1. CTSN -Aortic Valve Disease Read about the types of disease, incompetence, stenosis, symptoms, and diagnosis. Includes replacement surgery, the survival rate, and risks. http://www.ctsnet.org/residents/ctsn/archives/not42.html

Last revised 10/4/96 http://www.ctsnet.org/residents/ctsn/ Comments to John Doty

2. Aortic Valve Disease A look at stenosis and regurgitation of this valve. http://www.ps4ross.com/ross/back/avd.html

3. Aortic Valve Disease HEART CARE PROGRAM aortic valve disease The aortic valve is located between the left Pumping chamber (ventricle) and the aorta. http://www.med.umich.edu/hcp/pa_info/aortic.htm

H EART C ARE P ROGRAM AORTIC VALVE DISEASE The aortic valve is located between the left Pumping chamber (ventricle) and the aorta. This valve allows blood to flow from the heart to the body and leaflets which open and close with inability to close or open are the two major problems with this valve. To compensate for aortic stenosis (restricted opening), the heart has to squeeze harder to support normal blood flow, causing the heart muscle to enlarge Eventually, as the stenosis increases, the heart begins to fail. Symptoms of aortic Stenosis are shortness of breath, fainting episodes due to a lack of blood flow to the brain, chest pain due to lack of blood flow to collapse due to irregular heart rhythms that occurs when the aortic valve does not completely close and blood flows back from the aorta into the heart. Aortic Valve Replacement Valves are replaced because they rarely can be repaired. Three types of replacement valves are available: mechanical, bioprosthetic and human Mechanical valves, which normally last a lifetime, are synthetic and made of plastic, cloth, and metal. The moving parts are coated to help prevent the formation of a blood clot on the valve However blood thinners (Coumadin) must be used. Stroke or bleeding problems may occur with mechanical valves, so strict follow-up with your local physician is needed to regulate your blood thinning medication. Bioprosthetic (animal) valves are sterilized for human use and may not require blood thinners. Stroke and bleeding problems rarely occur with this type of valve, however, they tend to wear out and need to be replaced in seven to 10 years. Human valves are obtained from donors after death. These valves are superior to mechanical and bioprosthetic valves as they are most like your natural valve. Blood thinners are not necessary. The longevity of these valves is 15 to 20 years.

4. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease Tricuspid Valve Disease. aortic valve disease. AORTIC REGURGITATION. (Aortic Incompetence or Insufficiency) http://www.merck.com/pubs/mmanual/section16/chapter207/207c.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 207. Valvular Heart Disease Topics [General] Mitral Valve Disease Aortic Valve Disease Tricuspid Valve Disease Aortic Valve Disease AORTIC REGURGITATION (Aortic Incompetence or Insufficiency) Retrograde flow from the aorta into the left ventricle through incompetent aortic cusps. LV volume and LV stroke volume are increased because the LV must receive blood regurgitated in diastole in addition to normal blood flow from the pulmonary veins. LV hypertrophy occurs proportionally with dilation to maintain pressure. (Laplace's law: pressure = tension/radius. As the radius increases, tension is increased.) The cor bovinum of severe AR is the largest, heaviest heart in cardiac pathology. Symptoms, Signs, and Diagnosis Effort tolerance usually remains remarkably good for many years, even with severe AR, until dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea develop. Palpitations may occur because of awareness of the heart due to LV enlargement. In the absence of coronary disease, angina pectoris occurs in only about 5% of patients, and only with gross AR. It is especially common at night, perhaps because AR increases with slow heart rates. On auscultation, a pandiastolic decrescendo murmur is loudest over the sternum and left lower sternal border; S

5. Aortic Valve Disease Resources On The Internet millions of published articles for news on aortic valve disease. The eLibrary newspaper and magazine archive contains http://www.healthcyclopedia.com/aortic_valve_disease.html

