Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease...
-
Upload
barnaby-miller -
Category
Documents
-
view
317 -
download
0
Transcript of Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease...
![Page 1: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/1.jpg)
Tri-leaflet Aortic Valve
![Page 2: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/2.jpg)
Aortic Stenosis
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
![Page 3: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/3.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
Table 8. 2014 AHA/ACC Stages of Valvular AS
![Page 4: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/4.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
2014 AHA/ACC
Table 9. Summary of Recommendations for AS: Timing of Intervention
![Page 5: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/5.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
2014 AHA/ACC
Figure 1. Indications for AVR in Patients with AS
![Page 6: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/6.jpg)
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
![Page 7: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/7.jpg)
Aortic Regurgitation
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
![Page 8: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/8.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
Table 11. 2014 AHA/ACC Stages of Chronic AR
![Page 9: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/9.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
2014 AHA/ACC
Table 12. Summary of Recommendations for AR Intervention
![Page 10: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/10.jpg)
Nishimura, RA et al.2014 AHA/ACC Valvular Heart Disease Guideline
Figure 2. 2014 AHA/ACC Indications of AVR for Chronic AR
![Page 11: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/11.jpg)
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
![Page 12: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/12.jpg)
LT 02
![Page 13: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/13.jpg)
LT 04
![Page 14: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/14.jpg)
LT 30
![Page 15: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/15.jpg)
Case #1
Surgery placement #19 Medtronic supra-annular valve
Mean Gradient 8.8mm Hg
Peak Gradient 17mm Hg
![Page 16: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/16.jpg)
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
![Page 17: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/17.jpg)
IH 01
![Page 18: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/18.jpg)
IH 02
![Page 19: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/19.jpg)
IH 03
![Page 20: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/20.jpg)
IH 09
![Page 21: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/21.jpg)
IH 12
![Page 22: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/22.jpg)
IH 14
![Page 23: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/23.jpg)
Case #2
Procedure: 1) Pulmonary Vein Isolation
Ganglionic AblationMarshall Vein Ablation
2) CABG x 1 LIMA to LAD
3) AVR #25 Hancock II Bioprosthesis
![Page 24: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/24.jpg)
IH 30
Case #7 Post Procedure Echo
![Page 25: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/25.jpg)
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
![Page 26: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/26.jpg)
JH 01
![Page 27: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/27.jpg)
JH 10
![Page 28: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/28.jpg)
JH 04
![Page 29: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/29.jpg)
JH 05
![Page 30: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/30.jpg)
JH 07
![Page 31: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/31.jpg)
JH 09
![Page 32: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/32.jpg)
JH 13
![Page 33: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/33.jpg)
JH 14
![Page 34: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/34.jpg)
![Page 35: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/35.jpg)
![Page 36: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/36.jpg)
Case #3Aortic Root Valve Sparing
Reconstruction Underwent valve sparing aortic root
reconstruction with #26 Dacron graft using Yacoub technique.
![Page 37: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/37.jpg)
JH 44
Case #8 Post Procedure Echo
![Page 38: Tri-leaflet Aortic Valve. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline.](https://reader036.fdocuments.us/reader036/viewer/2022081416/5697bfab1a28abf838c9b123/html5/thumbnails/38.jpg)
JH 45
Case #8 Post Procedure Echo