الفهرس 
ANATOMICAL AND PATHOLOGICAL CONSIDERATION OF AORTIC VALVE DISEASEOnly 14 pages are availabe for public view
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Abstract
A
ortic valvular stenosis is a common condition and Surgical valve replacement is the only definitive therapeutic strategy, indicated in presence of severe symptomatic disease.
Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. Transcatheter aortic valve insertion is a new development that potentially offers a number of advantages to patients and healthcare providers. These include the avoidance of sternotomy and cardiopulmonary bypass, and much faster discharge from hospital and return to functional status. Modern design and manufacturing techniques have led to the development of a number of valve prostheses which can be compressed or crimped, reducing their size, and allowing delivery to the heart on a catheter through a vascular sheath
This transcatheter procedure is performed via puncture of the left ventricular (LV) apex or percutaneously, via the femoral artery or vein. Patients undergo general anesthesia, intense hemodynamic manipulation, and transesophageal echocardiography (TEE).
A general anesthetic is tailored to achieve extubation after procedure completion, at the same time the operating room should be fully equipped for the possibility of sternotomy and initiation of CPB.
The role of the anesthetist in such a procedure is very important, as patients are often elderly with multiple co morbidities and organ dysfunction. The hemodynamic consequences of vascular and cardiac access and valve deployment in the beating heart may lead to morbidity and mortality if not adequately managed, and the postoperative course may be complicated. Careful anesthetic management along with meticulous perioperative care should facilitate improvements in outcome.