It's Medical Monday!

Good morning everyone and welcome to our first week of February posts! The theme this month will be aortic valve disease!

Aortic Valve Anatomy

To understand aortic valve disease, we must first understand what the normal aortic valve is and does! After blood gets oxygenated in your lungs it re-enters the heart and fills the left ventricle. With each heartbeat, the left ventricle will pump blood through the aortic valve into the aorta, which carries it throughout the rest of the body.

The aortic valve therefore can be thought of as the gatekeeper between the heart and the rest of the body. It is the last valve blood will cross in the heart.

https://www.bcm.edu/healthcare/specialties/transplant/heart-transplant/aortic-valve-repair

To remember “normal” aortic valve anatomy, think of the infamous “Mercedes-Benz” logo. Most aortic valve are “tri-leaflet” in structure meaning three leaflets come together when it closes to prevent block from leaking backward. They also open at same time to allow blood to flow out.

https://www.facebook.com/Tabib.Alb/posts/loss-of-the-mercedes-benz-appearance-on-echo-may-suggesta-severe-tricuspid-regur/1228353452637006/

When looking at the aortic valve leaflets, it is important to think of each of the three separately.

Normally, we can divide them into:

• a left coronary cusp

• a right coronary cusp

• a non-coronary cusp

https://echocardiografie.nl/valves/aortic-valve/

The right coronary artery (RCA) and left coronary artery (LCA) originate from each respective cusp, and function to provide blood to the surface to the heart. When repairing or replacing a damaged aortic valve, surgeons must be very careful that they do not block the blood flow into the RCA and LCA!

When performing surgery, surgeons must also be mindful of nearby structures to each cusp. For example, the left and non-coronary cusp are very close to the mitral valve and can be damaged when operating there.

https://www.researchgate.net/figure/Mitral-valve-anatomy-Schematic-representation-of-the-mitral-valve-in-the-surgeon-view_fig6_318056916

Alternatively, the right and non-coronary cusp are near the tricuspid valve and the conduction system of the heart and damage there may cause heartblock that requires a pacemaker.

This month, we will be focusing on many specific diseases related to our beloved aortic valve including what happens when:

• It becomes too tight -> aortic stenosis

• It becomes too leaky -> aortic regurgitation

• When it has only two leaflets instead of three -> bicuspid

As well as some of the nuances of treating aortic valve disease including the different kind of surgeries and types of valves!

https://medicaldialogues.in/cardiology-ctvs/news/notion-verdict-out-tavr-comparable-to-savr-even-after-8-years-ehj-79623

We won't spoil too much today but be sure to tune in every Monday / Tuesday this month for more aortic valve education! Until then, stay warm and Think Aorta!

Adham