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==Biological prosthetic valves==
==Biological prosthetic valves==


{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"
|-
|-
|+ Normal values for Biological Aortic Valve Prosthesis
|+ Normal values for Biological Aortic Valve Prosthesis<cite>1</cite>
|-
|-
!Valve  
!Valve  
Line 10: Line 10:
!Peak gradient (mmHg)  
!Peak gradient (mmHg)  
!Mean gradient (mmHg)  
!Mean gradient (mmHg)  
!EOA (cm <sub>2</sub>)
!EOA (cm2)
|-
|-
|rowspan="5" valign="top"|Baxter Perimount  
|rowspan="5" valign="top"|Baxter Perimount  
Line 68: Line 68:
|1.1 ± 0.1
|1.1 ± 0.1
|-
|-
|Carpentier Edwards Pericardial  
|rowspan="4" valign="top"|Carpentier Edwards Pericardial  
|Stented bovine pericardial  
|rowspan="4" valign="top"|Stented bovine pericardial  
|19  
|19  
|32.1 ± 3.4  
|32.1 ± 3.4  
Line 90: Line 90:
|
|
|-
|-
|Carpentier Edwards Standard  
|rowspan="6" valign="top"|Carpentier Edwards Standard  
|Stented porcine  
|rowspan="6" valign="top"|Stented porcine  
|19  
|19  
|43.5 ± 12.7  
|43.5 ± 12.7  
Line 122: Line 122:
|2.8 ± 0.5
|2.8 ± 0.5
|-
|-
|Carpentier Supra - Annular stented porcine 19 34.1 ± 2.7 1.1 ± 0.1
|rowspan="5" valign="top"|Carpentier Supra - Annular  
|21 28.0 ± 10.5 17.5 ± 3.8 1.4 ± 0.9
|rowspan="5" valign="top"|Stented porcine  
|23 25.3 ± 10.5 13.4 ± 4.5 1.6 ± 0.6
|19  
|25 24.4 ± 7.6 13.2 ± 4.8 1.8 ± 0.4
|34.1 ± 2.7  
|27 16.7 ± 4.7 8.8 ± 2.8 1.9 ± 0.7
|
|1.1 ± 0.1
|-
|21  
|28.0 ± 10.5  
|17.5 ± 3.8  
|1.4 ± 0.9
|-
|23  
|25.3 ± 10.5  
|13.4 ± 4.5  
|1.6 ± 0.6
|-
|25  
|24.4 ± 7.6  
|13.2 ± 4.8  
|1.8 ± 0.4
|-
|-
|CryoLife Stentless 19 9.0 ± 2.0 1.5 ± 0.3
|27
|21 6.6 ± 2.9 1.7 ± 0.4
|16.7 ± 4.7  
|23 6.0 ± 2.3 2.3 ± 0.2
|8.8 ± 2.8
|25 6.1 ± 2.6 2.6 ± 0.2
|1.9 ± 0.7
|27 4.0 ± 2.4 2.8 ± 0.3
|-
|-
|Extended Biocor Stentless  
|rowspan="5" valign="top"|CryoLife
|rowspan="5" valign="top"|Stentless  
|19  
|19  
|17.5 ± 6.5 9.6 ± 3.6 1.4 ± 0.4
|
|21 17.5 ± 6.5 9.6 ± 3.6 1.4 ± 0.4
|9.0 ± 2.0
|23 14.7 ± 7.3 7.7 ± 3.8 1.7 ± 0.4
|1.5 ± 0.3
|25 14.0 ± 4.3 7.4 ± 2.5 1.8 ± 0.4
|-
|21
|
|6.6 ± 2.9
|1.7 ± 0.4
|-
|23
|
|6.0 ± 2.3
|2.3 ± 0.2
|-
|25
|
|6.1 ± 2.6
|2.6 ± 0.2
|-
|27
|
|4.0 ± 2.4
|2.8 ± 0.3
|-
