J Heart Valve Dis
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Review Case Reports
What is the role of balloon dilatation for severe aortic stenosis during pregnancy?
Severe aortic stenosis in pregnancy creates several challenges for the physician. In recent years, balloon valvuloplasty has become more widely used, though the indications for its use in this setting are unclear. A review of the available evidence is presented, and a suggested management strategy illustrated. ⋯ The use of aortic balloon valvuloplasty in pregnancy is useful as a palliative procedure, allowing deferral of valve replacement until after birth. Echocardiographic features alone are not enough to decide on management, and symptoms play a vital role in determining risk. The use of transesophageal echocardiography during the procedure significantly reduces fluoroscopy time.
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The finding of aortic valve calcification is of clinical relevance. Thickening and calcification of the aortic valve ('aortic sclerosis') may progress over time to calcific aortic stenosis, and calcification of the aortic valve has prognostic importance even in the absence of valve obstruction. Aortic valve calcification may also have effects on the conduction system. ⋯ CT appears able to fulfil this requirement, though the technique is still relatively novel. This review examines the need for aortic valve calcium quantification and the evolution of imaging to the current status. Future directions and the promise of new helical CT technologies with respect to cardiac imaging are explored.
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Valve selection for the small aortic root is a multifactorial process. Considerations include the effective orifice (EOA) of the implanted valve, annular size, body surface area (BSA), and valvular outflow tract of each patient. To decide if a valve is adequate for a patient, the valve EOA and patient BSA are used to calculate the indexed EOA (EOA/BSA). ⋯ Pledgetted sutures can draw tissue underneath the valve and reduce the EOA. In conclusion, multiple factors must be evaluated when deciding which valve to use as a replacement in the small aortic root. These include patient age, lifestyle, pregnancy status, and drug compliance, as well as the indexed EOA of available prosthetic valves and the surgical procedure required for implant.
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Multiplane transesophageal echocardiography (TEE) is useful in providing a detailed anatomic map for successful mitral valve repair. This report describes an approach, developed over the past two to three years, which helps to delineate valve anatomy in specific detail. Mid-esophageal views are selected to view different segments of the valve leaflets. When correlated with surgical anatomy, this approach is found to be both practical and useful.
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Mitral valve injury from blunt trauma to the chest is an uncommon entity. We report a case of mitral valve injury after a fall, and its repair. The English literature is reviewed from the earliest report in 1873 to the present. The diagnosis, types of injury and surgical correction are discussed.