Home Health Conditions by Category ... Contact Us Aortic Valve Disease Health News Search millions of published articles for news on Aortic Valve Disease The eLibrary newspaper and magazine archive contains articles from current and back issues of hundreds of publications, including: Modern Medicine Aging The Ardell Wellness Report HealthFacts The Journal of Environmental Health Medical Post Medical Update Men's Health and the National Women's Health Report Note: To access the full text of articles, sign up for a seven-day no-risk free trial subscription to eLibrary. Web Directory Web Links: Adam.com: An Overview - A look at aortic insufficiency and its alternative names, causes, incidence and risk factors. American Heart Association - Defines aortic regurgitation and looks at the causes and what should be done. Aortic Stenosis - Overview - Adam.com looks at this disorder and its causes, risk factors and incidence. Aortic Valve Disease - A look at stenosis and regurgitation of this valve. Cardiothoracic Surgery Notes - A look at the types of disease of the aortic valve, incompetence, symptoms, diagnosis, natural history of stenosis and regurgitation. Facts about replacement surgery, the survival statistics and risk factors post operation. Eric Berlin, MD: Health Answers

6. PS4ROSS: Aortic Valve Disease Back to the Ross page, aortic valve disease. Many problems can interferewith the proper functioning of a valve. They may be congenital http://ps4ross.com/ross/back/avd.html

Aortic Valve Disease Many problems can interfere with the proper functioning of a valve. They may be congenital (abnormal from birth), infectious (endocarditis), inflammatory (rheumatic fever), or just wear and tear over the years. In general, heart valve problems take one of two forms: Stenosis describes the condition when a valve does not open completely or the opening is too small, resulting in restricted blood flow; or Regurgitation , or Insufficiency, implies that blood leaks backward across the valve that should be closed. Some valves have both problems to varying degrees. Because the Ross procedure is primarily an aortic valve operation, this text focuses on problems pertaining to the aortic valve. table of contents E-mail: pstelzer@ps4ross.com phone:

7. PS4ROSS.COM UP, The Ross Procedure. The Ross procedure is an exciting surgical alternativefor people with aortic valve disease. UP, aortic valve disease. http://ps4ross.com/toc.html

table of contents E-mail: pstelzer@ps4ross.com phone: Website Table of Contents Printable Versions The Ross Procedure Aortic Valve Disease Other Surgical Treatments ... UP Printable Versions This is the printable version of the web site ps4ross.com. It describes aortic valve disease and various alternative surgical treatments, with particular emphasis on Dr. Paul Stelzer's experience with the Ross Procedure. text only , Text with illustrations UP The Ross Procedure The Ross procedure is an exciting surgical alternative for people with aortic valve disease. What makes the Ross procedure so exciting, aside from what goes on in the operating room, is what patients can do afterwards. What is an autograft Animated presentation Operative photos Video clips ... Risks , Stats, Historical perspective UP Aortic Valve Disease Many problems can interfere with the proper functioning of a valve. They may be congenital (abnormal from birth), infectious (endocarditis), inflammatory (rheumatic fever), or just wear and tear over the years. In general, heart valve problems take one of two forms: Stenosis describes the condition when a valve does not open completely or the opening is too small, resulting in restricted blood flow

8. CTSN - Aortic Valve Disease Selected References aortic valve disease References Selected Articles The first two selections are collectionsof several articles in single journal issues that provide the latest http://www.ctsnet.org/residents/ctsn/references/42refer.html

Aortic Valve Disease References Selected Articles The first two selections are collections of several articles in single journal issues that provide the latest information on valve surgery. We have provided the journal reference information but have not hyperlinked them through the internet Medline search engine. Cohn LH (guest editor). Prosthetic aortic valves. Seminars in Thoracic and Cardiovascular Surgery 1996;8:230-75. Several authors have contributed to the first section (dedicated to aortic valve surgery), including Emery, Arom and Nicoloff (St. Jude valve); Copeland (Carbomedics valve); Akins (Medtronic-Hall valve); Doty (homograft and autograft); Fann and Miller (porcine valves); and Cosgrove (pericardial valve). VIth International Symposium on Cardiac Bioprosthesis. Annals of Thoracic Surgery 1995;60 (suppl):S61-488. Jamieson and David provide the introduction for the complete set of articles from the symposium, many of which are directed to aortic valve surgery. Topics include allograft, autograft, stented and stentless heterografts, and comparison of mechanical and biological prostheses. Antunes MJ.

9. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease Topics. General. Mitral Valve Disease. aortic valve disease. Tricuspid Valve Disease.click here for navigation help. Mitral Valve Disease. MITRAL VALVE PROLAPSE. http://www.merck.com/pubs/mmanual/section16/chapter207/207b.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 207. Valvular Heart Disease Topics [General] Mitral Valve Disease Aortic Valve Disease Tricuspid Valve Disease Mitral Valve Disease MITRAL VALVE PROLAPSE A bulging of one or both mitral valve leaflets into the left atrium during systole, commonly producing a crisp systolic sound or click and a delayed or late systolic mitral regurgitation murmur. Primary mitral valve prolapse (MVP) is associated with dilation of the mitral annulus, abnormal chordal insertions, and myxomatous degeneration of the mitral valve, resulting in redundant mitral leaflet tissue and elongated chordae. Complete myxomatous degeneration of the valve can lead to severe mitral regurgitation (MR), or floppy valve syndrome. The tricuspid or aortic valve can also show myxomatous changes and produce tricuspid or aortic valve prolapse. MVP is occasionally familial with autosomal dominant inheritance. Prevalence varies between 1 and 6% in otherwise normal populations. It is higher in persons with Graves' disease, hypomastia, Duchenne muscular dystrophy, myotonic dystrophy, sickle cell disease, atrial septal defect, Marfan's syndrome, and rheumatic heart disease. About 25% of patients have joint laxity, a high-arched palate, or other skeletal abnormalities (eg, scoliosis, funnel chest, straight back). Carnitine and Mg deficiencies have been suggested as etiologic factors; subnormal mean lymphocyte and RBC Mg levels have been reported in patients with MVP.

10. SmartEngine - SmartGuide ( DISEASE : Aortic Valve Disease ) All about DISEASE aortic valve disease from SmartEngine.com Search For . DISEASE aortic valve disease. Featured Web Pages http://disease.smartengine.com/shell/smartpage/Aortic_Valve_Disease

SmartGuide Web Auctions DISEASE : Aortic Valve Disease Featured Web Pages The Maryland Vascular Center - http://www.umm.edu Located at the Univ. Of Maryland Medical System is a group of internationally recognized experts with broad experience in all forms of vascular problems, both surgical and non-surgical. Valvular Stenosis - HeartCenterOnline - http://www.heartcenteronline.com American Heart Association member edited encyclopedia - the most comprehensive resource dedicated exclusively to heart health: cardiology encyclopedia, news, community, animations and more. Categories (1-2 of 2) Health: Conditions_and_Diseases: Cardiovascular_Disorders: Heart_Disease: Valvular: Aortic_Valve_Disease Health: Conditions_and_Diseases: Cardiovascular_Disorders: Heart_Disease: Valvular Web Pages Aortic Valve Disease A look at stenosis and regurgitation of this valve. - http://www.ps4ross.com/ross/back/avd.html Health: Conditions and Diseases: Cardiovascular Disorders: Heart Disease: Valvular: Aortic Valve Disease Texas Medical Center: Types of Valve Disease A look at both stenosis and regurgitation of mitral valves, aortic valves, tricuspid valves and pulmonary valves. For each one causes, symptoms and signs are looked at. - http://www.tmc.edu/thi/valvedis.html

11. Aortic Valve Disease in one direction. But when aortic valve disease is present, the valveno longer opens or closes properly. Common aortic valve problems http://www.wiheart.cardiologydomain.com/images/uploaded/WiscHeart/AVD.cfm

Basic Facts A normal aortic valve opens wide to allow blood to be pumped from the heart to the rest of the body and closes tightly to prevent blood from flowing back into the heart. Aortic stenosis is a narrowing or obstruction of the aortic valve that prevents the valve from opening properly, impeding the flow of blood from the heart’s left ventricle into the aorta. Aortic regurgitation occurs when the aortic valve does not close properly between heartbeats, allowing blood to regurgitate, or spill back, from the aorta into the left ventricle. The heart is a muscular pump divided into four chambers. Two thin-walled chambers, the left atrium and right atrium, form the upper part of the heart. The other chambers, the left and right ventricles, are the heart’s main blood-pumping chambers and form the bottom part of the heart. The right atrium receives blood as it returns to the heart from the veins from different parts of the body and transports blood to the right ventricle, and the left atrium receives oxygenated blood from the lungs and transports it to the left ventricle. The right ventricle pumps blood into the lungs to be oxygenated, while the left ventricle pumps blood to the rest of the body to deliver the oxygen. The valves between these chambers affect the way that blood flows through the heart. There are two valves on the right side of the heart, the tricuspid and pulmonary valves, and two valves on the left side of the heart, the mitral and aortic valves. These valves resemble flaps, and each valve is made up of segments or leaflets. The valves open and close to keep blood flowing through the heart in only one direction.

