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“For Every Good Idea”

“For Every Good Idea”. Valve Prostheses. Ideal Prosthesis: Not Thrombogenic Durable Resistant to infection Mimics Normal Flow Ease of insertion/ available.

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“For Every Good Idea”

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  1. “For Every Good Idea”

  2. Valve Prostheses Ideal Prosthesis: Not Thrombogenic Durable Resistant to infection Mimics Normal Flow Ease of insertion/ available

  3. Valve Prostheses Biologic: Less Durable Less Thrombogenic More Resistant to Infection Mechanical: More Durable Requires Anticoagulation/ Coumadin

  4. Valve Surgery • Aortic Stenosis • Aortic Insufficiency • Mitral Stenosis • Mitral Insufficiency

  5. Aortic Stenosis • Acquired Calcific- Senile Degeneration • Congenital- Bicuspid Valve • Rheumatic Valvular Disease

  6. Aortic Stenosis Aortic Valve Area 2.5 -3.5 cm Mild 1.5 -2.0 cm Moderate 1.0 -1.5 cm Severe < 1.0 cm

  7. Aortic Stenosis Symptoms: Angina-Chest Pain Syncope CHF/ SOB Exam: Systolic Murmur Harsh Crescendo-decrescendo Pulsus Parvus et Tardus Surgery Indications: Symptoms AVA < 1.0 cm mpg >50 mmHg

  8. Aortic Insufficiency Annulo-Aortic Ectasia Connective Tissue Disorders: Marfan’s Syndrome Ehlers -Danlos Syndrome Rheumatic Valvulitis Endocarditis Syphillis Trauma Aortic Dissection

  9. Aortic Insuffficiency Symptoms : SOB/ DOE Angina Exam: Diastolic Murmur Widened Pulse Pressure (Corrigan’s) Surgery Indications: NYHA III-IV Rule of “50’s” C/T ratio > 50% EF < 50% ESD > 50mm

  10. Mitral Stenosis • Rheumatic Valvulitis • Congenital • Mitral Annular Calcification • Systemic Lupus Erythematosus • Myxoma

  11. Mitral Stenosis Symptoms: SOB/ DOE Cough- Hemoptysis Orthopnea- PND Emboli Exam: Diastolic Murmur-Rumble Opening Snap Increased First Heart Sound

  12. Mitral Stenosis Normal Mitral Valve Area 4- 6 cm Mild: > 2.0cm < 5 mmHg Moderate: 1.0- 2.0 cm 5-10 mmhg Severe: < 1.0 cm > 10mmhg Indications for Surgery: NYHA III-IV Atrial Fibrillation

  13. Mitral Insufficiency Myxomatous Degeneration Barlow’s Syndrome Mitral Valve Prolapse (4-5%) Rheumatic Heart Disease Endocarditis Coronary Ischemia-Infarction

  14. Mitral Insufficiency Symptoms: DOE/ SOB Fatigue Palpitations Exam: Apical holo-systolic murmur Diastolic flow murmur Indications for Surgery: NYHA III-IV NYHA I-II

  15. Aortic Dissection

  16. Debakey Classification

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