Table Of ContentVALVE SURGERY AT THE TURN
OF THE MILLENNIUM
Developments in Cardiovascular Medicine
232. A. Bayés de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.):
Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X
233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease.
2000. ISBN: 0-7923-7829-6
234. J. Candell-Riera, J. Castell-Conesa, S. Aguadé Bruiz (eds): Myocardium at
Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3
235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing: New Concepts for the
New Century. 2001. ISBN: 0-7923-7378-2
236. Douglas L. Mann (ed.): The Role of Inflammatory Mediators in the Failing
Heart. 2001 ISBN: 0-7923-7381-2
237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac
Contractile Force, Second Edition. 2001 ISBN: 0-7923-7157-7
238. Brian D. Hoit, Richard A. Walsh (eds.): CardiovascularPhysiology in the
Genetically Engineered Mouse, Second Edition. 2001 ISBN 0-7923-7536-X
239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Genetics for Clinicians
2001 ISBN 1-4020-0097-9
240. Stephen M. Factor, Maria A.Lamberti-Abadi,JacoboAbadi (eds.): Handbook of
Pathology and Pathophysiology of Cardiovascular Disease. 2001
ISBN 0-7923-7542-4
241. Liong Bing Liem, Eugene Downar (eds): Progress in CatheterAblation. 2001
ISBN 1-4020-0147-9
242. Pieter A. Doevendans, Stefan Kääb (eds): CardiovascularGenomics: New
PathophysiologicalConcepts. 2002 ISBN 1-4020-7022-5
243. Daan Kromhout, AlessandroMenotti,Henry Blackburn (eds.): Prevention
of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven
Countries Study. 2002 ISBN 1-4020-7123-X
244. Antonio Pacifico (ed.), Philip D. Henry, Gust H. Bardy, Martin Borggrefe,
Francis E. Marchlinski, Andrea Natale, Bruce L. Wilkoff (assoc. eds):
Implantable Defibrillator Therapy: A Clinical Guide. 2002 ISBN 1-4020-7143-4
245. Hein J.J. Wellens, Anton P.M. Gorgels, Pieter A. Doevendans (eds.):
The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk
Stratification. 2002 ISBN 1-4020-7214-7
246. Jack Rychik, Gil Wernovsky(eds.): Hypoplastic Left Heart Syndrome. 2003
ISBN 1-4020-7319-4
247. Thomas H. Marwick: Stress Echocardiography. Its Role in the Diagnosis and Evaluation
of Coronary Artery Disease 2nd Edition. ISBN 1 -4020-7369-0
248. Akira Matsumori: Cardiomyopathies and Heart Failure: Biomolecular, Infectious
and Immune Mechanisms. 2003 ISBN 1-4020-7438-7
249. Ralph Shabetai: The Pericardium. 2003 ISBN 1-4020-7639-8
250. Irene D. Turpie; George A. Heckman (eds.): Aging Issues in Cardiology. 2004
ISBN 1-40207674-6
251. C.H.Peels; L.H.B.Baur (eds.): Valve Surgery at the Turn of the Millennium. 2004
ISBN 1-4020-7834-X
252. JasonX.-J.Yuan (ed.): Hypoxic Pulmonary Vasoconstriction: Cellular and Molecular
Mechanisms. 2004 ISBN 1-4020-7857-9
Previous volumes are still available
VALVE SURGERY AT THE TURN
OF THE MILLENNIUM
edited by
C. H. Peels
Catharina Hospital
Eindhoven, The Netherlands
and
L.H.B. Baur
Atrium Medical Center
Heerlen, The Netherlands
KLUWER ACADEMIC PUBLISHERS
NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW
eBookISBN: 1-4020-7848-X
Print ISBN: 1-4020-7834-X
©2004 Kluwer Academic Publishers
NewYork, Boston, Dordrecht, London, Moscow
Print ©2004 Kluwer Academic Publishers
Boston
All rights reserved
No part of this eBook maybe reproducedor transmitted inanyform or byanymeans,electronic,
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TABLE OF CONTENTS
PAGE1 PREFACE TO “VALVE SURGERY AT THE TURN OF THE
MILLENNIUM”
Preface By C.H. Peels and L.H.B. Baur
SECTION I: PRE AND PERIOPERATIVE EVALUATION OF MITRAL VALVE
DISEASE
PAGE 3 CHAPTER 1: PREOPERATIVE EVALUATION OF MITRAL
VALVE STENOSIS: WHAT DO WE NEED?
