Anatomy Of Aortic Valve And Root - Startseite
Anatomy of aorticvalve and rootEmmanuel Lansac,Isabelle Di CentaCardiac SurgeryInstitut Mutualiste Montsouris,Paris, France
The aortic valve : a passive ordynamic structure?Leonardo da Vinci 1508Quadr Anat IVBelhouse Cir Res 1969In vitro Vortex formationThubrikar JTCVS 1979 : In vivo 9%commissural expansion prior ejectionCircular orificeBrewer JTCVS 1976Interdependence of valveopening and root expansionDagum Circulation 1999Deformational dynamicsof the aortic root (60Hz)
Sino-tubular junctionThe aortic annulus: a 3D structureMembranousseptumInter leaflets triangleAortic annular base2D 2D3DSutton et al. ATS 1995Anderson et al. ATS 1991
Aortic Root 2 functional compartmentsSUPRAVALVULAR COMPARTMENT:STJ ascending aortaAortic HemodynamicsSUPRA sSUBVALVULAR COMPARTMENT:Aortic annular Base Commissures (inter-leaflet triangles)LV HemodynamicsSutton et al. ATS 1995Lansac et al. EJTCS 2002
Aortic root expansion starts prior to ejection36.7 3.3% of root volume C CONTRACTION1.0BSTJCCHANGE IN AREA.8.6maxmedian.4.2.0min-.2-.4-.6-.8-1.04321AAN 24B24C24STJ24AAAORTIC ROOT LEVELLansac et al. EJTCS 2002; 22:497-503
Aortic valve opening starts prior to ejection(2.1 0.5%)Related to annular base and commissural (subvalvularcompartment) pre-ejectional expansionCorrelated to LV pressure increase (r 0.95)Due to a redistribution of LV volume below the leaflets(inter-leaflet triangle)Optimize ejectionStressless openingLansac et al. EJTCS 2002; 22:497-503
Aortic valve opening is maximumduring the 1/3 of ejection250IVCIVCEjectionEJECTIONArea (mm 2)200150DIASTOLEIVRIVRMidMIDDiastole70Ao overshotLeaflet areaCommissural area20by 28.8 3.4%LV hemodynamic performance0unimpededblood flowthe sino-tubular6,556,6 through6,656,7junction to the systemic circulationTime (s)-130L-1806,756,8Pressure (mmHg)SYSTOLE
Aortic root expansion is asymetricTilt angle of the aortic valve during cardiac cycleEnd diastole: 16.3 1.5 postero-leftDuring systole:- 6.6 1.5 Alignement of LVOT and ascending aortaMaximize ejection60During diastole: 6.6 1.5 2450Ao3014Tilt Angle20910LV0Tilt Angle (degrees)Pressure (mmHg)1940Shock absorber44.24.44.64.855.25.45.6Time (s)Lansac et al. JHVD 2005; 14:400-407
Importance of Sinuses of ValsalvaLeonardo da Vinci 1508 Belhouse Cir Res 1969Quadr Anat IVIn vitro Vortex formationKilner Circulation 19933D MRIRecirculating flows (vortices) accommodated by the sinusescontribute to efficient and smooth valve closure at end systoleKatawama 2008
Aorto mitral junction dynamics :two to tangoDIASTOLESYSTOLEAortic Ø 10.6 0.3%T1 -11.5 2.3%T2T1 11.5 2.3% T2Transverse Ø : -12.1 1.5%Antero Posterior Ø : -23.6 2.5%MAXIMIZE LV FILLINGMAXIMIZE EJECTIONLansac et al. JTCVS 2002; 123:911-918
Annulus excursionduring cardiac cycle13 2.3 mmThe angle between themitral and aortic annulusreduces 11 in systole.150 144 Annulus excursioncontributes to an efficientcardiac outputAlignement of LVOTand ascending aortaMaximize ejectionSughimoto JHVD 2010Goetz Am J Physiol Heart Circ 2005, Asian CVT annals 2006
What are the normal diametersof the aortic 005Babaee2007N1351107010050Annular Ø24.5( 3)23.4( 2.4)22.7( 2.7)20.55 ( 3)24.421.8 2.421 322.3 1,4( 4.1) (20.5-32.4)STJ Ø27.5( 3)28.1( 3.2)24.7( 2.8)31.2( 3.7)29.5 3.127 426.7 2.2( 4.1) (31.2-23.4)STJ/annulus1.121.21.11.31132 1521,621 2,820,3 8,727,325 3,723.4 3,11,31,21,125.41.11.31.2 0.1(1.1-1.3)1.3Dilated 35 mmDilated 25 mmSTJ AnnulusRatio 1.2 (1.1-1.3)
Expansibility of the aortic rootLeygh1999EchoDe Paulis2002EchoVarnous2003EchoN107100Annular base9.6 1.5%7.7%2.55%SoV10.3 3.4%4.4%STJ7.0 choDe Heer2011CT scanZhu2001Echo5051083145.7%5.1%(2.5-9.6)6.8%7 1.8%4.6%2.7%2.1%4.3%(0.5-10.3)0.5%3.7%7.2 1.8%2.1%4%2.8%5.4%5.7%(1.7-9.8)5.9%9.8 6.2%1.7%5%5 5995.4%5.7%Aortic annulus andSTJ expansion
Parameters for valve coaptationSTJcHgHcH 4-5 mmeH 9 mmeHAortic annular base annulus Ø from 20-30 mmgHBicuspid : nonfused 24 2 mm eH from 10.9 to 8.0 mmTricuspid :NC : 21 2 / LC : 20 2 / RC 20 2 cH from 3.3 to 0.3 mmCorrelates with body height, weight, BSA,sinus Ø, aortoventricular ØTamas JHVD 2007Bierbach EJTCVS 2010Schäfers JTCVS 2012Marom JTCVS 2012
What is the aortic annulusfrom a surgical point of view ?From Anderson R. with permission
External Dissectionof the Subvalvular Plane
