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    VHD Surgery

    Uploaded by

    Osama Fahmy

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    VHD Surgery

    Uploaded by

    Osama Fahmy
    8 views1 page

    Original Title

    VHD surgery

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    8 views1 page

    VHD Surgery

    Uploaded by

    Osama Fahmy

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    © All Rights Reserved
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    AS MS AR MR

     Rheuma c AS Primary Valve Disease Primary Valve Disease


     Calcified AS  Congenital (BAV)  Rheuma c fever
     Bicuspid Aor c Valve (BAV)  Rheuma c fever  Degenera ve
     Endocardi s  Endocardi s
     Degenera ve  Systemic lupus erythematosus (SLE) &
    Secondary Disease rheumatoid arthri s (RA)
    E ology

     Aor c dilata on (Marfan syndrome, Ehlers-  Mitral annular calcifica on (MAC)


    Danlos syndrome, Loeys-Dietz syndrome) Secondary Disease
     Aor c dissec on  Cardiomyopathy
     Aor c inflamma on (Behçet's disease, aor s)  Ischemic heart disease (ischemic mitral
    regurgita on [IMR])
     Atrial fibrilla on (AF)
     Conges ve heart failure (CHF)
    Medical (Li le Role) Medical Medical
     Diure cs  Diure cs  Diure cs
     Control hypertension (HTN)  ACE inhibitors (ACEIs) & Angiotensin II  ACEIs & ARBs
     Sta ns for lipids receptor blockers (ARBs)  Beta-blockers
     Thromboprophylaxis
     IE prophylaxis
    Surgical Surgical: Surgical aor c valve replacement (SAVR): Surgical
    1.Surgical aor c valve replacement (SAVR): Mitral valve replacement (MVR): in non-repairable valves Mitral valve replacement (MVR)
    in non-repairable valves -Open MVR (full sternotomy).  Open AVR (full sternotomy AVR). in non-repairable valve
    Treatment op ons

    - Open AVR (full sternotomy AVR). -Minimally invasive MVR:  Minimally invasive AVR (MIAVR):  Open MVR (full sternotomy).
    - Minimally invasive AVR (MIAVR): -Mini-thoracotomy MVR.  Mini-thoracotomy AVR.  Minimally invasive MVR:
    - Mini-sternotomy AVR. -Endoscopic MVR.  Mini-sternotomy AVR.  Mini-thoracotomy MVR
    - Mini-thoracotomy AVR. Mitral valvotomy  Endoscopic AVR  Endoscopic MVR.
    - Endoscopic AVR. (commissurotomy): Aor c valve repair Mitral valve repair:
    2.Aor c valvotomy (valvuloplasty). -Closed mitral commissurotomy in repairable valves and repair is feasible in repairable valves and repair is feasible
    3.Aor c valve repair (Tubbs valvutome).  Annuloplasty (ring, suture).  Ring annuloplasty.
    (commissurotomy, leaflet shaving, leaflet -Open mitral commissurotomy.  Commissural plica on.  Resec on of prolapsed segment (triangular or
    extension). - Interven onal  Leaflet plica on. quadrangular resec on).
    Interven onal Percutaneous mitral balloon  Leaflet patching.  Chordal replacement (Neo-chordae
    - Trans-catheter aor c valve replacement (TAVR). commissurotomy (PMBC). tendineae).
    - Trans-catheter aor c balloon dilata on.  Leaflet patching.
    Interven onal
    Trans-catheter mitral edge-to-edge repair (TEER)
    “MitraClip”.
    1.Symptoma c sever AS. 1. Symptoma c sever MS. 1.Symptoma c sever AR. 1. Symptoma c sever MR.
    2.Asymptoma c severe AS with: 2. Asymptoma c sever MS with: 2.Asymptoma c sever AR with: 2. Asymptoma c sever AR with:
    Indica ons for

     LV – Ejec on frac on (EF) ≤50%.  Pulmonary hypertension  LV – Ejec on frac on (EF) ≤55%.  LV – Ejec on frac on (EF) ≤60%.
     Pa ent undergoing cardiac surgery for [pulmonary artery systolic  LV dilata on [LV-end systolic dimension (ESD)  LV dilata on [LV-end systolic dimension (ESD)
    surgery

    other cause (e.g.: undergoing CABG). pressure (PASP) ≥50mmHg]. ≥50mm] ≥40mm]
     Very severe AS (aor c velocity of ≥5 m/s).  New onset atrial fibrilla on  Pa ent undergoing cardiac surgery for other cause  Pa ent undergoing cardiac surgery for other
     Posi ve exercise test. (AF). (e.g: undergoing CABG). cause (e.g: undergoing CABG).
    3.Moderate AS in a pa ent undergoing other 3.Moderate AR in a pa ent undergoing other cardiac 3.Moderate MR in a pa ent undergoing other cardiac
    cardiac surgery (e.g.: undergoing CABG). surgery (e.g: undergoing CABG). surgery (e.g: undergoing CABG).

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