Dr. L.H.B. Baur
Assessment of mitral valve stenosis
Pre-operative Assessment for Surgical Intervention
Guideline for Treatment of Mitral Valve Stenosis
PAGE 15 CHAPTER 2: PREOPERATIVE EVALUATION OF MITRAL
REGURGITATION: THE CHALLENGE OF OPTIMAL TIMING
C.H. Peels
Introduction
Evaluation of the cause of MR
Evaluation of the severity of MR
Left ventricular function and mitral regurgitation
Why optimal timing
Factors influencing timing of surgery
PAGE 25 CHAPTER 3: PERIOPERATIVE TRANSESOPHAGEAL
ECHOCARDIOGRAPHY IN MITRAL VALVE SURGERY
Dr. R.B.A. van den Brink, Prof.dr. B.A.J.M. de Mol
Introduction
How to image the mechanism of mitral valve
regurgitation by multiplane TEE?
Anatomy of the valve: The surgeons view
Anatomy of the valve: The echocardiographers view
vi
Function of the mitral valve
Mechanism of mitral regurgitation
How to assess severity of mitral regurgitation?
Does intraoperative TEE during mitral valve repairpredict
early and late mitral valve dysfunction?
Evaluation of mitral prostheses by transesophagea
ehocardiography
Conclusion
SECTION II: MITRAL VALVE SURGERY: TECHNIQUES
PAGE 45 CHAPTER 1: LONG-TERM RESULTS OF PROSTHETIC
DEVICES IN MITRAL POSITION
Dr. G.L. van Rijk-Zwikker, Dr. B.J. M. Delemarre,
Prof. dr. R.A.E. Dion
The Natural History of Mitral Incompetence
Role of atrial fibrillation
Pre-operative determinants for late survival
Postoperative determinants for late survival after mitral
valve replacement
Post-operative thrombo-embolic events and bleeding
Re-operations
Endocarditis
Post-operative pulmonary hypertension
Structuralfailure
Paravalvular Defects
Valve Thrombosis
Pannus
Summary
PAGE 59 CHAPTER 2: POSTOPERATIVE EVALUATION AFTER MITRAL
VALVE SURGERY
Dr. F. Flachskampf
Introduction
General considerations: indications for and goals of the
postoperative echo study
Postoperative evaluation of mitral valve repair
Postoperative evaluation of mitral valve replacement
Other typical postoperative problems
Does the postoperative echo make a difference
vii
SECTION III: PRE AND PERI-OPERATIVE EVALUATION OF AORTIC VALVE
DISEASE
PAGE 69 CHAPTER 1: PREOPERATIVE EVALUATION OF AORTIC
INSUFFICIENCY: OPTIMAL TIMING
C.H. Peels
Introduction
Etiology of aortic regurgitation
Assessment of severity of aortic regurgitation
Noninvasive follow up in chronic aortic regurgitation
Timing of surgical intervention
Factors influencing outcome after surgery for aortic
regurgitation
Summary
PAGE 77 CHAPTER 2: HEMODYNAMIC EVALUATION OF AORTIC
STENOSIS
Dr. J.M. van Dantzig
Introduction
Echocardiographic evaluation of aortic stenosis:
Assessment of valve morphology
Echocardiographic evaluation of aortic stenosis:
Assessment of stenosis severity
Assessment of stenosis severity in low-flow states
Conclusion
PAGE 85 CHAPTER 3: THE ROLE OF TRANSESOPHAGEAL
ECHOCARDIOGRAPHY IN THE PERI-OPERATIVE PERIOD
Dr. L.H.B. Baur
Aortic Valve Disease
Mitral Valve Disease
Detection of Ischemia
Measurement of Systolic Function and Preload
viii
