Blocks for Shoulders

80 something year old male came for reverse total shoulder replacement. He had severe COPD as well as an EF 20% with CHF. He had been appropriately optimized. Preoperatively, we performed an anterior approach suprascapular block (10ml, 0.25% bupi) combined with an infraclavicular block (20ml, 0.25% bupi). In retrospect, we could have used 5ml for suprascapular block and 15ml for infraclavicular block.

Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials. International Journal of Surgery, Volume 45, September 2017, Pages 85-91.

  • Supraclavicular block could provide similar analgesic efficacy compared with interscalene block.
  • Ultrasound-guided supraclavicular block was associated with a low incidence of hoarseness and Horner syndrome.

Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery: A systematic review and meta-analysis. European Journal of Anaesthesiology 36(6):p 427-435, June 2019

Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery: A Randomized, Double-blind, Noninferiority Trial. Anesthesiology July 2018, Vol. 129, 47–57.

From Anesthesiology July 2018, Vol. 129, 47–57.

A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery. Regional Anesthesia & Pain Medicine 2018;43:590-595.

A combination of infraclavicular and suprascapular nerve blocks for total shoulder arthroplasty: A case series. Acta Anaesthesiol Scand. 2021; 65: 674– 680.

Suprascapular nerve block is a clinically attractive alternative to interscalene nerve block during arthroscopic shoulder surgery: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research volume 16, Article number: 376 (2021).

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review. Osteology 20222(1), 52-61.

YouTube: Anterior suprascapular nerve block and literature 11:43 for procedure

YouTube: Suprascapular and axillary nerve block

VO2 Max and Health/Wellness

VO2 max

After listening to the Huberman Lab podcast (and you should too! He’s got nuggets of info on health!), I decided to schedule a Dexa Scan as well as VO2 max test. I want to have a baseline of where I am at my age. This year has been a huge year of change. I’ve committed to my health (yes I’m currently 7 months in with a strength program called Rise; I started 1-2x/wk rowing; MMA 1x/wk). I’m changing jobs. I have cut back or cut out unnecessary or harmful things to my life. I’m participating in a glucose monitoring study. I wish I had done these metrics every decade of my life starting at 10.

What is VO2 max?

How to Improve VO2 max

6 Ways to Improve Your VO2 Max

VO2 Max: The Fitness Metric That Can Help You Run Faster and Workout Harder

Effect of dietary fat on metabolic adjustments to maximal VO2 and endurance in runners. Med Sci Sports Exerc. 1994 Jan;26(1):81-8.

VO2 max test on Concept 2

The more I dig into the world of health and wellness, the more there is to learn. Hormones, gut health, nutrition, supplements, macros/micros, exercise (role for mobility, flexibility, cardio, strength, functional, etc). I wish they taught this stuff in medical school. This is the real foundation of health and wellness.

Cardiorespiratory Coordination in Collegiate Rowing PDF

A New Fitness Test of Estimating VO2max in Well-Trained Rowing Athletes. Front. Physiol., 02 July 2021. Sec. Exercise Physiology

How to Improve:

Indoor Rowing Workouts That Boost Your Vo2 Max

More gems:

iollo – metabolomics testing (metabolite measuring)

Zoe – gut health, blood sugar, blood fat

Athletic Greens – comprehensive nutrition and gut health support

Ka’Chava – whole health meal replacement

Vedge Nutrition – fitness supplements made by vegans for vegans

Mud/WTR and Ryze – mushroom supplementation

DNAfit

23andMe

Overall, I felt I could have pushed a bit harder but I was nervous on the treadmill. My legs were burning. Oh the dreadmill.

Anesthesia for Latissimus Dorsi Flap for Breast Reconstruction

What is a latissimus dorsi flap?

From MDAnderson.org

Latissimus Dorsi Flap in Breast Reconstruction. Cancer Control. 2018 Jan-Dec; 25(1): 1073274817744638.

A Retrospective Study of Latissimus Dorsi Flap in Immediate Breast Reconstruction. Front. Oncol., 04 November 2021. https://doi.org/10.3389/fonc.2021.598604

Anesthetic Techniques

Regional Anesthesia For Breast Reconstruction. [Updated 2022 Feb 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Anaesthesia for breast surgery. BJA Education, 18(11): 342e348 (2018).

