Aortic Valve - Science topic

These are the ganglionated plexuses of the heart which lie within the epicardial fat predominantly in the atria. You can also see the beginning of a nerve in "high zoom top.png". The individual cells are called ganglion cells. You can confirm using immunohistochemistry such as PGP9.5 or NSE.

is there a image of tracing

I'm unable to see

That's a good question

Just seeing this thread now, but I am going to answer this here in case it is helpful to anyone who might stumble upon this .... You could look up this website: www.rnassist.com. This product called vivoPHIX enables tissue fixation and then dissociation for tissues, prior to downstream applications !

Thierry C Gillebert Thank you very much for your answer. It was really helpful.

As far as we know there is no difference in symptom progression due to bicuspid aortic valve disease in diabetic patients. This could be related to a poor representation of this patients in clinical trials. Usually symptoms depends on the degree of valve dysfunction. You should expect dyspnea, chest pain o syncope when valve disease is advanced. Perhaps chest pain could presente earlier in diabetic patients who are more prompt to develop coronary disease and relative ischemia in bicuspid valve advanced stenosis or regurgitation.

Aortic stenosis followed by mitral regurgitation. However, we observe sometimes in patients with chronic IE a combined aortic vitium (Stenosis & regurgitation)

Thank you all for this interesting discussion

Which program are you using in the first place to create the NURBS geometry? You may have the option to create a less detailed geometry at that point. Otherwise I would suggest using a 3D modelling software such as SolidWorks or similar to simplify your geometry before importing to Ansys. 

Thank you for your response! I will investigate this further.

We could try to arrange DNA testing in our lab? We have been sequencing the FBN1 gene for several years now and this could potentially be performed without cost if your patient cannot afford this.

Let me know if this would be usefull.

There is a very recent case report with free text available: 

Ann Card Anaesth. 2016 Jan-Mar;19(1):166-8. doi: 10.4103/0971-9784.173041.

Perceval S aortic valve implantation in an achondroplastic Dwarf.

Baikoussis NG1, Argiriou M, Argiriou O, Dedeilias P.

Author information

 

Abstract

Despite cardiovascular disease in patients with dwarfism is not rare; there is a lack of reports referring to cardiac interventions in such patients. Dwarfism may be due to achondroplasia or hormonal growth disorders. We present a 58-year-old woman with episodes of dyspnea for several months. She underwent on transthoracic echocardiography, and she diagnosed with severe aortic valve stenosis. She referred to our department for surgical treatment of this finding. In accordance of her anthropometric characteristics and her very small aortic annulus, we had the dilemma of prosthesis selection. We decided to implant a stentless valve to optimize her effective orifice area. Our aim is to present the successful Perceval S valve implantation and the descriptions of the problems coming across in operating on these special patients. To our knowledge, this is the first case patient in which a Perceval S valve is implanted according to the international bibliography.

It is easier to obtain a good orientation in paraffin sections.

You can start cutting with the microtome or cryostat from the aorta and observe the sections to detect when the first commissure appears. Then, you slightly re-orient the block and cut several more sections until you obtain the distal part of the three commissures in the same section.

Alternatively, before or after fixation you can carefully cut the aorta transversally at the most distal level of the commissures, in order to obtain a complete transversal plain. Then you just cut exactly with that orientation in the microtome or criostat.

Hope this helps

The focused thing in this case is atrial fibrillation, so one should follow the CHA2DS2 VASc  score in deciding the anticougulant therapy. Considering  findings from the ADVANCE study, one is to aware of the increased risk of thromboembolism in TAVR patient. Weighing the risk for bleeding ( BLED score ), I may opt for anti-cougulants if the bleeding risk is low.

The sudden bradycardia and cardiac distention does not fit with hypovolaemia. Although it is a bit late, gas emobism from an inadequtely vented LV, down the right coronary artery would precipitate ischaemia of the sinoartrial node so bradycardia as well as RV dysfuntion and distention.

Hi Subhash,

1. that depends on the valve you're looking at.

120mmHg is the aortic pressure during end-systole. The aortic valve is open, thus there is no load on it (if wall shear stress or other are neglected). The main load on this valve is reached shortly after valve closure. Here is a picture were you can see some pressure gradients during the heart cycle: http://howmed.net/physiology/cardiac-cycle/  The max load on the aortic valve occurs after valve closure (pAorta - pLeftVentricle: ~100 mmHg).

Another question is if you are looking at healthy or diseased hearts.

2+3. You can find several publications on this topic I guess. Maybe start with the book 'Biomechanics - Mechanical Properties of Living Tissues' or '

Biomechanics: Motion, Flow, Stress, and Growth', both by Yuan-Cheng Fung

maybe this reference also can help you:

Importance of Measurement of the Diameter of the Aorta during Peroperative Blood Flow Monitoring; 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; p.2402 - 2403; DOI: 10.1109/IEMBS.1992.5761425.

Dear Roberto how, are you?

I think that TF should be consider theoretically less invasive compare to TA, DAo or subclavian but in my opinion proximal access site allow a more precise valve positioning.

Was this an isolated AVR or a root? Was it done for endocarditis?

That's a tough one, 'cause price of valves varies, according to several factors: a) total amount of valves sold to your institution/ group, b) country (even local area or region) where you practice, c) time-frame of payment (hospital to company), d) whether the company/ agent sells other fungibles or expendables to your hospital/ group (can afford to sell cheaper valves if fringe benefits on other entries, i.e. pacemakers).

The center I work in buys mechanicals (SJM, Carbomedix) for somewhere in between 2500 and 2800 Euro, slightly less for BPV's (periardial or porcine). Then again, this is a public institution, with all nuances you might think of. These are well-functioning valves, beyond all doubt, as are ATS, On-X and most BPV's.

Choose your pick of both types, at least two providers on each, and be confident and comfortable with them.