• Degenerative calcification 📷
• bicuspid aortic valve (congenital) 📷
• Rheumatism (acute rheumatic fever) 📷

• LV hypertrophy
• low cardiac flow

when effort:

• angina
• dyspnea
• syncope
• death

• pulsus parvus et tardus 📷
• systolic ejection murmor
• diminished BP in systoly

• ECG → LV hypertrophy
• Ecocardiography #most important
• xray → calcification
• coronarography → for planning of surgery (most of patient are old and often have coronary diseases)

depends on valvular lesions, specific symptoms, ventricle function, comorbities

• symptomatic = surgery
• asymptomatic with severe stenosis + ventricular dysfunction/ventricular tachycardia/hypertrophy(>15mm septum), orrifice <0.6cm2) = surgery
• moderate stensosis, in patient which also receive operation on asc. aorta or coronary artery = surgery

replacement aortic valve (Øpossible to repair)

→ under CPB

→ open aorta → replace valve with mechanical/biological valve (with stent or stent-less)📷

Mechanical: Østrucural defect, but anticoagulant for indefinite time

Biological: Øanticoagulation, but ↑rate of structural defects (over time)

Aortic valve cant close properly → backflow during diastole from aorta to ventricle → ↑blood volume in ventricle

• endocarditis
• Rheumatism
• Aortic dilation: dissection or collagen diseases
• trauma

• Inflammatory disease
• Bicuspide aortic valve

• endocarditis (i.e. due to rheumatic fever)
• aortic dissection
• trauma

• ventricle is not adapted to that much volume
• ↑hypoxia of coronaries

• hypertrophy of ventricle → dilation → mitral insuff → pulmonary congestion (esp when complicated)

• angina
• dyspnea (effort)
• asthenia

• ↑pulse pressure (↓diastolic)

‣

💬

• diastolic murmor 4th ICS

• ECG → LV hypertrophy
• Ecocardiography #MVP→ valvular modification
• Doppler → regurgitation
• Xray → dilated heart + asc. aorta
• CT + MRI

• Endocarditis prophylaxis
• Vasodilators + ACE inhibitors ⇒ ↓after-load

• symptomatic with severe. aortic insufficience + EF>60(normal)
• severe aortic insuff + normal EF, but progressive ventricular dialtion
• symptomatic/ asymptomatic dysfunction of LV

1. Reconstruction 📷
2. Replacement: Mechanical/biological valve 📷

via sternotomy

1. Thromboembolism - esp with mechanical valve → anticoagulation
2. Thrombotic blocking of mechnaical valve
3. Hemorrhage
4. Valve
1. Endocarditis on valve prothesis
2. Valvular dysfunction
3. Hemolysis