|rowspan="4" valign="top"|Extended Biocor
|rowspan="4" valign="top"|Stentless
|19
|17.5 ± 6.5  
|9.6 ± 3.6  
|1.4 ± 0.4
|-
|21  
|17.5 ± 6.5  
|9.6 ± 3.6  
|1.4 ± 0.4
|-
|23  
|14.7 ± 7.3  
|7.7 ± 3.8  
|1.7 ± 0.4
|-
|25  
|14.0 ± 4.3  
|7.4 ± 2.5  
|1.8 ± 0.4
|-
|rowspan="3" valign="top"|Hancock
|rowspan="3" valign="top"|Stented porcine
|21
|18.0 ± 6.0
|12.0 ± 2.0
|
|-
|23
|16.0 ± 2.0
|11.0 ± 2.0
|
|-
|25
|15.0 ± 3.0
|10.0 ± 3.0
|
|-
|rowspan="4" valign="top"|Hancock II
|rowspan="4" valign="top"|Stented porcine
|21
|
|14.8 ± 4.1
|1.3 ± 0.4
|-
|-
|Hancock stented porcine 21 18.0 ± 6.0 12.0 ± 2.0
|23
|23 16.0 ± 2.0 11.0 ± 2.0
|34.0 ± 13.0  
|25 15.0 ± 3.0 10.0 ± 3.0
|16.6 ± 8.5
|1.3 ± 0.4
|-
|25  
|22.0 ± 5.3  
|10.8 ± 2.8
|1.6 ± 0.4
|-
|-
|Hancock II stented porcine 21 14.8 ± 4.1 1.3 ± 0.4
|29
|23 34.0 ± 13.0 16.6 ± 8.5 1.3 ± 0.4
|16.2 ± 1.5  
|25 22.0 ± 5.3 10.8 ± 2.8 1.6 ± 0.4
|8.2 ± 1.7  
|29 16.2 ± 1.5 8.2 ± 1.7 1.6 ± 0.2
|1.6 ± 0.2
|-
|-
|Homograft  
|Homograft  
Line 157: Line 244:
|?
|?
|-
|-
|Intact stented porcine 19 40.4 ± 15.4 24.5 ± 9.3
|rowspan="5" valign="top"|Intact  
|21 40.9 ± 15.6 19.6 ± 8.1 1.6 ± 0.4
|rowspan="5" valign="top"|Stented porcine  
|23 32.7 ± 9.6 19.0 ± 6.1 1.6 ± 0.4
|19  
|25 29.7 ± 15.0 17.7 ± 7.9 1.7 ± 0.3
|40.4 ± 15.4  
|27 25.0 ± 7.6 15.0 ± 4.5
|24.5 ± 9.3
|
|-
|21  
|40.9 ± 15.6  
|19.6 ± 8.1  
|1.6 ± 0.4
|-
|23  
|32.7 ± 9.6  
|19.0 ± 6.1  
|1.6 ± 0.4
|-
|25  
|29.7 ± 15.0  
|17.7 ± 7.9  
|1.7 ± 0.3
|-
|27  
|25.0 ± 7.6  
|15.0 ± 4.5
|
|-
|rowspan="4" valign="top"|Ionescu - Shiley
|rowspan="4" valign="top"|Stented bovine pericardial
|17
|23.8 ± 3.4
|
|0.9 ± 0.1
|-
|19
|19.7 ± 5.9
|13.3 ± 3.9
|1.1 ± 0.1
|-
|21
|26.6 ± 9.0
|
|
|-
|23
|
|15.6 ± 4.4
|
|-
|rowspan="4" valign="top"|Labcor Santiago
|rowspan="4" valign="top"|Stented bovine pericardial
|19
|18.6 ± 5.0
|11.8 ± 3.3
|1.2 ± 0.1
|-
|21
|17.5 ± 6.6
|8.2 ± 4.5
|1.3 ± 0.1
|-
|23
|14.8 ± 5.2
|7.8 ± 2.9
|1.8 ± 0.2
|-
|25
|12.3 ± 3.4
|6.8 ± 2.0
|2.1 ± 0.3
|-
|rowspan="4" valign="top"|Labcor Synergy
|rowspan="4" valign="top"|Stented porcine
|21
|24.3 ± 8.1
|13.3 ± 4.2
|1.1 ± 0.3
|-
|-
|Ionescu - Shiley bovine pericardial stented 17 23.8 ± 3.4 0.9 ± 0.1
|23  
|19 19.7 ± 5.9 13.3 ± 3.9 1.1 ± 0.1