Anaesthesia for free flap breast reconstruction. BJA Education, Volume 16, Issue 5, May 2016, Pages 162–166.

Paravertebral Analgesia with Levobupivacaine Increases Postoperative Flap Tissue Oxygen Tension after Immediate Latissimus Dorsi Breast Reconstruction Compared with Intravenous Opioid Analgesia. Anesthesiology February 2004, Vol. 100, 375–380.

Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review. Anesth Pain Med. 2016 Oct; 6(5): e39476.

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives. J Pain Res. 2018;11:1567-1581.

Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis. J Clin Anesth. 2021 Sep;72:110274.

Efficacy of regional anesthesia techniques for postoperative analgesia in patients undergoing major oncologic breast surgeries: a systematic review and network meta-analysis of randomized controlled trials. Can J Anaesth. 2022 Apr;69(4):527-549.

Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2021 Mar;76(3):404-413.

Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study. Pain Physician. 2021 May;24(3):203-213.

Erector Spinae Plane Block for Mastectomy and Breast Flap Reconstructive Surgery: A Three Case Series. Open Journal of Anesthesiology
Vol.10 No.01(2020), Article ID:97889,8 pages.

Regional Anesthesia for AV fistula revision

Case info

Types of regional anesthesia for AV fistula

Regional anaesthesia practice for arteriovenous fistula formation surgery. Anaesthesia 2020, 75, 626–633.

Observational study of the efficacy of supraclavicular brachial plexus block for arteriovenous fistula creation. Indian J Anaesth. 2018 Aug; 62(8): 616–620.

NYSORA Ultrasound-guided Supraclavicular Block video

Ultrasound-guided supraclavicular versus infraclavicular brachial plexus nerve block in chronic renal failure patients undergoing arteriovenous fistula creation. Egyptian Journal of Anaesthesia. Volume 30, Issue 2, April 2014, Pages 161-167.

SonoSite Ultrasound-guided Supraclavicular Block video

Practical Anesthesia Techniques ultrasound-guided infraclavicular block video

From Doctorlib.info

A brachial plexus block technique for upper arm AV Fistula. BJA: British Journal of Anaesthesia, Volume 113, Issue eLetters Supplement, 29 December 2014.

Axillary Nerve Block for Upper Extremity Arteriovenous Fistula Creation. Proceedings of UCLA Healthcare. VOLUME 21 (2017).

Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure. Saudi J Anaesth. 2017 Jan-Mar; 11(1): 77–82.

Long-Term Functional Patency and Cost-Effectiveness of Arteriovenous Fistula Creation under Regional Anesthesia: a Randomized Controlled Trial. JASN August 2020, 31 (8) 1871-1882.

Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis. BMC Anesthesiology volume 20, Article number: 219 (2020).

From Doctorlib.info

Is it ok to do regional blocks in sepsis patients?

Neuraxial Regional Anaesthesia in Patients with Active Infection and Sepsis: A Clinical Narrative Review. Turk J Anaesthesiol Reanim. 2018 Feb; 46(1): 8–14.

Exparel

Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system.

Exparel FDA drug sheet

  • Max Dose: 266 mg or 4mg/kg (6yo-17yo). Interscalene NB max dose (adults) =133mg
Exparel website: Field blocks
Exparel website: Interscalene NB

Exparel dosing company info: Pocket Dosing Guide , Billing Guide

Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res. 2012; 5: 257–264.

Emerging roles of liposomal bupivacaine in anesthesia practice. J Anaesthesiol Clin Pharmacol. 2017 Apr-Jun; 33(2): 151–156.

Liposomal bupivacaine peripheral nerve block for the management of postoperative pain. Cochrane Database Syst Rev. 2016 Aug 25;2016(8):CD011476.

Liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain. Cochrane Database Syst Rev. 2017 Feb; 2017(2): CD011419.

