Av & Mv Diseases

1. CASE REPORT

2. Male, 66 years old
H 167;
W 63Kg
BSA 1.15mq;
BMI 22.6 Kg/mq
Diagnosis:
Aortic (valve) insufficiency +3/ 4 degree
Heart failure
Hypertension

3. Symptoms
 Fatigue and weakness
 Shortness of breath
 Lightheadedness
 Heart palpitations.  Worsening of symptoms
past 2 weeks

4. Instrumental Findings
 EF- 45%

5. Results
 Aortic valve repair
was done successfully.
 Postoperative Ejection fraction -45%
 Patient was discharged from hospital
on the 7th day of hospitalization.

6. AORTIC VALVE

7.  Stenosis
 Regurgitati
on
Aortic Valve
 Normal Aortic
Valve
Aortic Valve
Aortic Valve

8. Trans-
thoracic
Echo (TTE)
Chest
X-ray
Electro-
cardiogram
Cardiac
Cath.
Auscultatio
n
Assessment of Aortic Valve
8
 Clinical
Manifestation

9. Euro Heart Survey
Valvular Heart Disease

10. Aortic valve
Disease
AVR-38%

11. The management depends on the particular disease
type.
• Improve symptoms to enhance well-being and quality
of life
• Increase exercise tolerance and try to improve
survival
• Prevent progressive heart failure
• Prevent sudden death
• Prevent thromboembolic episodes
Treatment goals

12. Treatment
ESC
AHA
ACC
EACTS
• Lifestyle changes
• Medication
• Surgery

13.  Beta blockers
 ACE inhibitors
 Diuretics
 Inotropic agents
 Intervention or Surgery
Medications

14. Indication for surgery of Aortic
Valve
ESC /AHA/ACC/EACTS Guidelines
2021 ESC/EACTS Guidelines for the management of valvular heart
disease: Developed by the Task Force for the management of
valvular heart disease of the European Society of Cardiology (ESC)
and the European Association for Cardio-Thoracic Surgery (EACTS)

15. VALVE REPAIR OR REPLACEMENT
Aortic valve Replacement
- Stenosis of the aortic valve
*Degeneration
*Rheumatic
*Calcification
*Cusp retraction
Aortic valve Repair
-Isolated aortic valve surgery
*Aortic valve regurgitation
*Congenital (bicuspid valve,
unicuspid)
-DAVID Procedure
2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of
the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

16. Mini Invasive Approaches

17. Types of Prosthetic Heart Valves
Mechanical
Bioprosthetic

18. MITRAL VALVE

19. Euro Heart Survey
Mitral valve Disease

20. Carpentier’s Pathophysiologic Triad
Valve dysfnction
resulting from the lesions
Valve lesions
resulting from the disease
Etiology
cause of the disease
Assessment Of The Valve

21.  Degenerative
 Ischemic
 Associated valvular
 Rheumatic
 Congenital
 Idiopatic dilated cardiomyopathy
 Endocarditis
 Obstructive
Etiology of Mitral Valve Disease

22.  Affecting around 2% of the population
Degenerative mitral valve disease

23.  Barlow's disease is the most
severe form of degenerative
mitral valve disease, commonly
characterized by bileaflet
prolapse.
 Myxomatous pathological
changes, resulting in “Floppy
leaflets” that are thickened and
distended.
Barlow’s Disease

24. Treatment
ESC
AHA
ACC
EACTS
• Lifestyle changes
• Medication
• Surgery

25.  Beta blockers
 ACE inhibitors
 Diuretics
 Inotropic agents
 Intervention or Surgery
Medications

26. ESC /AHA/ACC/EACTS Guidelines
2021 ESC/EACTS Guidelines for the management of valvular heart
disease: Developed by the Task Force for the management of
valvular heart disease of the European Society of Cardiology (ESC)
and the European Association for Cardio-Thoracic Surgery (EACTS)
Indication for surgery of Mitral
Valve

27.  Open-Heart Surgery
Approach
Minimally Invasive
Surgery

28. Repair
Valvuloplasty
Commissuroto
my
Decalcification
Reshaping
Patching
Replacement
Surgical Treatment Types

29. Repair VS Replacement
>80% of MR are Repairable
Advantages of Repair
 Better long term survival
 Improved lifestyle
 Improved heart function and maintain heart
structure, preserves LV function
 Produces more physiological flow states
 Better valve durability
 Less thrombolic events
 Lower risk of stroke and infection (endocarditis)
 Decreased need for anticoagulation

30. Valves
Bioprosthetic
The Carpentier-Edwards Classic ring
Mechanical

31. Patient Satisfaction
 A smaller incision= Less scarring and better cosmetic
appearance
 Less pain after surgery
 A shorter hospital stay after operation
 A shorter recovery time
 Less rehabilitation resources and rapid return to work

32. RECOMMENDED FOLLOW-UP
ECHOCARDIOGRAM CONTROL :
 Moderate Organic MR - EVERY 2YEARS
 Severe Organic MR - EVERY 1 YEAR
 EF-60-65% and EVSD 22-40 MM/M2- EVERY 6 MONTHS
OTHER PARAMETRS NEED TO BE
ASSESSED:
EF - %
ANNULAR SIZE
THE DEVELOPMENT OF A FLAIL
LEAFLET
LA area or VOLUME
PULMONARY SYSTOLIC
ARTERIAL PRESSURE
OCCURRENCE AF ATRIAL
ARRHYTMIAS

33. THANK YOU FOR YOUR
ATTENTION!
Any Questions?