LNCR 2.4 3.4 1.4 2.4-3.1-2.1-3.1Aortic annuloplasty can be performed in the subvalvular plan, except atthe level of the infundibulum where the dissection stops 1,4 1,8 mmabove the nadir of the right coronary sinus(80% below or within 3mm above the nadic of the KhelilR ) et al ATS 2015
NC LeafletLC leaflet2.02 0.472.74 0.81L At.External aortic annuloplasty induces a minimum of 5 mmreduction of aortic annular base C leafletcommissure3.34 1.123.25 0.81Khelil et al ATS 2015
Aortic valveTricuspidBicuspid valveType 00 rapheCommissures 120 Good candidatesCommisures 180 forNC-LCNC-RCType 11 rapheCommisures 120-180 repairUnicuspid valveType 22 raphes
Landmarks to AV conduction systemRight coronary aortic leafletNon-coronary aortic leafletMembranous septumLeft bundle branch descendsfrom nadir of hinge of right coronary leafletFrom Anderson R. with permission
Left bundle branchMembranous septumVentricular septumBranching atrioventricular bundleFrom Anderson R. with permission
Left bundle branchNon-coronary aortic sinusRight coronaryaortic sinusAtrioventricular nodeFrom Anderson R. with permission
Right coronaryaortic sinusNon-coronaryaortic sinusMembranous septum &interleaflet triangle
Dynamic anatomyAortic Root expansion Stress less opening andclosure of the valveValve repairDilated STJ 35 mmTreatment of dilateddiametersAortic annular base ØSTJ ØPreserves root dynamicsNeosinuses of valsalvaSystolic expansionClover shape orifice(interleaflet triangles)Restores cuspeffective heightCusp effectiveheightDilated annulus 25 mmAnnulus STJRatio 1.2Durability of a native valveRestores ratioDurability of repair
Belhouse Cir Res 1969 In vitro Vortex formation Thubrikar JTCVS 1979 : In vivo 9% . (r 0.95) Optimize ejection Lansac et al. EJTCS 2002; 22:497-503 . 2004 Echo Maselli 20
Mitral valve disease unspecified; Chronic mitral valve Disease Rheumatic NOS 105.9 Rheumatic aortic stenosis; aortic valve disorder 106.0 Rheumatic aortic insufficiency; Aortic Regurgitation 106.1 Rheumatic aortic stenosis with aortic regurgitation 106.2 Other rheumatic aortic valve disease 106.8 Rheumatic aortic valve disease unspecified NOS 106.9
3 2.0 Indications The Edwards SAPIEN XT Transcatheter Heart Valve, model 9300TFX, systems are indicated for relief of aortic stenosis in patients with symptomatic heart disease due to severe native calcific aortic stenosis (aortic valve area 1.0 cm2 or aortic valve area index 0.6 cm2/m2, a mean aortic valve gradient of
the flow rate and pressure. To select the correct valve to fulfill these functions properly, an outline of the different types of valves and their features is given below. Butterfly valve Butterfly valve and globe valve Butterfly valve and ball valve Butterfly valve and gate valve Check valve Gate valve Globe valve Ball valve Valve shaped like a
G- Autoflow Valve 2.0 GPM H- Autoflow Valve 2.5 GPM I- Autoflow Valve 2.8 GPM J- Autoflow Valve 3.0 GPM K- Autoflow Valve 3.3 GPM L- Autoflow Valve 3.5 GPM M- Autoflow Valve 4.0 GPM N- Autoflow Valve 4.5 GPM O- Autoflow Valve 5.0 GPM P- Autoflow Valve 5.5 GPM Q- Autoflow Valve 6.0 GPM R- Autoflow Valve
V AR V Alias R Flow From Ao Flow Into LV Area PISA x V Alias 2 x R2 x V Alias 6.28 x R2 x V LV Alias Effective Regurgitant Orifice (ERO) Ao . 61 y/o Female: Dyspnea and heart failure . No color baseline shift . Aliasing velocity 50 cm/s . Aliasing velocity 40 cm/s .File Size: 9MBPage Count: 102Explore furtherASE Guidelines on Aortic Regurgitation What Do I Measure?asecho.orgAortic Regurgitation: Etiology and Echo Quantificationasecho.orgClassification of valve stenosis and regurgitation - Echopediawww.echopedia.orgEchocardiogram Criteria For Severe Aortic Valve Diseasewww.heart-valve-surgery.comA Complete Guide to Performing MR PISA! - Cardioservwww.cardioserv.netRecommended to you b
TAVR: Overview of the Application Overview: CT Transcatheter Aortic Valve Replacement (TAVR) planning assists with the assessment of the aortic valve and in pre-operational planning and post-operative evaluation of tr
mortality rate and a new scoring system (German AV score) has been developed for a more accurate assessment of operative risk. In this study, we aimed to validate German Aortic Valve Score in our clinic in patients undergoing isolated aortic valve replacement. Methods: A total of 35 patients who underwent isolated open
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