Valve Surgery at the Turn of the Millennium

Abstract

Preface C.H. Peels, L.H.B. Baur. Section I: Pre and perioperative evaluation of mitral valve disease. 1: Preoperative Evaluation Of Mitral Valve Stenosis: What Do We Need? L.H.B. Baur. -Assessment of mitral valve stenosis. -Pre-operative Assessment for Surgical Intervention. -Guideline for Treatment of Mitral Valve Stenosis. 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. 3: Perioperative Transesophageal Echocardiography In Mitral Valve Surgery R.B.A. van den Brink, B.A.J.M. de Mol. - Introduction. -How to image the mechanism of mitral valve. regurgitation by multiplane TEE? -Anatomy of the valve: The surgeon's view. -Anatomy of the valve: The echocardiographer's view. -Function of the mitral valve. -Mechanism of mitral regurgitation. -How to assess severity of mitral regurgitation? -Does intraoperative TEE during mitral valve repair predict early and late mitral valve dysfunction? -Evaluation of mitral prostheses by transesophageal echocardiography. -Conclusion. Section II: Mitral Valve Surgery: Techniques. 1: Long-Term Results Of Prosthetic Devices In Mitral Position G.L. van Rijk-Zwikker, B.J. M. Delemarre, 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. -Structural failure. -Paravalvular Defects. -Valve Thrombosis. -Pannus. -Summary. 2: Postoperative Evaluation After Mitral Valve Surgery 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? Section III: Pre And Peri-Operative Evaluation Of Aortic Valve Disease. 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. 2: Hemodynamic Evaluation Of Aortic Stenosis 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. 3: The Role Of Transesophageal Echocardiography In The Peri-Operative Period L.H.B. Baur. -Aortic Valve Disease. -Mitral Valve Disease. -Detection of Ischemia. -Measurement of Systolic Function and Preload. 4: Evaluation Of Valve Disease With Novel Imaging Techniques E.E. van der Wall. -Technical Aspects in MR Imaging. -Contraindications to MR Imaging. -Aortic Valve Stenosis. -Aortic Valve Insufficiency. -Mitral Valve Stenosis. -Mitral Valve Regurgitation. -Tricuspid Valve Disease. -Pulmonic Valve Disease. -Mixed Valvular Disease. -Prosthetic Valves. -Conclusions. Section IV: Aortic valve surgery: Techniques and Choice of Prostheses. 1: The Place Of Tissue Valves In Aortic Valve Surgery H.A. Huysmans. -Introduction. -Porcine Xenografts. -Autografts. -Experience and Use of Tissue Valves. -Indications for the Use of Tissue Valves. 2: The Place Of The Ross Procedure In Aortic Valve Disease M. Hazekamp, P. Schoof. -Introduction. -Technical aspects. -Advantages. -Disadvantages. -Results. -Comment. 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. 4: Postoperative Regression Of Left Ventricular Hypertrophy L.H.B. Baur, C.H. Peels, J. Kooiker, A. Huysmans. -Introduction. -Aortic Stenosis. -Aortic Insufficiency. -Our own experience in patients with aortic valve disease. -Influence of etiology on left ventricular remodeling. -Influence of concomitant coronary artery disease on left ventricular remodeling. -Mitral Insufficiency. 5: Valve Prosthesis -Patient Mismatch How To Assess It And Is It Really A Clinical Problem? R.B.A. van den Brink, A.P. Yazdanbakhsh, 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. Section V: Problems In Valve Disease. 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? -Cardiac arguments: Mitral regurgitation, 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. 2: Prosthetic Valve Dysfunction B.J.M. Delemarre, G.L. van Rijk-Zwikker, R.A.E. Dion. -Introduction. -Prosthesis related dysfunction, orientation. -Prosthesis related dysfunction, subvalvular apparatus. -Dysfunction of the valve prosthesis, structural. -Dysfunction of the valve prosthesis, non structural. 3: Valvular Pathology In Pregnancy K. Konings, F.J.M.E. Roumen, L.H.B. Baur. -Introduction. -Pregnancy and Valve Pathology Physiological Adaptation. -Stenotic Valve Lesions. -Regurgitant Valve Pathology. -Prosthetic Heart Valves. -Discussion and Conclusions. 4: Surgical Approach Of Acute Endocarditis A.H.M. van Straten. -Introduction. -Indications for surgical intervention. -Surgical technique. -Results of surgery. -Discussion. Index.