12. Kirklin Clinic Digital Library Patient/Family Resources by Topic Cardiovascular Disorders aortic valve disease Patient/Family Resources Spanish Miscellaneous See also Aortic Stenosis Patient/Family Resources General Cardiovascular Disorders Patient/Family Resources Aortic http://kirklinclinic-dl.slis.ua.edu/patientinfo/cardiology/valvular/aorticvalved

Patient/Family Resources by Topic: Cardiovascular Disorders Aortic Valve Disease Patient/Family Resources Spanish Miscellaneous See also: Aortic Stenosis Patient/Family Resources General Cardiovascular Disorders Patient/Family Resources Aortic Valve Disease Clinical Resources MD Consult: Homepage Lister Hill Library subscription INFO Patient Handouts Table of content Aortic Valve Stenosis: Access document Image American Heart Association: Homepage Heart and Stroke A-Z Guide: Table of contents Aortic Regurgitation: Access document Congenital Heart Disease: Access document MEDLINEPlus and the Patient Education Institute: Homepage Interactive Health Tutorials: Table of contents Heart Valve Replacement: Table of contents (Flash Plug-in Required) MEDLINE plus Medical Encyclopedia: Table of contents Aortic Stenosis: English Spanish Aortic Insufficiency: English Spanish Aortic Arch Syndrome: English Spanish Merck Manual Home Edition Table of contents Chapter 19. Heart Valve Disorders: Access document Complete Home Medical Guide: Table of contents Heart and Blood Vessel Diseases: Table of contents Types of Cardiovascular Disease: Access document Heart Valve Disease: Access document Spanish MEDLINE plus Medical Encyclopedia: Table of contents Aortic Stenosis: English Spanish Aortic Insufficiency: English Spanish Aortic Arch Syndrome: English Spanish Miscellaneous Aortic Valve Disease Patient/Family Resources Healthfinder (US DHHS): Homepage Mitral Valve Prolapse: List of documents National Library of Medicine MEDLINE plus Health Topics: Index Heart Valve Diseases:

13. Pediatric Cardiology: Aortic Valve Disease aortic valve disease. Chest Radiograph Aortic stenosis, angiogram;Aortic stenosis, infant; Aortic stenosis, supravalve, angiogram; http://www.kumc.edu/kumcpeds/cardiology/aorticvalvedfct.html

Aortic Valve Disease Chest Radiograph: Aortic stenosis, angiogram Aortic stenosis, infant Aortic stenosis, supravalve, angiogram Aortic stenosis, supravalve, renal arteries, angiogram Diagrams: Aortic Valve Stenosis Subvalvular Aortic Stenosis Supravalvular Aortic Stenosis Auscultation areas ... Cardiac cycle Echocardiogram (video): Normal heart, aortic arch Normal heart, branch pulmonary arteries Normal heart, long axis, (with labeled frame) Normal heart, long axis #2 ... Subaortic stenosis Echocardiogram (still frame): M-mode, left ventricle, normal M-mode values 4 chamber view, normal (4c) 4 chamber view 1, normal (4c invert) ... Echo diagram, suprasternal notch Electrocardiogram: Aortic stenosis, #1, child Aortic stenosis, #2, child Normal, #1, child Normal, #2, child ... Return to the defect index page

14. AORTIC VALVE REPLACEMENT Causes of malfunction, warning signs for a failing valve, how to know if surgery is needed, options Category Health Conditions and Diseases Valvular Surgery...... For example, the aortic valve may be abnormal from birth (congenital aortic valvedisease), or it could become diseased with age (acquired aortic valve disease http://www.sts.org/doc/3620

Description Author: Thoralf M. Sundt, MD Medical Illustrations: Jill Rhead, MA AORTIC VALVE REPLACEMENT Table of Contents: What is Aortic Valve Replacement? What is the Aortic Valve? What Causes an Aortic Valve to Malfunction? Are There Any Warning Signs for a Failing Aortic Valve? ... What Will My Condition Be Like After Aortic Valve Replacement WHAT IS AORTIC VALVE REPLACEMENT? Aortic valve replacement is an "open heart" procedure performed by cardithoracic surgeons for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve WHAT IS THE AORTIC VALVE? The location of the aortic valve is shown in the diagram to the left. The heart has two sets of pumping chambers: the right-sided chambers pump blood to the lungs, and the left side pumps blood to the rest of the body. The left side, therefore, has a harder job than the right side, and the left side does most of the work. The main pumping chambers of the heart are called the ventricles Because the ventricle is a pump, it must have both an inflow valve and an outflow valve. The aortic valve is on the left side of the heart and is the outflow valve. The aortic valve opens to allow blood to leave the left ventricle (the main pumping chamber of the heart) and closes to prevent blood from leaking backwards into the ventricle from the rest of the body.

