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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