Trileaflet Aortic Valve

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.

Severe Aortic Regurgitation

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

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.

Severe Aortic Stenosis

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 IsolationGanglionic 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 2.3cmSinuses of Valsalva 5.3cmSTJ 4.2cmAscending 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