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| ==Surgery== | | ==Surgery== |
| ===[[Aortic stenosis surgery devices|Mechanical and Device Based Therapy]]=== | | ===[[Aortic stenosis surgery devices|Mechanical and Device Based Therapy]]=== |
| Aortic stenosis requires [[aortic valve replacement]] if medical management does not successfully control symptoms.
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| According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.<ref>{{cite journal |author=Grube E, Laborde JC, Gerckens U, ''et al'' |title=Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study |journal=Circulation |volume=114 |issue=15 |pages=1616-24 |year=2006 |pmid=17015786 |doi=10.1161/CIRCULATIONAHA.106.639450}}</ref>
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| *Bileaflet Mechanical Aortic Valve
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| <googlevideo>4541951625687665949&hl=en</googlevideo>
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| ===[[Aortic stenosis surgery aortic valvuloplasty|Aortic valvuloplasty]]=== | | ===[[Aortic stenosis surgery aortic valvuloplasty|Aortic valvuloplasty]]=== |
| ===Patient selection and treatment choices===
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| * Surgical Aortic valve replacement is the treatment of choice for aortic stenosis but many patients are not good candidates due to advanced age and multiple co-morbidities
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| * Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure
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| * It can be performed emergently in patients with end-stage heart failure due to aortic stenosis: patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis
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| * Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
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| * Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina
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| ====Technique====
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| The retrograde technique is the most commonly used technique.
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| *8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
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| *Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
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| *The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
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| *0.035” straight wire is commonly used to cross the valve and advance via pig-tail or Amplatz catheter; Right heart catheterization is done and transaortic gradient is typically measured pre-procedure
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| *The 0.035” wire is then exchanged for a stiffer 0.038”Amplatz exchange length wire with the tip shaped into a pig-tail shape so as not to injure the LV
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| *The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
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| *The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
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| *Meticulous control of balloon position must be maintained at all times by backward traction on the balloon to prevent jumping forward and injuring/perforating the LV apex
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| ==References== | | ==References== |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Congenital heart disease]] | | [[Category:Congenital heart disease]] |
| | [[Category:Mature chapter]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]; Priyamvada Singh, MBBS [[5]]
Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]
Overview
Surgical intervention may be a necessary component of treatment. Intervention methods may include mechanical and device based therapies such as bileaflet mechanical aortic valves. An alternative treatment method includes aortic valvuloplasty.
Surgery
References
Template:WH
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