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Valvular Heart Disease

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  1. Valvular Heart Disease Ronald D’Agostino, D.O., F.A.C.C., F.A.C.P. Director of Non-Invasive Cardiology Long Island Cardiovascular and Internal Medicine Manhasset, N.Y.

  2. Calcified Ao Valve 2nd to acquired AoV Stenosis

  3. Severely calcified tricuspid valve from an elderly patient

  4. Phonogram of a 20yoa women with moderate AoV congenital stenosis with a bicuspid valve, presenting with an ejection click, increased A2 and systolic ejection murmur

  5. Phonogram of a 20yoa male with severe non-calcified AoVS. Seen here is a paradoxical splitting of S2, late systolic ejection murmur and prominent S4. The LV is noted to have a low volume and a slow up swing of the carotid pulse.

  6. Apexcardiogram of the severe AoVS showing a sustained “a” wave, causing a palpable S4 gallop (the non-compliant ventricle)

  7. 70yoa male with sever AoVS, note the absence of both the ejection click and Ao second sound (circled). Also there is a slow up swing of the carotid pulse.

  8. The window to the inner world – The Eyes • Note the multiple calcific emboli in the retina of this elderly patient presenting with amaurosis fugax • Patient was Dx with severe acquired AoVS

  9. Catheter gradients are reported as peak to peak pressure differences • This is not a true measurement of pressure drop off across the AoV because they do not occur at the same time • Echocardiogram is ideal for pressure drop off across the valve • The two should be used together to evaluate the patient for validation studies • Peak to Peak pressure diff • Pressure Drop off

  10. Percutanous valvuloplasty with a prophylactic RV Pacemaker to combat bradycardia during the procedure

  11. Ross Procedure

  12. Survival in the elderly (ave age of 60) after a AoV replacement (AVR)

  13. Pt with Marfan’s syndrome

  14. Marfan’s with type-A Ao dissection

  15. Growth the heart muscle A – Infant’s heart weighing about 15gm and LV is 7gm B – Adult’s weighing 300gm and 100gm respectively C – Athlete's is 500gms and 200gm D – Concentric Hypertrophy – 650gms and 400gms E – Decompensated Eccentric Hypertrophy – 900gms and 500gms – fewer myocytes are noted, replaced by fibrotic scar tissue

  16. rh

  17. Pulse and Reflected wave velocities in an elastic Ao

  18. What about in a stiff aorta?