|
|
| (43 intermediate revisions by 8 users not shown) |
| Line 1: |
Line 1: |
| {{Aortic stenosis}} | | __NOTOC__ |
| {{CMG}} | | {| class="infobox" style="float:right;" |
| | |- |
| | | [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br> |
| | | [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| | {{Aortic stenosis surgery}} |
|
| |
|
| '''Associate Editors-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]; [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com]; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]] | | '''For the WikiPatient page for this topic, click [[Aortic valve surgery (patient information)|here]]''' |
|
| |
|
| '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]] | | '''For the WikiDoc page of Aortic stenosis, click [[Aortic stenosis|here]]''' |
|
| |
|
| ==Overview==
| | {{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@wikidoc.org]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] |
| Surgical intervention may be a necessary component of treatment. Intervention methods may include mechanical and devise based therapies such as bileaflet mechanical aortic valves. An alternative treatment method includes aortic valvuloplasty.
| |
|
| |
|
| ==Surgery== | | ==[[Aortic stenosis surgery overview|Overview]]== |
| ===Mechanical and Device Based Therapy===
| |
| Aortic stenosis requires [[aortic valve replacement]] if medical management does not successfully control symptoms. | |
| 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>
| |
|
| |
|
| *Bileaflet Mechanical Aortic Valve
| | ==[[Aortic stenosis surgery epidemiology and demographics|Epidemiology and Demographics]]== |
| <googlevideo>4541951625687665949&hl=en</googlevideo>
| |
|
| |
|
| ===Aortic valvuloplasty=== | | ==[[Aortic stenosis surgery indications|Indications]]== |
| ===Patient selection and treatment choices===
| |
| * 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
| |
| * 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
| |
| * 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
| |
| * Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
| |
| * Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina
| |
|
| |
|
| ====Technique==== | | ==[[Aortic stenosis surgery preoperative evaluation|Preoperative Evaluation]]== |
| The retrograde technique is the most commonly used technique.
| |
| *8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
| |
| *Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
| |
| *The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
| |
| *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
| |
| *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
| |
| *The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
| |
| *The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
| |
| *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
| |
|
| |
|
| ==References== | | ==[[Aortic stenosis surgery procedure|Procedure]]== |
| {{reflist|2}}
| |
|
| |
|
| [[Category:DiseaseState]] | | ==[[Aortic stenosis surgery recovery|Recovery]]== |
| [[Category:Signs and symptoms]] | | |
| [[Category:Physical Examination]] | | ==[[Aortic stenosis surgery prognosis|Outcomes and Prognosis]]== |
| | |
| | ==[[Aortic stenosis surgery complications|Complications]]== |
| | |
| | ==[[Aortic stenosis surgery videos|Videos]]== |
| | |
| | {{WH}} |
| | {{WS}} |
| | [[CME Category::Cardiology]] |
| | |
| | [[Category:Disease]] |
| [[Category:Valvular heart disease]] | | [[Category:Valvular heart disease]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Congenital heart disease]] | | [[Category:Congenital heart disease]] |
| | | [[Category:Cardiac surgery]] |
| {{WH}}
| | [[Category:Surgery]] |
| {{WS}}
| |