|27.3 ± 13.7
|21 26.6 ± 9.0
|15.3 ± 6.9  
|23 15.6 ± 4.4
|1.4 ± 0.4
Stented bovine pericardial Labcor Santiago 19 18.6 ± 5.0 11.8 ± 3.3 1.2 ± 0.1
|-
|21 17.5 ± 6.6 8.2 ± 4.5 1.3 ± 0.1
|25
|23 14.8 ± 5.2 7.8 ± 2.9 1.8 ± 0.2
|22.5 ± 11.9
|25 12.3 ± 3.4 6.8 ± 2.0 2.1 ± 0.3
|13.2 ± 6.4  
|1.5 ± 0.4
|-
|-
|Labcor Synergy
|27
|Stented porcine 21 24.3 ± 8.1 13.3 ± 4.2 1.1 ± 0.3
|17.8 ± 7.0  
|23 27.3 ± 13.7 15.3 ± 6.9 1.4 ± 0.4
|10.6 ± 4.6  
|25 22.5 ± 11.9 13.2 ± 6.4 1.5 ± 0.4
|1.8 ± 0.5
|27 17.8 ± 7.0 10.6 ± 4.6 1.8 ± 0.5
|-
|-
|Medtronic Freestyle  
|rowspan="5" valign="top"|Medtronic Freestyle  
|Stentless  
|rowspan="5" valign="top"|Stentless  
|19  
|19  
|
|13.0 ± 3.9
|13.0 ± 3.9
|21 9.1 ± 5.1 1.4 ± 0.3
|
|23 11.0 ± 4.0 8.1 ± 4.6 1.7 ± 0.5
|-
|25 5.3 ± 3.1 2.1 ± 0.5
|21
|27 4.6 ± 3.1 2.5 ± 0.1
|
|9.1 ± 5.1  
|1.4 ± 0.3
|-
|23  
|11.0 ± 4.0  
|8.1 ± 4.6  
|1.7 ± 0.5
|-
|25  
|
|5.3 ± 3.1  
|2.1 ± 0.5
|-
|27  
|
|4.6 ± 3.1  
|2.5 ± 0.1
|-
|rowspan="5" valign="top"|Medtronic Mosaic
|rowspan="5" valign="top"|Stented porcine
|21
|
|14.2 ± 5.0
|1.4 ± 0.4
|-
|23
|23.8 ± 11.0
|13.7 ± 4.8
|1.5 ± 0.4
|-
|25
|22.5 ± 10.0
|11.7 ± 5.1
|1.8 ± 0.5
|-
|27
|
|10.4 ± 4.3
|1.9 ± 0.1
|-
|-
|Medtronic Mosaic
|29
|Stented porcine 21 14.2 ± 5.0 1.4 ± 0.4
|
|23 23.8 ± 11.0 13.7 ± 4.8 1.5 ± 0.4
|11.1 ± 4.3  
|25 22.5 ± 10.0 11.7 ± 5.1 1.8 ± 0.5
|2.1 ± 0.2
|27 10.4 ± 4.3 1.9 ± 0.1
|29 11.1 ± 4.3 2.1 ± 0.2
|-
|-
|Mitroflow  
|Mitroflow  
|Stented bovine pericardial 19 18.6 ± 5.3 13.1 ± 3.3 1.1 ± 0.2
|Stented bovine pericardial  
|Prima  
|19  
|Stentless 21 28.8 ± 6.0 13.7 ± 1.9 1.4 ± 0.7
|18.6 ± 5.3  
|23 21.5 ± 7.5 11.5 ± 4.9 1.5 ± 0.3
|13.1 ± 3.3  
|25 22.1 ± 12.5 11.6 ± 7.2 1.8 ± 0.5
|1.1 ± 0.2
|-
|rowspan="3" valign="top"|Prima  
|rowspan="3" valign="top"|Stentless  
|21  
|28.8 ± 6.0  
|13.7 ± 1.9  
|1.4 ± 0.7
|-
|23  
|21.5 ± 7.5  
|11.5 ± 4.9  
|1.5 ± 0.3
|-
|25  
|22.1 ± 12.5  
|11.6 ± 7.2  
|1.8 ± 0.5
|-
|rowspan="3" valign="top"|Sorin Pericarbon
|rowspan="3" valign="top"|Stentless
|19
|36.5 ± 9.0
|28.9 ± 7.3
|1.2 ± 0.5
|-
|21
|28.0 ± 13.3
|23.8 ± 11.1
|1.3 ± 0.6
|-
|23
|27.5 ± 11.5
|23.2 ± 7.6
|1.5 ± 0.5
|-
|rowspan="5" valign="top"|St. Jude Medical
|rowspan="5" valign="top"|Stentless
