[HSF] Aortic valve

[Prasanna Simha M]

Going by children , it works well.
Prasanna

On Fri, May 23, 2008 at 7:42 AM, Edward Bender <ebender001 at charter.net>
wrote:

> A couple of days ago I was referred a 79 year old male with myelodysplastic
> problems, along with easy fatigability, class 3 heart failure symptoms and
> a
> loud murmur at the aortic area.  The cardiologist did an echo in his office
> which showed aortic stenosis (indexed valve area of 0.4 cm2)  He did a
> right
> and left heart cath revealing trivial coronary disease, and mildly elevated
> PA pressures.  He did not feel the need to cross the valve since this was
> so
> obviously a stenotic aortic vaalve.  He did, however do a TEE confirming
> AS.
> His office echo purported to also show severe PI.  TEE did not show this.
> Do you see where I am going with this case?
>
> I operated on him 2 days ago (minimally invasive approach).  The valve was
> tri-leaflet, with easy mobility of the leaflets into a wide open position.
> Annulus was about 22 - 23 mm, and there was no  LVOTO by direct inspection
> or intra-operative TEE.  There was however a very large amount of heaped up
> calcium on the left coronary leaf, and lesser amounts on the other two
> leaflets with no restriction of motion.
>
> I could not justify replacing this valve, so I pealed all the calcium off
> the leaflets.  This was easy, but left a very thin area on the majority of
> the left leaflet, so I sutured in a piece of gluteraldehyde treated
> pericardium to bolster the thinned leaflet.  Echo on post-op day 1 showed a
> peak velocity of about 2 cm/sec. Which translates into about a 16-20 mm
> gradient with trace AI.
>
> My question to the valve experts are:
> 1. His pre-op Hct was 24.  Coupled with the increased mass of the leaflets,
> could this account for a false positive diagnosis of AS?  Does a slower
> opening time (assuming increased inertia to get the valve open)  cause an
> artificially elevated transvalvar gradient?
> 2. What do you think the durability of such a repair might be?  Is the
> experience with patches to the perforated leaflet secondary to endocarditis
> applicable to calcific degeneration pathology?
> 3. I will not get into the behavior and practice standards questions
> regarding the complete workup of potential AS.  Most new cardiologists I
> know have learned this lesson.
>
> Thanks for anyone¹s input.
>
> Ed Bender, MD
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-- 
Prasanna Simha M