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Alsharqia.riyadh Echo meeting

Alsharqia.riyadh Echo meeting. Dammam KSA SAYED ABOU EL SOUD MD SBCC. Case 1. History. 48 y old Saudi lady Hypothyroidism,ch . Spondylisis H/O intracranial HTN 6 years before admission & ventriculoperitoneal shunt ( removed later )

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Alsharqia.riyadh Echo meeting

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  1. Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC

  2. Case 1

  3. History • 48 y old Saudi lady • Hypothyroidism,ch. Spondylisis • H/O intracranial HTN 6 years before admission & ventriculoperitoneal shunt ( removed later ) • Labarscopiccholecystecomy & RT modified mastectomy • Now neurologically grossly intact

  4. S/P AVR in other hospital with tissue valve size 21 ( mosaic valve ) in 6/2011 ( 2 ys ago ) • Presented to SBCC ( 2 month ago) with C/O chest pain , dyspnea and syncobal attacks • O/E obese well oriented pt • Ejection syst . murmer • ECG LV hypertrophy & strain • HB is 12.6 , creatinine 1.5

  5. Preoperative TTE

  6. PREOPERATIVE TEE

  7. IMPRESSION • 48 y lady , obese , multiple co morbidities • Severely symptomatic relatively early postoperative • Significant : • gradient across AV & OFT • Severe LVH , normal LV function • Tilting partially supra- annular valve • leaflets opening well • Remnants of the native valve in 1st operation

  8. GEOMETRIC ORIFICE AREA ( area blood flow through ) • MOUNTING AREA (area occupied by the valve in the native annulus )

  9. IMPLANT TECHNIQUE • TOATLLY INTRA ANNULAR : GOA/MOUNTING AREA = 40-70 % • PARTIAL SUPRA-ANNULAR : GOA/MOUNTING AREA= 80 %-85 % • TOTALLY SUPRAANNULAR : APPROACHES 100% MAXIMIZING BOOLD FLOW

  10. Surgery • Aortic patch ( dilate aorta ) • Valve replacement (tissue valve ) has Hx of intracranial HGE • Myomectomy ( dilate LVOT )

  11. POSTOPERATIVE TEE

  12. POSTOPERATIVE TTE

  13. Case 2

  14. History • 46 y old saudi female • K/C of HTN, hypothyroidism • K/C AVD, bicuspid AV with sever AS • S/P AVR “tissue valve”1 year ago

  15. History • presented to our ER C/O • progressive exertional dyspnea up to NYHA III. • She also c/o of chest pain & near syncopal attacks • O/E • Pt had mild pulm. congestion & uncontrolled B/P 160/95 • Ejection systolic murmur over the AV

  16. TTE

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