Aortic valve replacement

Question 1

Presentation

Answer 1

Midline sternotomy scar with an loud second heart sound suggestive of a metallic aortic heart valve replacement
+ signs valve is not functioning well?
+signs of IE?

Question 2

Indications for replacement

Answer 2

AORTIC STENOSIS:
Symptomatic +mean gradient >50mmHg
Asymptomatic + other cardiac surgery, OR +LVSD (gradient >40mmHg), abnormal BP response to exercise, VT, valve area <0.6cm2
AORTIC REGURGE
Symptomatic
Asymptomatic +other cardiac surgery OR LVSD (EF<50%), dilated LV
OTHER
- IE with failed medical therapy

Question 3

Mechanical or tissue?

Answer 3

Tissue if:
- anticoagulation contraindicated
- lifespan of person is less than lifespan of valve,
- >70yo

Question 4

Associations

Answer 4

Associated with arrhythmias, look for the pace maker scar

Question 5

Complications

Answer 5

thromboembolism, bleeding, valve dysfunction, endocarditis, haemolysis