Aortic valve disorders and left ventricular assist devices

Figures

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  Figure 1. Blind circulatory loop in the setting of AR. Left, normal circuit. Right, In the setting of AI, a portion of the LVAD output regurgitates through the AV into the LV and back again through the LVAD, creating a blind loop and decreasing the effective forward flow and, hence, end organ perfusion. 1 = aorta; 2 = left ventricle; 3 = inflow cannula; 4 = pump; 5 = outflow cannula; and 6 = peripheral perfusion. AR, aortic regurgitation. Reproduced with permission from (12).

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  Figure 2. Representative heartware tracings of severe aortic insufficiency. Reproduced with permission from (19).

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  Figure 3. Novel echocardiographic parameters for assessment of LVAD-AI. Reproduced with permission from (25).

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  Figure 4. Park’s stitch. Pledgeted 4-0 Prolene sutures are applied to approximate the fibrous nodules of Arantius to create a coaptation stitch. Reproduced with permission from (1).

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  Figure 5. Modified park’s stitch.

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  Figure 6. A circular patch of bovine pericardium was sutured circumferentially to the aortic annulus above the native aortic valve leaflets. Reproduced with permission from (43).

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  Figure 7. Recommendations for management of aortic insufficiency.

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  Figure 8. (A) Amplatzer device (*) implant for severe AI 3 years after HMII implantation. (B) Echocardiograpic appearance of device.

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  Figure 9. (A–C) Attempted Evolut R implant with ventricular migration immediately after release stabilized with 29 mm Sapien 3 implant inside the malpositioned Evolut. (D–F) Ventricular migration of Evolut R valve in another patient with repositioning using a gooseneck snare (asterisk) and implantation of a second Evolut R inside with post dilation reducing aortic insufficiency to trace.