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Atrial Septal Defect 2 (ASD) Typically known as a hole in the atrial portion of
the heart
Patients with both congenital defects, or myocardial diseases, may be a candidate for
one of three procedures
Open
Laparoscopic
In the late 1970s; aortic porcine (pig) heart valve replacement 5, aortic bovine
heart valve replacement, as well as donated human valve replacements where
performed. These are biological tissue valve replacements id.. Open AVR procedures
are highly invasive, having several long term and short term risks. Open AVRs involve
a patient undergoing a median sternotomy. (midsagittal incision is made) , and
osteoclasis, exposing the pericardium, giving the surgeon access to the heart to
replace the defective valve. It also requires arresting the heart during the operation.
U.S National Library of Medicine Transposition of the great vessels is a heart defect that occurs from birth (congenital). The
two major vessels that carry blood away from the heart -- the aorta and the pulmonary artery -- are switched (transposed).
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Saint Jude Medical Heart Valve Replacement Tissue valves are made with tissues from porcine (pig) heart
valves or bovine (cow) cardiac tissue because they function like human heart valves. Once the tissue is removed
from the animal, it is chemically treated to preserve the tissue and prevent immulogic reactions once it is placed in a
patient. https://health.sjm.com/heart-valve-answers/treatment-options/heart-valve-replacement
Biological (tissue) valves are taken from pig, cow, or human donors.
Most TAVR procedures are performed in a hybrid operating room7 with a fixed
fluoroscopic imaging system8. A fluoroscope is used to determine a diagnosis from
live display of patient anatomy id,
Annuls of Cardiothroacic Surgery Vol 2, No 1 (January 2013) The role of echocardiography in aortic valve repair
Susheel K. Kodali, M.D., Mathew R. Williams, M.D., Craig R. Smith, M.D., Lars G. Svensson, M.D., Ph.D., John G. Webb, M.D., Raj R.
Makkar, M.D., Gregory P. Fontana, M.D., Todd M. Dewey, M.D., Vinod H. Thourani, M.D., Augusto D. Pichard, M.D., Michael Fischbein,
M.D., Ph.D., Wilson Y. Szeto, M.D., Scott Lim, M.D., Kevin L. Greason, M.D., Paul S. Teirstein, M.D., S. Chris Malaisrie, M.D., Pamela S.
Douglas, M.D., Rebecca T. Hahn, M.D., Brian Whisenant, M.D., Alan Zajarias, M.D., Duolao Wang, Ph.D., Jodi J. Akin, M.S., William N.
Anderson, Ph.D., and Martin B. Leon, M.D. for the PARTNER Trial Investigators
N Engl J Med 2012; 366:1686-1695May 3, 2012 DOI: 10.1056/NEJMoa1200384
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The AAPM/RSNA Physics Tutorial for Residents General Overview of Fluoroscopic Imaging
The Procedure
Echocardiograms are used to determine the amount of aortostenosis. Once a patient
is confirmed having a valvular heart disease, such as calcfic aortic stenosis, the
surgeon will determine if he/ she is a candidate for TAVR, or will require an open AVR.
A TAVR does not require a general anesthesia, while the preoperative procedures are
the same, determining whether the patient is a candidate for TAVR. The patient is taken
to the operating room, where an anesthesiologist places the patient under
conscientious sedation using one of a variety of medications on the patient.
Fluoroscopy is used to perform any catheter, wire, sheath, or dilator insertion or
removal. The femoral artery is also measured using the fluoroscope prior to the surgery,
to determine the sheath size used in a TAVR. After Heparin is administered, the
replacement is delivered through an incision into inter costal region, entering the apex of
the heart via the thoracic cavity. The valve may also be delivered via an incision made
to the femoral artery, where the implant sheath is inserted in the artery, and advanced
up the artery into the aorta. The sheath transports a balloon to be expanded inside the
aorta, allowing a shunt, housing the new valve and assists in properly seating the valve.
Once the balloon is inflated, the shunt is placed in the aorta and expanded. A pressure
test is performed on the new valve, insuring no reflux occurs with the new valve. A
contrast is administered to test for proper blood flow, and or that no damage or defects
that may require a revision. Once the valve is in place, the wire and sheath are
extracted, and the incisions sutured.
Risks / Complications
Stroke, bleeding