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.
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
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.
Apexcardiogram of the severe AoVS showing a sustained “a” wave, causing a palpable S4 gallop (the non-compliant ventricle)
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.
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
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
Percutanous valvuloplasty with a prophylactic RV Pacemaker to combat bradycardia during the procedure
Survival in the elderly (ave age of 60) after a AoV replacement (AVR)
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