1- Treatment of aortic valve stenosis, aortic valve insufficiency.

what is the treatment of AS

• no effective medical treatment

  • statins are contraindicated due to bone formation?

• aortic valve replacement

• palliative treatment, treatment for HF

• caution with vasodilators

what are the types of aortic valve replacements

• open

  • mechanical/ biological prosthesis

• transcatheter aortic valve implantation- TAVI

  • high (intermediate) surgical risk patients

• balloon valvuloplasty

what are the entrance options for TAVI

• transapical
• transfemoral
• subclavian/ axillary
• carotid
• common iliac a.

how do you decide if you should do TAVI vs surgery

• surgery
  • low surgical risk
  • anatomical unsuitability
  • LV aortic mass
  • endocarditis
• TAVI
  • high surgical risk
  • LIMA graft
  • chest deformity
  • chest irradiation

describe aortic valve replacement

• gold standard treatment
• for pts with positive stress test + symptoms + EF <50%
• safe + effective
• bioprosthetic vavle preferred in older patients

what is balloon aortic valvuloplasty

• non surgical alternative treatment
• 50% restenosis rate within 6 months
• for patients unfit for AVR or who refuse surgery
• balloon is inflated → stretches stenosis

what is the treatment for AR

• no specific medical treatment
• surgical aortic valve replacement/ repair
• heart failure treatment

what is the medical management of AR

• asymptomatic AND AR → follow up with echo to monitor
• severe AR with LV dysfunction or symptoms
  • loop diuretics- furosemide
  • digoxin
  • vasodilators- ACEi, CCB
  • nitrates for angina
• acute evere AR → urgent surgical intervention

what are the indications for intervention in AR

• symptoms
• LV dilation
• LV dysfunction

when is valve replacement indicated in AR

• severe AR with EF <50% and severe LV dilatio