|21
|22.6 ± 14.5  
|10.7 ± 7.2
|1.3 ± 0.6
|-
|23
|16.2 ± 9.0
|8.2 ± 4.7
|1.6 ± 0.6
|-
|-
|Sorin Pericarbon
|25
|Stentless 19 36.5 ± 9.0 28.9 ± 7.3 1.2 ± 0.5
|12.7 ± 8.2  
|21 28.0 ± 13.3 23.8 ± 11.1 1.3 ± 0.6
|6.3 ± 4.1  
|23 27.5 ± 11.5 23.2 ± 7.6 1.5 ± 0.5
|1.8 ± 0.5
|-
|27  
|10.1 ± 5.8
|5.0 ± 2.9
|2.0 ± 0.3
|-
|-
|St. Jude Medical
|29
|Stentless 21 22.6 ± 14.5 10.7 ± 7.2 1.3 ± 0.6
|7.7 ± 4.4
|23 16.2 ± 9.0 8.2 ± 4.7 1.6 ± 0.6
|4.1 ± 2.4  
|25 12.7 ± 8.2 6.3 ± 4.1 1.8 ± 0.5
|2.4 ± 0.6
|27 10.1 ± 5.8 5.0 ± 2.9 2.0 ± 0.3
|29 7.7 ± 4.4 4.1 ± 2.4 2.4 ± 0.6
|}
|}


{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"
|-
|+ Normal values for Biological Mitral Valve Prosthesis<cite>1</cite>
|-
!Valve
!Type
!Size (mm)
!Peak gradient (mmHg)
!Mean gradient (mmHg)
!Peak Velocity (m/s)
!Pressure half-time (ms)
!width="100px"|EOA (cm2)
|-
|rowspan="4" valign="top"|Biocor
|rowspan="4" valign="top"|Stentless bioprosthesis
|27
|13 ± 1
|
|
|
|
|-
|29
|14 ± 2.5
|
|
|
|
|-
|31
|11.5 ± 0.5
|
|
|
|
|-
|33
|12 ± 0.5
|
|
|
|
|-
|rowspan="4" valign="top"|Bioflo pericardial
|rowspan="4" valign="top"|Stented bioprosthesis
|25
|10 ± 2
|6.3 ± 1.5
|
|
|2 ± 0.1
|-
|27
|9.5 ± 2.6
|5.4 ± 1.2
|
|
|2 ± 0.3
|-
|29 
|5 ± 2.8 
|3.6 ± 1
|
|
|2.4 ± 0.2
|-
|31
|4.0
|2.0
|
|
|2.3
|-
|rowspan="4" valign="top"|Carpentier - Edwards
|rowspan="4" valign="top"|Stented bioprosthesis
|27
|
|6 ± 2 
|1.7 ± 0.3 
|98 ± 28
|
|-
|29
| 
|4.7 ± 2
|1.76 ± 0.27
|92 ± 14
|
|-
|31
|
|4.4 ± 2
|1.54 ± 0.15
|92 ± 19
|
|-
|33
|
|6 ± 3
|
|93 ± 12
|
|-
|rowspan="4" valign="top"|Carpentier - Edwards pericardial
|rowspan="4" valign="top"|Stented Bioprosthesis
|27
|
|3.6
|1.6
|100
|
|-
|29
|
|5.25 ± 2.36
|1.67 ± 0.3
|110 ± 15
|
|-
|31
|
|4.05 ± 0.83
|1.53 ± 0.1
|90 ± 11
|
|-
|23
|
|1.0
|0.8
|80
|
|-
|rowspan="4" valign="top"|Hancock I (or NOS)
|rowspan="4" valign="top"|Stented bioprosthesis
|27
|10 ± 4
|5 ± 2
|
|
|1.3 ± 0.8
|-
|29
|7 ± 3
|2:46 ± 0.79
|
|115 ± 20
|1.5 ± 0.2
|-
|31
|4 ± 0.86
|4.86 ± 1.69
|
|95 ± 17
|1.6 ± 0.2
|-
|33
|3 ± 2
|3.87 ± 2
|
|90 ± 12
|1.9 ± 0.2
|-
|rowspan="4" valign="top"|Hancock II
|rowspan="4" valign="top"|Stented bioprosthesis
|27
|
|
|
|
|2.21 ± 0.14
|-
|29
|
|
|
|
|2.77 ± 0.11
|-
