alsharqia.riyadh echo meeting dammam ksa sayed abou el soud md sbcc
TRANSCRIPT
![Page 1: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/1.jpg)
Alsharqia.riyadh Echo meeting
Dammam KSA SAYED ABOU EL SOUD
MDSBCC
![Page 2: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/2.jpg)
Case 1
![Page 3: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/3.jpg)
History • 48 y old Saudi lady • Hypothyroidism,ch. Spondylisis• H/O intracranial HTN 6 years
before admission & ventriculoperitoneal shunt ( removed later )
• Labarscopic cholecystecomy & RT modified mastectomy
• Now neurologically grossly intact
![Page 4: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/4.jpg)
• S/P AVR in other hospital with tissue valve size 21 ( mosaic valve ) in 6/2011 ( 2 ys ago )
• Presented to SBCC ( 2 month ago) with C/O chest pain , dyspnea and syncobal attacks
• O/E obese well oriented pt• Ejection syst . murmer • ECG LV hypertrophy & strain • HB is 12.6 , creatinine 1.5
![Page 5: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/5.jpg)
Preoperative TTE
![Page 6: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/6.jpg)
![Page 7: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/7.jpg)
![Page 8: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/8.jpg)
![Page 9: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/9.jpg)
![Page 10: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/10.jpg)
![Page 11: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/11.jpg)
![Page 12: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/12.jpg)
![Page 13: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/13.jpg)
![Page 14: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/14.jpg)
![Page 15: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/15.jpg)
![Page 16: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/16.jpg)
![Page 17: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/17.jpg)
![Page 18: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/18.jpg)
PREOPERATIVE TEE
![Page 19: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/19.jpg)
![Page 20: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/20.jpg)
![Page 21: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/21.jpg)
![Page 22: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/22.jpg)
![Page 23: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/23.jpg)
![Page 24: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/24.jpg)
![Page 25: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/25.jpg)
![Page 26: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/26.jpg)
![Page 27: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/27.jpg)
![Page 28: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/28.jpg)
![Page 29: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/29.jpg)
IMPRESSION • 48 y lady , obese , multiple co
morbidities• Severely symptomatic relatively early
postoperative • Significant : – gradient across AV & OFT– Severe LVH , normal LV function – Tilting partially supra- annular valve – leaflets opening well – Remnants of the native valve in 1st operation
![Page 30: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/30.jpg)
![Page 31: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/31.jpg)
• GEOMETRIC ORIFICE AREA ( area blood flow through )
• MOUNTING AREA (area occupied by the valve in the native annulus )
![Page 32: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/32.jpg)
IMPLANT TECHNIQUE
• TOATLLY INTRA ANNULAR : GOA/MOUNTING AREA = 40-70 %
• PARTIAL SUPRA-ANNULAR : GOA/MOUNTING AREA= 80 %-85 %
• TOTALLY SUPRAANNULAR : APPROACHES 100% MAXIMIZING BOOLD FLOW
![Page 33: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/33.jpg)
Surgery • Aortic patch ( dilate aorta )• Valve replacement (tissue
valve ) has Hx of intracranial HGE
• Myomectomy ( dilate LVOT )
![Page 34: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/34.jpg)
POSTOPERATIVE TEE
![Page 35: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/35.jpg)
![Page 36: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/36.jpg)
![Page 37: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/37.jpg)
![Page 38: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/38.jpg)
![Page 39: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/39.jpg)
POSTOPERATIVE TTE
![Page 40: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/40.jpg)
![Page 41: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/41.jpg)
![Page 42: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/42.jpg)
![Page 43: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/43.jpg)
![Page 44: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/44.jpg)
![Page 45: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/45.jpg)
![Page 46: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/46.jpg)
![Page 47: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/47.jpg)
Case 2
![Page 48: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/48.jpg)
History• 46 y old saudi female• K/C of HTN, hypothyroidism• K/C AVD, bicuspid AV with
sever AS• S/P AVR “tissue valve”1 year
ago
![Page 49: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/49.jpg)
History• presented to our ER C/O– progressive exertional dyspnea up
to NYHA III. – She also c/o of chest pain & near
syncopal attacks
• O/E – Pt had mild pulm. congestion &
uncontrolled B/P 160/95– Ejection systolic murmur over the AV
![Page 50: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/50.jpg)
TTE
![Page 51: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/51.jpg)
![Page 52: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/52.jpg)
![Page 53: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/53.jpg)
![Page 54: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/54.jpg)
![Page 55: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/55.jpg)
![Page 56: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/56.jpg)
![Page 57: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/57.jpg)
![Page 58: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/58.jpg)
![Page 59: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/59.jpg)
TEE
![Page 60: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/60.jpg)
![Page 61: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/61.jpg)
![Page 62: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/62.jpg)
Impression
• Tissue valve opening well• Tilting valve • Significant gradient across aortic end of valve
![Page 63: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/63.jpg)
Course • Discharged for second opinion• Lost follow up
![Page 64: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/64.jpg)
Case 3
![Page 65: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/65.jpg)
History• 18 yeas old saudi male.• s/p AVR “ metalic valve” &
closure of VSD in another hospital
• Pt presented to OPD completely asymptomatic.
• Pt referred for echocardiography as baseline post operative echo.
![Page 66: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/66.jpg)
TTE
![Page 67: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/67.jpg)
![Page 68: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/68.jpg)
![Page 69: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/69.jpg)
![Page 70: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/70.jpg)
![Page 71: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/71.jpg)
![Page 72: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/72.jpg)
![Page 73: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/73.jpg)
![Page 74: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/74.jpg)
![Page 75: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/75.jpg)
![Page 76: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/76.jpg)
TEE
![Page 77: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/77.jpg)
![Page 78: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/78.jpg)
![Page 79: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/79.jpg)
![Page 80: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/80.jpg)
![Page 81: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/81.jpg)
Impression • Severely impaired LV function.
( normal preoperative ) • tilting valve with Significant
gradient across the aortic end . ( false moderate gradient due to LV dysfunction )
• Fluoroscopy showed freely mobile leaflets with full range of movement
![Page 82: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/82.jpg)
![Page 83: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/83.jpg)
Course • very high risk for REDO
surgery • Pt preferred to be referred
back to the hospital where he performed 1st surgery
![Page 84: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/84.jpg)
Arguments
• Partially supra annular implantation to incraese GVA IS OPTIMAL ???
• Why gradients not usually appear immediate postoperative and appear later in follow up???
![Page 85: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/85.jpg)
Home message
Left for respected panel
![Page 86: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/86.jpg)
![Page 87: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/87.jpg)
• Published data about Doppler hemodynamic parameters of normofunctioning prosthetic valves in aortic position
![Page 88: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/88.jpg)
![Page 89: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/89.jpg)
Baseline valve assessment
• Therefore, the optimal timing of the baseline assessment of valve prosthesis haemodynamics should be placed between the third and the sixth month (not later than 1 year) after surgery.
![Page 90: Alsharqia.riyadh Echo meeting Dammam KSA SAYED ABOU EL SOUD MD SBCC](https://reader030.vdocuments.us/reader030/viewer/2022032705/56649dc35503460f94ab5f58/html5/thumbnails/90.jpg)
• . In patients undergoing aortic valve replacement, there is a relatively high output state immediately after the operation due to relative anaemia and sudden reduction of left ventricular afterload, which affects transprosthetic gradients. Moreover, perivalvular oedema and haematoma may reduce prosthetic EOA. Finally, left ventricular function will change significantly soon after aortic valve replacement due to regression of hypertrophy and adaptation to the changed pre- and afterload conditions