Tri-leaflet Aortic Valve

Aortic Stenosis Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline Table AHA/ACC Stages of Valvular AS

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Table 9. Summary of Recommendations for AS: Timing of Intervention

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Figure 1. Indications for AVR in Patients with AS

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

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline Table AHA/ACC Stages of Chronic AR

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Table 12. Summary of Recommendations for AR Intervention

Nishimura, RA et al AHA/ACC Valvular Heart Disease Guideline Figure AHA/ACC Indications of AVR for Chronic AR

Case #1 u u 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. u u Aortic Root: Surgical Annulus2.1cm Sinus of Valsalva2.9cm STJ cm

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Case #1 u u Surgery placement #19 Medtronic supra-annular valve Mean Gradient 8.8mm Hg Peak Gradient 17mm Hg

Case #2 u u 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. u u Aortic Root: Surgical Annulus2.4cm Sinus of Valsalva3.2cm STJ2.6cm

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Case #2 Procedure: 1) 1) Pulmonary Vein Isolation Ganglionic Ablation Marshall Vein Ablation 2) 2) CABG x 1 LIMA to LAD 3) 3) AVR #25 Hancock II Bioprosthesis

IH 30 Case #7 Post Procedure Echo

Case #3 Aortic Root Valve Sparing Reconstruction u u 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. u u Trileaflet aortic root:Surgical Annulus 2.3cm Sinuses of Valsalva 5.3cm STJ 4.2cm Ascending Aorta 3.5cm

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Case #3 Aortic Root Valve Sparing Reconstruction u u 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