““For Every Good Idea”For Every Good Idea”

Valve ProsthesesValve Prostheses

Ideal Prosthesis: Not ThrombogenicIdeal Prosthesis: Not Thrombogenic

DurableDurable

Resistant to Resistant to infectioninfection

Mimics Normal FlowMimics Normal Flow

Ease of insertion/ Ease of insertion/ availableavailable

Valve ProsthesesValve Prostheses

Biologic: Less DurableBiologic: Less Durable

Less ThrombogenicLess Thrombogenic

More Resistant to InfectionMore Resistant to Infection

Mechanical: More DurableMechanical: More Durable

Requires Anticoagulation/ Requires Anticoagulation/ CoumadinCoumadin

Valve SurgeryValve Surgery

Aortic StenosisAortic Stenosis Aortic InsufficiencyAortic Insufficiency Mitral StenosisMitral Stenosis Mitral InsufficiencyMitral Insufficiency

Aortic StenosisAortic Stenosis

Acquired Calcific- Senile Acquired Calcific- Senile DegenerationDegeneration

Congenital- Bicuspid ValveCongenital- Bicuspid Valve Rheumatic Valvular DiseaseRheumatic Valvular Disease

Aortic StenosisAortic Stenosis

Aortic Valve Area 2.5 -3.5 cmAortic Valve Area 2.5 -3.5 cm

Mild 1.5 -2.0 cmMild 1.5 -2.0 cm

Moderate 1.0 -1.5 cmModerate 1.0 -1.5 cm

Severe < 1.0 cmSevere < 1.0 cm

Aortic StenosisAortic Stenosis

Symptoms: Angina-Chest PainSymptoms: Angina-Chest Pain SyncopeSyncope CHF/ SOBCHF/ SOB

Exam: Systolic MurmurExam: Systolic Murmur Harsh Crescendo-decrescendoHarsh Crescendo-decrescendo Pulsus Parvus et TardusPulsus Parvus et Tardus

Surgery Indications: SymptomsSurgery Indications: Symptoms AVA < 1.0 cmAVA < 1.0 cm mpg >50 mmHgmpg >50 mmHg

Aortic Aortic InsufficiencyInsufficiency

Annulo-Aortic EctasiaAnnulo-Aortic EctasiaConnective Tissue Disorders:Connective Tissue Disorders: Marfan’s SyndromeMarfan’s Syndrome Ehlers -Danlos SyndromeEhlers -Danlos SyndromeRheumatic ValvulitisRheumatic ValvulitisEndocarditisEndocarditisSyphillisSyphillisTraumaTraumaAortic DissectionAortic Dissection

Aortic InsuffficiencyAortic InsuffficiencySymptoms : SOB/ DOESymptoms : SOB/ DOE

AnginaAngina

Exam: Diastolic MurmurExam: Diastolic Murmur

Widened Pulse Pressure (Corrigan’s)Widened Pulse Pressure (Corrigan’s)

Surgery Indications: NYHA III-IVSurgery Indications: NYHA III-IV

Rule of “50’s”Rule of “50’s” C/T ratio > 50%C/T ratio > 50%

EF < 50%EF < 50%

ESD > 50mmESD > 50mm

Mitral StenosisMitral Stenosis

Rheumatic ValvulitisRheumatic Valvulitis CongenitalCongenital Mitral Annular CalcificationMitral Annular Calcification Systemic Lupus ErythematosusSystemic Lupus Erythematosus MyxomaMyxoma

Mitral StenosisMitral Stenosis

Symptoms: SOB/ DOESymptoms: SOB/ DOE Cough- HemoptysisCough- Hemoptysis Orthopnea- PNDOrthopnea- PND EmboliEmboli

Exam: Diastolic Murmur-RumbleExam: Diastolic Murmur-Rumble Opening SnapOpening Snap Increased First Heart SoundIncreased First Heart Sound

Mitral StenosisMitral Stenosis

Normal Mitral Valve Area 4- 6 cmNormal Mitral Valve Area 4- 6 cm

Mild: > 2.0cm < 5 mmHgMild: > 2.0cm < 5 mmHg Moderate: 1.0- 2.0 cm 5-10 mmhgModerate: 1.0- 2.0 cm 5-10 mmhg Severe: < 1.0 cm > 10mmhgSevere: < 1.0 cm > 10mmhg

Indications for Surgery: NYHA III-IVIndications for Surgery: NYHA III-IV Atrial FibrillationAtrial Fibrillation

Mitral InsufficiencyMitral Insufficiency

Myxomatous DegenerationMyxomatous Degeneration

Barlow’s SyndromeBarlow’s Syndrome

Mitral Valve Prolapse (4-5%)Mitral Valve Prolapse (4-5%)

Rheumatic Heart DiseaseRheumatic Heart Disease

EndocarditisEndocarditis

Coronary Ischemia-InfarctionCoronary Ischemia-Infarction

Mitral InsufficiencyMitral Insufficiency

Symptoms: DOE/ SOBSymptoms: DOE/ SOB Fatigue PalpitationsFatigue Palpitations

Exam: Apical holo-systolic murmurExam: Apical holo-systolic murmur Diastolic flow murmurDiastolic flow murmur

Indications for Surgery: NYHA III-IVIndications for Surgery: NYHA III-IV NYHA I-IINYHA I-II

Aortic DissectionAortic Dissection

Debakey ClassificationDebakey Classification