tri-leaflet aortic valve. aortic stenosis nishimura, ra et al. 2014 aha/acc valvular heart disease...

Tri-leaflet Aortic Valve

Aortic Stenosis

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

Table 8. 2014 AHA/ACC Stages of Valvular AS

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

2014 AHA/ACC

Table 9. Summary of Recommendations for AS: Timing of Intervention

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

2014 AHA/ACC

Figure 1. Indications for AVR in Patients with AS

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

2014 AHA/ACC

Table 10. Summary of Recommendations for AS: Choice of Surgical or Transcatheter Intervention

Aortic Regurgitation

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

Table 11. 2014 AHA/ACC Stages of Chronic AR

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

2014 AHA/ACC

Table 12. Summary of Recommendations for AR Intervention

Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline

Figure 2. 2014 AHA/ACC Indications of AVR for Chronic AR

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 2.1cmSinus of Valsalva 2.9cmSTJ 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

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 2.4cmSinus of Valsalva 3.2cmSTJ 2.6cm

IH 01

IH 02

IH 03

IH 09

IH 12

IH 14

Case #2

Procedure: 1) Pulmonary Vein Isolation

Ganglionic AblationMarshall Vein Ablation

2) CABG x 1 LIMA to LAD

3) AVR #25 Hancock II Bioprosthesis

IH 30

Case #7 Post Procedure Echo

Case #3Aortic 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 #3Aortic Root Valve Sparing

Reconstruction Underwent valve sparing aortic root

reconstruction with #26 Dacron graft using Yacoub technique.

JH 44

Case #8 Post Procedure Echo

JH 45

Case #8 Post Procedure Echo