV function. EF 20-25%.
Aortic Valve gradient mean 5.2 mmHg.

Aortic Root: Surgical Annulus 2.1cm
Sinus of Valsalva 2.9cm
STJ
1.8-2.0cm
LT 02
LT 04
LT 30
Case #1

Surgery placement #19 Medtronic
supra-annular valve
Mean Gradient 8.8mm Hg
Peak Gradient 17mm Hg
Severe Aortic Stenosis
Management strategy for patients with severe aortic stenosis. Preoperative coronary angiography should be
performed routinely as determined by age, symptoms, and coronary risk factors. Cardiac cathereterization
and angiography may also be helpful when there is discordance between clinical findings and
echocardiography, Modified from CM Otto. Valvular aortic stenosis; disease severity and timing of
intervention. J Am Coll Cardiol 2006;47:2141-51(149). AVA indicate aortic valve area; BP, blood pressure;
CABG, coronary artery bypass graft surgery; echo, echocardiography; LV, left ventricular; and Vmax,
maximal velocity across aortic valve by Doppler echocardiography.
Case #2

83 y/o male with know aortic stenosis progressed in
symptoms with SOB and fatigue. In past had stent
to LAD. More recently angina with exertion, LAD
now with 70% in stent stenosis. Periods of rapid
atrial fibrillation.
Dynamic LV function recently as low as 30%.
Aortic valve gradient mean 37mmHg,
peak 70mmHg.

Aortic Root: Surgical Annulus
Sinus of Valsalva
STJ
2.6cm
2.4cm
3.2cm
IH 01
IH 02
IH 03
IH 09
IH 12
IH 14
Case #2
Procedure:
1) Pulmonary Vein Isolation
Ganglionic Ablation
Marshall Vein Ablation
2) CABG x 1 LIMA to LAD
3) AVR #25 Hancock II Bioprosthesis
Case #7 Post Procedure Echo
IH 30
Case #3
Aortic Root Valve Sparing
Reconstruction


53 year old man with elevated cholesterol underwent
Cardiac CT for coronary calcium scoring.
Found to have dilated aortic root.
Trivial to mild aortic insufficiency.
Coronaries clear on cath.
Trileaflet aortic root:
Surgical Annulus
2.3cm
Sinuses of Valsalva 5.3cm
STJ 4.2cm
Ascending Aorta
3.5cm
JH 01
JH 10
JH 04
JH 05
JH 07
JH 09
JH 13
JH 14
Case #3
Aortic Root Valve Sparing
Reconstruction

Underwent valve sparing aortic root
reconstruction with #26 Dacron graft
using Yacoub technique.
Case #8 Post Procedure Echo
JH 44
Case #8 Post Procedure Echo
JH 45