Novel Local Anesthetics in Clinical Practice: Pharmacologic Considerations and Potential Roles for the Future. Anesth Pain Med. 2022 Feb; 12(1): e123112.

Cardiac/Thoracic

The role of liposomal bupivacaine in thoracic surgery. J Thorac Dis. 2019 May; 11(Suppl 9): S1163–S1168.

Intercostal nerve blockade for thoracic surgery with liposomal bupivacaine: the devil is in the details. J Thorac Dis. 2019 May; 11(Suppl 9): S1202–S1205.

  • VATs: Dilute liposomal bupivacaine (266 mg, 20 cc) mixed with 20 cc injectable saline. We use two syringes to save time (refill syringe between injections).
  • For planned thoracotomy, we add 60 cc injectable saline for wider injection.
  • The efficacy of this strategy requires attention to specific details, such as timing and technique of injection, dilution with saline, and injection of multiple interspaces (typically interspaces 3–10 when technically possible).
  • Inject EXPAREL slowly and deeply (generally 1-2 mL per injection) into soft tissues using a moving needle technique (ie, inject while withdrawing the needle)
  • Infiltrate above and below the fascia and into the subcutaneous tissue
  • Aspirate frequently to minimize the risk of intravascular injection
  • Use a 25-gauge or larger-bore needle to maintain the structural integrity of the liposomal particles
  • Inject frequently in small areas (1-1.5 cm apart) to ensure overlapping analgesic coverage

Liposomal Bupivacaine Versus Bupivacaine for Intercostal Nerve Blocks in Thoracic Surgery: A Retrospective Analysis. Pain Physician. 2020 Jun;23(3):E251-E258.

Intercostal Blocks with Liposomal Bupivacaine in Thoracic Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth. 2021 May;35(5):1404-1409.

Is liposomal bupivacaine superior to standard bupivacaine for pain control following minimally invasive thoracic surgery? Interactive CardioVascular and Thoracic Surgery, Volume 31, Issue 2, August 2020, Pages 199–203, https://doi.org/10.1093/icvts/ivaa083

Paravertebral Nerve Block With Liposomal Bupivacaine for Pain Control Following Video-Assisted Thoracoscopic Surgery and Thoracotomy. J Surg Res. 2020 Feb;246:19-25.

Rib fractures case report: ESP block


Evaluation of an Enhanced Recovery After Surgery Protocol Including Parasternal Intercostal Nerve Block in Cardiac Surgery Requiring Sternotomy. Am Surg. 2021 Dec;87(10):1561-1564.

Ultrasound-guided Modified Parasternal Intercostal Nerve Block: Role of Preemptive Analgesic Adjunct for Mitigating Poststernotomy Pain. Anesth Essays Res. 2020 Apr-Jun; 14(2): 300–304.

Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. J Card Surg. 2020 Jul;35(7):1525-1530.

Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol. 2021; 21: 98.

Pain Relief Following Sternotomy in Conventional Cardiac Surgery: A Review of Non Neuraxial Regional Nerve Blocks. Ann Card Anaesth. 2020 Apr-Jun; 23(2): 200–208.

A Novel Use of Liposomal Bupivacaine in Erector Spinae Plane Block for Pediatric Congenital Cardiac Surgery. Case Rep Anesthesiol. 2021; 2021: 5521136.

Breast/Gen Surg

Evaluating the Efficacy of Two Regional Pain Management Modalities in Autologous Breast Reconstruction. Plast Reconstr Surg Glob Open. 2022 Jan 19;10(1):e4010.

Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction. Anesth Pain Med. 2020 Oct; 10(5): e105686.

Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review. Plast Reconstr Surg Glob Open. 2021 Nov 16;9(11):e3932.

Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019; 19: 31.


Efficacy of liposomal bupivacaine versus bupivacaine in port site injections on postoperative pain within enhanced recovery after bariatric surgery program: a randomized clinical trial. Surg Obes Relat Dis. 2019 Sep;15(9):1554-1562.

The use of extended release bupivacaine with transversus abdominis plane and subcostal anterior quadratus lumborum catheters: A retrospective analysis of a novel technique. J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar; 36(1): 110–114.