PAGE 93 CHAPTER 4: EVALUATION OF VALVE DISEASE WITH
NOVEL IMAGING TECHNIQUES
Prof. dr. E.E. van der Wall
Technical Aspects in MR Imaging
Contraindications to MR Imaging
Aortic Valve Stenosis
AorticValveInsufficiency
Mitral Valve Stenosis
Mitral Valve Regurgitation
Tricuspid Valve Disease
Pulmonic Valve Disease
Mixed Valvular Disease
Prosthetic Valves
Conclusions
SECTIONIV: AORTIC VALVE SURGERY: TECHNIQUES AND CHOICE OF
PROSTHESES
PAGE 105 CHAPTER 1: THE PLACE OF TISSUE VALVES IN AORTIC
VALVE SURGERY
Prof. dr. H.A. Huysmans
Introduction
Porcine xenografts
Autografts
Experience and use of tissue valves
Indications fr the use of tissue valves
PAGE 111 CHAPTER 2: THE PLACE OF THE ROSS PROCEDURE IN
AORTIC VALVE DISEASE
Prof. dr. M. Hazekamp, P. Schoof
Introduction
Technical aspects
Advantages
Disadvantages
Results
Comment
ix
PAGE 117 CHAPTER 3: IS A MECHANICAL PROSTHESIS ALWAYS
THE BEST SOLUTION FOR AN AORTIC VALVE
REPLACEMENT IN ADULTS ?
A.H.M. van Straten
Introduction
Hemodynamic performance
Valve related morbidity
Valve related death
Availability
Implantation technique
Comfort for the patient
Discussion
PAGE 125 CHAPTER 4: POSTOPERATIVE REGRESSION OF LEFT
VENTRICULAR HYPERTROPHY
Dr. L.H.B. Baur, C. H. Peels, J. Kooiker,
Prof. dr. H.A.Huysmans
Introduction
Aortic Stenosis
Aortic Insufficiency
Our own experience in patients with aortic valve disease
Influence of etiology on leftventricularremodeling
Influence of concomitant coronary artery disease on left
ventricular remodeling
Mitral Insufficiency
PAGE 137 CHAPTER 5: VALVE PROSTHESIS – PATIENT MISMATCH
HOW TO ASSESS IT AND IS IT REALLY A CLINICAL
PROBLEM?
Dr. R.B.A. van den Brink, A.P. Yazdanbakhsh,
Prof. dr. B.A.J.M. de Mol
Introduction
Assessment of Valve prosthesis – Patient Mismatch (VP- PM)
Clinical impact of valve prosthesis – Patient Mismatch
Clinical impact of mitral valve prosthesis – Patient Mismatch(MVP-PM)
Conclusion
x
SECTION V: PROBLEMS IN VALVE DISEASE
PAGE 155 CHAPTER 1: VALVULAR HEART DISEASE:
IS IT EVER TOO LATE TO OPERATE?
C.H. Peels
Introduction
Cardiac arguments: Severe Aortic Stenosis, when not to
operate?
Cardiac arguments: Aortic regurgitation, ever too late to operate?
Cardiacarguments:Mitralregurgitation, when is the operative
risk prohibitive?
Cardiac arguments: Mitral stenosis, never too late to operate
Non-cardiac arguments: Comorbidity influencing the decision to
defer from operation
PAGE 163 CHAPTER 2: PROSTHETIC VALVE DYSFUNCTION
Dr. B.J.M. Delemarre, Dr. G.L. van Rijk-Zwikker,
Prof. dr. R.A.E. Dion
Introduction
Prosthesis related dysfunction, orientation
Prosthesis related dysfunction, subvalvular apparatus
Dysfunction of the valveprosthesis, structural
Dysfunction of the valve prosthesis, non structural
PAGE 179 CHAPTER 3: VALVULAR PATHOLOGY IN PREGNANCY
Dr. K. Konings, Dr. F.J.M.E. Roumen, Dr. L.H.B.Baur
Introduction
Pregnancy and Valve Pathology; Physiological Adaptation
Stenotic Valve Lesions
Regurgitant Valve Pathology
Prosthetic HeartValves
Discussion and Conclusions
