1. Tri-leaflet Aortic Valve

2. Aortic Stenosis Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline

3. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline Table 8. 2014 AHA/ACC Stages of Valvular AS

4. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Table 9. Summary of Recommendations for AS: Timing of Intervention

5. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Figure 1. Indications for AVR in Patients with AS

6. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Table 10. Summary of Recommendations for AS: Choice of Surgical or Transcatheter Intervention

7. Aortic Regurgitation Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline

8. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline Table 11. 2014 AHA/ACC Stages of Chronic AR

9. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline 2014 AHA/ACC Table 12. Summary of Recommendations for AR Intervention

10. Nishimura, RA et al. 2014 AHA/ACC Valvular Heart Disease Guideline Figure 2. 2014 AHA/ACC Indications of AVR for Chronic AR

11. Case #1 u u 78 year old woman admitted to hospital in heart failure. Found to have trileaflet Aortic valve with severe aortic insufficiency and reduced LV function. EF 20-25%. Aortic Valve gradient mean 5.2 mmHg. u u Aortic Root: Surgical Annulus2.1cm Sinus of Valsalva2.9cm STJ1.8-2.0cm

12. LT 02

13. LT 04

14. LT 30

15. Case #1 u u Surgery placement #19 Medtronic supra-annular valve Mean Gradient 8.8mm Hg Peak Gradient 17mm Hg

16. Case #2 u u 83 y/o male with know aortic stenosis progressed in symptoms with SOB and fatigue. In past had stent to LAD. More recently angina with exertion, LAD now with 70% in stent stenosis. Periods of rapid atrial fibrillation. Dynamic LV function recently as low as 30%. Aortic valve gradient mean 37mmHg, peak 70mmHg. u u Aortic Root: Surgical Annulus2.4cm Sinus of Valsalva3.2cm STJ2.6cm

17. IH 01

18. IH 02

19. IH 03

20. IH 09

21. IH 12

22. IH 14

23. Case #2 Procedure: 1) 1) Pulmonary Vein Isolation Ganglionic Ablation Marshall Vein Ablation 2) 2) CABG x 1 LIMA to LAD 3) 3) AVR #25 Hancock II Bioprosthesis

24. IH 30 Case #7 Post Procedure Echo

25. Case #3 Aortic Root Valve Sparing Reconstruction u u 53 year old man with elevated cholesterol underwent Cardiac CT for coronary calcium scoring. Found to have dilated aortic root. Trivial to mild aortic insufficiency. Coronaries clear on cath. u u Trileaflet aortic root:Surgical Annulus 2.3cm Sinuses of Valsalva 5.3cm STJ 4.2cm Ascending Aorta 3.5cm

26. JH 01

27. JH 10

28. JH 04

29. JH 05

30. JH 07

31. JH 09

32. JH 13

33. JH 14

36. Case #3 Aortic Root Valve Sparing Reconstruction u u Underwent valve sparing aortic root reconstruction with #26 Dacron graft using Yacoub technique.

37. JH 44 Case #8 Post Procedure Echo

38. JH 45 Case #8 Post Procedure Echo