Ortho

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block. Clin Orthop Relat Res. 2017 Jan;475(1):110-117.

OB

Transversus Abdominis Plane Block With Liposomal Bupivacaine for Pain After Cesarean Delivery in a Multicenter, Randomized, Double-Blind, Controlled Trial. Anesth Analg. 2020 Dec; 131(6): 1830–1839.

Abdominal Compartment Syndrome

A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care 24, 97 (2020). https://doi.org/10.1186/s13054-020-2782-1

From Crit Care 24, 97 (2020).

Abdominal compartment syndrome among surgical patients. World J Gastrointest Surg. 2021 Apr 27; 13(4): 330–339.

Patients with ACS will usually be critically ill and unable to provide history and symptoms. On physical exam, patients present with a distended abdomen. However, palpation and abdominal circumference are not reliable for the diagnosis of ACS[25].

A prospective study in postoperative ICU patients showed physicians have less than a 50% chance to identify IAH by clinical examination[25]. The clinical abdominal exam as IAP assessment has an estimated sensitivity of 56%-60% and specificity of 80%-87%[25,26].

Signs of ACS will present as the end-organ effect from the physiologic changes (Table ​(Table2).2). The most notorious signs are usually abdominal distention, oliguria, high ventilatory pressures, diminished cardiac output, and metabolic acidosis[26].

Abdominal Compartment Syndrome. StatPearls, Nov 2021.

The more commonly used method is an indirect measurement such as intravesicular catheter pressures (e.g., Foley catheter), which has become the gold standard due to its widespread availability and limited invasiveness. The trans-bladder technique involves using aseptic clamping the drainage tubing of the Foley then connecting the Foley to a three-way stop tap adjusted to the level of the mid-axillary line at the iliac crest to zero transducers follow by injecting 25 cc of sterile saline into the bladder.  Measurements should be taken at end-expiration and complete supine position and expressed in mmHg.  Bladder pressures below 5 mm Hg are expected in healthy patients. Pressures between 10 to 15 mm Hg can be expected following abdominal surgery and in obese patients. Bladder pressures over 25 mm Hg are highly suspicious of abdominal compartment syndrome and should be correlated clinically. It is recommended that pressure measurements be trended to show and recognize the worsening of intra-abdominal hypertension.

Contraindications to using bladder pressures include bladder trauma, neurogenic bladder, BPH, and pelvic hematoma. Bladder pressures may be inaccurate if the patient is not sedated or lying flat.[9][10]

How to Measure Intrabdominal Pressure

From London Health Science Centre

The primary treatment for ACS is surgical decompression. However, the early use of non-surgical interventions may prevent the progression of IAH to ACS. Early recognition involves supportive care to include keeping patients comfortable with pain well-controlled.  Decompressive procedures such as NG tube placement for gastric decompression, rectal tube placement for colonic decompression, and percutaneous drainage of abscesses, ascites, or fluid from the abdominal compartment. The neuromuscular blockade has been described to be used as a brief trial in an attempt to relax the abdominal musculature, leading to a significant decrease in abdominal compartment pressures in the ventilated ICU patient. If conservative and medical management does not resolve the IAH and further organ damage is noted, surgical decompression using emergent laparotomy may be considered. [11][2]

After surgical laparotomy for compartment syndrome, the abdominal fascia may be closed using temporary closure devices such as (vacs, meshes, and zippers). The fascia can be appropriately closed after 5 to 7 days after the compartment pressures and swelling have decreased.

Fascia Iliaca blocks for TAVR under conscious sedation

Editorial: The use of Fascia iliaca Block with Minimal Conscious Sedation in Transcatheter Aortic Valve Replacement: Advances in TAVR Anesthesia. Cardiovasc Revasc Med. 2020 May;21(5):602-603. doi: 10.1016/j.carrev.2020.03.017.

Local Anesthesia-Conscious Sedation: The Contemporary Gold Standard for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2018 Mar 26;11(6):579-580. doi: 10.1016/j.jcin.2018.01.238.

