DK2985_C000 1..28 - AlSharqia Echo Club

366 Transesophageal EchocardiographyFigure 16.1 Aortic valve bioprosthesis endocarditis in an 83-year-old man. (A, B) A mobile mass was seen in the mid-esophageal longaxisview. (C, D) Furthermore, a fistula between the aorta (Ao) and the right atrium (RA) was present. (E) Intraoperative findings: the mobilemass was a vegetation attached to the inferior aspect of the aortic bioprosthetic valve (AoPV) (LA, left atrium; LV, left ventricle, LVOT: leftventricular outflow tract; PA, pulmonary artery; RA, right atrium; RV, right ventricle). (Photo E courtesy of Dr. Denis Bouchard.)Dubois and Dubois fBSA ¼ [(Weight kg) 0.425 (Height cm) 0.725 ] 0.007184g or the chartsderived from that formula.2. Determine the minimal EOA that the prosthesis beingimplanted must have in order to avoid mismatch; thisis accomplished by multiplying the desired objectivefor the postoperative indexed EOA (e.g. 0.85 cm 2 /m 2 ) by the patient’s BSA. Therefore, if the patient’sBSA is 1.53 m 2 , the minimal EOA that the prosthesisbeing implanted should have in order to avoidmismatch is 1.53 m 2 multiplied by 0.85 cm 2 /m 2 ,that is, 1.30 cm 2 (Fig. 16.5).3. The prosthesis is then chosen using the publishedreference values of EOA for different types andsizes of prostheses (Table 16.3). To follow theaforementioned example, if one had chosen toinsert a Carpentier–Edwards pericardial bioprosthesis,the minimal size that should be utilized toyield the desired objective of 1.30 cm 2 should bea #21 (Fig. 16.5).4. The aortic annulus diameter is measured at the baseof the aortic leaflet. Therefore, if the patient’sannulus accepted only a size #19, as may be thecase in patients with a small aortic annulus