15. PROFESSIONAL REFERENCE Allergy Immunlogy Cardiology Dermatology aortic valve disease by David M Shavelle, MD, Best Practice of Medicine.March 2001. Last modified December 14, 2001. ICD9-CM http://merck.praxis.md/index.asp?page=bpm_brief&chapter=BPM01CA15

16. PROFESSIONAL REFERENCE Allergy Immunlogy Cardiology Dermatology aortic valve disease by David M Shavelle, MD, Best Practice of Medicine. ShavelleDM, Otto CM aortic valve disease aortic stenosis and aortic regurgitation. http://merck.praxis.md/bpm/bpmrefs.asp?page=BPM01CA15

17. Member Sign In Mortality and Need for Reoperation in Patients With Mildto-Moderate Asymptomaticaortic valve disease Undergoing Coronary Artery Bypass Graft Alone from http://www.medscape.com/viewarticle/417257

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

18. Member Sign In Need for Reoperation in Asymptomatic aortic valve disease from AmericanHeart Journal. Discussion. In this study 14.5% of patients http://www.medscape.com/viewarticle/417257_4

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

19. Aortic Valve Disease This particular chapter, coauthored by RM Novaro, MD and GM Mills, MD, deals withaortic valve disease from its diagnosis to today's popular treatment methods http://www.clevelandclinicmeded.com/diseasemanagement/cardiology/aortic_valve/ao

Published May 29, 2002 R. M. Mills, MD Department of Cardiology G.M. Novaro, MD Department of Cardiology Print Chapter The Cleveland Clinic Foundation The availability of two-dimensional Doppler echocardiography and the development of reliable valve prostheses, both bioprosthetic and mechanical, have quietly revolutionized the clinical management of valvular heart disease. The cardiac valves have two functions. By opening, they control the direction in which blood flows, and by closing they allow pressure differentials to exist in a closed system. Abnormal valve function produces either pressure overloading due to restricted opening or volume overloading due to inadequate closure. Valvular heart disease can be approached either on the basis of the pathologic lesion, ie, aortic stenosis or aortic regurgitation, or pathophysiologically as pressure overloading versus volume overloading. In this chapter, we will summarize our current approach to aortic valve disease, namely

20. Heart1.com - Statins May Help Aortic Valve Disease Statins May Help aortic valve disease. June 04, 2002 MONDAY In aorticvalve disease, the valve doesn't open or shut properly. People http://www.heart1.com/news/mainstory.cfm/25/1

Search Heart1 Search Network Search Medline Main Page Heart News Feature Story Research Center ... Bookmark Us HEART NEWS: Feature Story Print this Article Email this Article Discuss this Article Statins May Help Aortic Valve Disease June 04, 2002 MONDAY, June 3 (HealthScoutNews) The cholesterol-lowering drugs known as statins could have yet another health benefit for the heart: Animal research suggests they can treat the early stages of a disease that strikes the organ's plumbing. There is no drug therapy for the disease, in which skeletal bone structures grow in the valve. The best doctors can do is replace the valves once the disease reaches its later stages. "Valve replacement is the only option," says Dr. Daniel Fisher, a cardiologist and clinical assistant professor at New York University Medical Center. "It's effective, but it's major cardiac surgery and it occasionally requires a lifelong blood thinner if the replacement is a metal valve." Part of the reason for the lack of effective therapies is a lack of information on the cellular causes of aortic valvular disease. This study, appearing in tomorrow?s issue of Circulation, appears to be the first to explain the specific cellular mechanisms behind the disease. "Up until now, people really thought it was a wear-and-tear phenomenon," says Dr. Nalini Rajamannan, study author and assistant professor of cardiology at Northwestern University. "They didn't realize the valve itself has its own biology." The Northwestern team worked jointly on the study with researchers at the Mayo Clinic.

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