Transfemoral Transcatheter Aortic Valve Replacement Using Fascia Iliaca Block as an Alternative Approach to Conscious Sedation as Compared to General Anesthesia. Cardiovasc Revasc Med. 2020 May;21(5):594-601. doi: 10.1016/j.carrev.2019.08.080. Epub 2019 Sep 7.

**NYSORA U/S guided Fascia Iliaca nerve block**

From EMbeds.co.uk – FOAMed @ CHT-ED

TCT-808 Transfemoral Transcatheter Aortic Valve Replacement Using Fascia Iliaca Block as an Alternative Approach to Conscious Sedation as Compare to General Anesthesia: Findings From a Single Center. J Am Coll Cardiol. 2019 Oct, 74 (13_Supplement) B792

Tricuspid Clip

Updated: August 2021

Echocardiographic Imaging for Transcatheter Tricuspid Edge‐to‐Edge Repair. Journal of the American Heart Association. 2020;9:e015682.

State of the Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging.2016;9:e005332.

Screening TEE for Transcatheter Tricuspid Valve Repair. Cardiac Interventions Today. May/June 2020.

Echocardiography for Tricuspid Valve Intervention. Cardiac Interventions Today. July/August 2018.

Tricuspid Clip in Tricuspid Regurgitation. Amer Coll of Card, Feb 2020.

Percutaneous management of tricuspid regurgitation. Image-guided step-by-step MitraClip procedure. REC Interv Cardiol. 2020;2:118-128.

Intraprocedural Imaging of Transcatheter Tricuspid Valve Interventions. JACC: Cardiovascular Imaging,Volume 12, Issue 3, March 2019, Pages 532-553.

Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Front. Cardiovasc. Med., 13 August 2020.

 


 
From US Cardiology Review

Fascia Iliaca block for hip surgery

Why place regional blocks for surgery?

JNYSORA Volume 10 March 2009: Nerve Blocks For Postoperative Analgesia: Choices After Common Lower Extremity Procedures.

What is it?

NYSORA description

From Starship Child Health

NYSORA video describing the block

Academic Life in EM. Aug 21, 2019. Fascia iliaca nerve block: A hip fracture best-practice

EM St. John. Fascia Iliaca Nerve Block. .

From Starship Child Health

How to do it?

Suprainguinal Fascia Iliaca Plane block

MySigRA Suprainguinal Fascia Iliaca Plane block

From Highland EM Ultrasound

Literature says:

Journal of Orthopaedic Trauma: January 2020 – Volume 34 – Issue 1 – p 49-54. Fascia Iliaca Block Decreases Hip Fracture Postoperative Opioid Consumption: A Prospective Randomized Controlled Trial.

Eur J Emerg Med. 2016 Feb;23(1):12-8. Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites.

BJA VOLUME 120, ISSUE 6, P1368-1380, JUNE 01, 2018. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation.

Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial. BMC Geriatr 19, 180 (2019).

Anesthesiology September 2018, Vol. 129, 536–543. Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial.

J Surg, Volume 16:2, 2020. Peripheral Nerve Blocks in Hip Arthroscopy.

Am J Orthop (Belle Mead NJ).  2018 Jun;47(6). Outcomes After Peripheral Nerve Block in Hip Arthroscopy.

Prosthetic Heart Valves

ASE Guidelines: Recommendations For Evaluation of Prosthetic Valves with Two-Dimensional and Doppler Echocardiography.

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound. A Report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, Endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. JASE Guidelines and Standards| Volume 22, ISSUE 9, P975-1014, September 01, 2009.

Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. European Heart Journal – Cardiovascular Imaging, Volume 17, Issue 6, June 2016, Pages 589–590, https://doi.org/10.1093/ehjci/jew025

Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.

From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.
From Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr. 2014 Oct-Dec; 24(4): 103–113.

Evaluation of Aortic Prosthetic Valves. JASE 2018. PPT.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72–e227.

Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management. Circulation. 2009;119:1034–1048.

Prosthetic Heart Valves
From Circulation. 2009;119:1034–1048
From Circulation. 2009;119:1034–1048
From Circulation. 2009;119:1034–1048
From Circulation. 2009;119:1034–1048

On-X heart valve echo. Slideshare, Jan 2016.