“For Every Good Idea”

Valve Prostheses Ideal Prosthesis: Not Thrombogenic Ideal Prosthesis: Not Thrombogenic Durable Durable Resistant to infection Resistant to infection Mimics Normal Flow Mimics Normal Flow Ease of insertion/ available Ease of insertion/ available

Valve Prostheses Biologic: Less Durable Less Thrombogenic Less Thrombogenic More Resistant to Infection More Resistant to Infection Mechanical: More Durable Requires Anticoagulation/ Coumadin Requires Anticoagulation/ Coumadin

Valve Surgery Aortic Stenosis Aortic Stenosis Aortic Insufficiency Aortic Insufficiency Mitral Stenosis Mitral Stenosis Mitral Insufficiency Mitral Insufficiency

Aortic Stenosis Acquired Calcific- Senile Degeneration Acquired Calcific- Senile Degeneration Congenital- Bicuspid Valve Congenital- Bicuspid Valve Rheumatic Valvular Disease Rheumatic Valvular Disease

Aortic Stenosis Aortic Valve Area cm Aortic Valve Area cm Mild cm Mild cm Moderate cm Moderate cm Severe < 1.0 cm Severe < 1.0 cm

Aortic Stenosis Symptoms: Angina-Chest Pain Syncope Syncope CHF/ SOB CHF/ SOB Exam: Systolic Murmur Harsh Crescendo-decrescendo Harsh Crescendo-decrescendo Pulsus Parvus et Tardus Pulsus Parvus et Tardus Surgery Indications: Symptoms AVA < 1.0 cm AVA < 1.0 cm mpg >50 mmHg mpg >50 mmHg

Aortic Insufficiency Annulo-Aortic Ectasia Connective Tissue Disorders: Marfan’s Syndrome Marfan’s Syndrome Ehlers -Danlos Syndrome Ehlers -Danlos Syndrome Rheumatic Valvulitis EndocarditisSyphillisTrauma Aortic Dissection

Aortic Insuffficiency Symptoms : SOB/ DOE Angina Angina Exam: Diastolic Murmur Widened Pulse Pressure (Corrigan’s) Widened Pulse Pressure (Corrigan’s) Surgery Indications: NYHA III-IV Rule of “50’s” Rule of “50’s” C/T ratio > 50% C/T ratio > 50% EF < 50% EF < 50% ESD > 50mm ESD > 50mm

Mitral Stenosis Rheumatic Valvulitis Rheumatic Valvulitis Congenital Congenital Mitral Annular Calcification Mitral Annular Calcification Systemic Lupus Erythematosus Systemic Lupus Erythematosus Myxoma Myxoma

Mitral Stenosis Symptoms: SOB/ DOE Cough- Hemoptysis Cough- Hemoptysis Orthopnea- PND Orthopnea- PND Emboli Emboli Exam: Diastolic Murmur-Rumble Opening Snap Opening Snap Increased First Heart Sound Increased First Heart Sound

Mitral Stenosis Normal Mitral Valve Area 4- 6 cm Normal Mitral Valve Area 4- 6 cm Mild: > 2.0cm 2.0cm < 5 mmHg Moderate: cm 5-10 mmhg Moderate: cm 5-10 mmhg Severe: 10mmhg Severe: 10mmhg Indications for Surgery: NYHA III-IV Indications for Surgery: NYHA III-IV Atrial Fibrillation Atrial Fibrillation

Mitral Insufficiency Myxomatous Degeneration Barlow’s Syndrome Barlow’s Syndrome Mitral Valve Prolapse (4-5%) Mitral Valve Prolapse (4-5%) Rheumatic Heart Disease Endocarditis Coronary Ischemia-Infarction

Mitral Insufficiency Symptoms: DOE/ SOB Fatigue Palpitations Fatigue Palpitations Exam: Apical holo-systolic murmur Diastolic flow murmur Diastolic flow murmur Indications for Surgery: NYHA III-IV NYHA I-II NYHA I-II

Aortic Dissection

Debakey Classification