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Aortic Regurgitation 23 March 2012 – Hannes Meyer Symposium

Aortic Regurgitation 23 March 2012 – Hannes Meyer Symposium. Jehron Pillay le Roux Institute of Thoracic Surgery. Aortic Valve Competence. Dependant on the normal anatomical and physiological functioning of the contents of the aortic root…. sinuses aortic valve leaflets commissures

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Aortic Regurgitation 23 March 2012 – Hannes Meyer Symposium

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  1. Aortic Regurgitation23 March 2012 – Hannes Meyer Symposium Jehron Pillay le Roux Institute of Thoracic Surgery

  2. Aortic Valve Competence Dependant on the normal anatomical and physiological functioning of the contents of the aortic root… sinuses aortic valve leaflets commissures interleaflet triangles annulus

  3. Aortic Regurgitation • The anatomy of the aortic root • How the root functions • Surgical consideration of the valvular and leaflet component • Surgical consideration of the annular component

  4. Aortic Valve Competence Sinotubular junction Leaflets Ventriculo aortic junction

  5. AORTIC ROOT Boundries: Sinotubular Junction Ventriculo-aortic Junction Contents: sinuses aortic valve leaflets commissures interleaflet triangles

  6. ANATOMY OF THE ROOT

  7. ANATOMY OF THE ROOT

  8. ANATOMY OF THE ROOT

  9. ANATOMY OF THE ROOT

  10. ANATOMY OF THE ROOT

  11. ANATOMY OF THE ROOT

  12. ANATOMY OF THE ROOT 120 degree - LAX Systole Annulus ST junction Tubular aorta Sinuses Diastole

  13. ROOT FUNCTION MYTH Complex haemodynamic system Distal Root Proximal Root Role of the sinuses

  14. ROOT FUNCTION

  15. Surgical considerationsLEAFLET DISEASE Rheumatic Infective endocarditis Congenital Iatrogenic

  16. Surgical considerationsLEAFLET DISEASE Valve replacement mechanical bioprosthesis - allograft - xenograft - autograft (Ross)

  17. Surgical considerationsLEAFLET DISEASE (ROSS)

  18. Surgical considerationsLEAFLET DISEASE Valve repair cusp perforation cusp extension cusp prolapse cusp with stress fenestration bicuspid aortic valve

  19. Surgical considerationsLEAFLET DISEASE • cusp perforation

  20. Surgical considerationsLEAFLET DISEASE • cusp extension

  21. Surgical considerationsLEAFLET DISEASE • cusp prolapse

  22. Surgical considerationsLEAFLET DISEASE • cusp with stress fenestration

  23. Surgical considerationsLEAFLET DISEASE • bicuspid aortic valve

  24. Surgical considerationsROOT Aneurysms AnnuloEctasia Marfans Other

  25. Surgical considerationsROOT REMODELING YACOUB DAVID

  26. Surgical considerationsROOT YACOUB PROCEDURE

  27. Surgical considerationsROOT DAVID PROCEDURE

  28. Surgical considerationsROOT RECONSTRUCTION BENTALL

  29. Surgical considerationsROOT BENTALL PROCEDURE

  30. FINAL POINTS • remodeling - late deterioration in valve function • dacron damage • marfan syndrome

  31. REFERENCES • The aortic root: structure, function, and surgical reconstruction, M J Underwood, G El Khoury, D Deronck, D Glineur, R Dion, Heart 2000;83:376–380 • David T Ei . Aortic Valve Repair and Aortic Valve–Sparing Operations.
CohnLh, ed. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2008:935-948. • Kunzelman KS, Grande J, David TE, Cochran RP, Verrier ED. Aortic root and valve relationships: impact on surgical repair. J ThoracCardiovascSurg 1994;107:162–170. • The surgical anatomy of the aortic root, Robert H. Anderson, mmcts.2006.002527

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