Aortic valve disease

Question 1

Mx: AS

Answer 1

surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
transcatheter AVR (TAVR) is used for patients with a high operative risk

Question 2

AS: balloon valvuloplasty

Answer 2

in children with no aortic valve calcification
in adults limited to patients with critical aortic stenosis who are not fit for valve replacement

Question 3

TAVI

Answer 3

• local anaesthesia
• XR fluoroscopy guidance
• inserting a guidewire via the femoral artery. A sheath carrying the collapsed heart valve is then passed over the guidewire into position over the aortic valve (Fig. 4), to then be deployed (either via balloon or a self-expanding mechanism) over the existing valve. Once the valve is completely deployed, an ECHO is performed to assess the new valve’s function and check for perivalvar leakage.

Question 4

Open Heart Surgery (surgical AVR)

Answer 4

Regurg - repair
Stenosis - replace

Median sternotomy
CP bypass

Question 5

Mechanical vs tissue valves

Answer 5

Age group
M: Younger (<60)
T:Older (>70)

Durability
M: Longer (Lifelong)
T: Shorter (10-15 years)

Anticoagulation
M: Required (initially heparin, then warfarin lifelong)
T: Not required