|31
|
|
|
|
|2.84 ± 0.1
|-
|33
|
|
|
|
|3.15 ± 0.22
|-
|rowspan="2" valign="top"|Hancock pericardial
|rowspan="2" valign="top"|Stented bioprosthesis
|29
|
|2.61 ± 1:39
|1:42 ± 0:14
|105 ± 36
|
|-
|31
|
|3.57 ± 1.02
|1.51 ± 0.27
|81 ± 23
|
|-
|rowspan="4" valign="top"|Ionescu - Shiley
|rowspan="4" valign="top"|Stented bioprosthesis
|25
|
|4.87 ± 1.08
|1.43 ± 0.15
|93 ± 11
|
|-
|27
|
|3.21 ± 0.82
|1.31 ± 0.24
|100 ± 28
|
|-
|29
|
|3.22 ± 0.57
|1.38 ± 0.2
|85 ± 8
|
|-
|31
|
|3.63 ± 0.9
|1.45 ± 0.06
|100 ± 36
|
|-
|rowspan="2" valign="top"|Ionescu - Shiley low profile
|rowspan="2" valign="top"|Stented bioprosthesis
|29
|
|3.31 ± 0.96
|1.36 ± 0.25
|80 ± 30
|
|-
|31
|
|2.74 ± 0.37
|1.33 ± 0.14
|79 ± 15
|
|-
|rowspan="3" valign="top"|Labcor-Santiago pericardial
|rowspan="3" valign="top"|Stented bioprosthesis
|25
|8.7
|4.5
|
|97
|2.2
|-
|27
|5.6 ± 2.3
|2.8 ± 1.5
|
|85 ± 18
|2.12 ± 0.48
|-
|29
|6.2 ± 2.1
|3 ± 1.3
|
|80 ± 34
|2.11 ± 0.73
|-
|rowspan="4" valign="top"|Medtronic Intact Porcine
|rowspan="4" valign="top"|Stented bioprosthesis
|29
|
|3.5 ± 0.51
|1.6 ± 0.22
|
|
|-
|31
|
|4.2 ± 1.44
|1.6 ± 0.26
|
|
|-
|33
|
|4 ± 1.3
|1.4 ± 0.24
|
|
|-
|35
|
|3.2 ± 1.77
|1.3 ± 0.5
|
|
|-
|rowspan="4" valign="top"|Mitroflow
|rowspan="4" valign="top"|Stented bioprosthesis
|25
|
|6.9
|2.0
|90
|
|-
|27
|
|3.07 ± 0.91
|1.5
|90 ± 20
|
|-
|29
|
|3.5 ± 1.65
|1.43 ± 0.29
|102 ± 21
|
|-
|31
|
|3.85 ± 0.81
|1.32 ± 0.26
|91 ± 22
|
|-
|rowspan="3" valign="top"|Stentless quadrileaflet bovine pericardial
|rowspan="3" valign="top"|Stentless bioprosthesis
|26
|
|2.2 ± 1.7
|1.6
|103 ± 31
|1.7
|-
|28
|
|
|1:58 ± 0.25
|
|1.7 ± 0.6
|-
|30
|
|
|1.42 ± 0.32
|
|2.3 ± 0.4
|-
|-
|+ Normal Values ​​biological Mitralisklepprothese
|rowspan="2" valign="top"|Wessex
|rowspan="2" valign="top"|Stented bioprosthesis
|29
|
|3.69 ± 0.61
|1.66 ± 0.17
|83 ± 19
|
|-
|-
|Valve Type Size ( mm) Peak gradient (mmHg) Mean gradient (mmHg) Peak Velocity ( m / s) Pressure half-time (ms ) EOA (cm2)
|31  
Biocor Stentless bioprosthesis 27 13 ± 1
|
29 14 ± 2.5
|3.31 ± 0.83
31 11.5 ± 0.5
|1.41 ± 0.25
33 12 ± 0.5
|80 ± 21
Stented pericardial bioprosthesis BioFlo 25 10 ± 2 6.3 ± 1.5 0.1 ± 2
|
27 9.5 ± 2.6 5.4 ± 1.2 2 ± 0.3
29 5 ± 2.8 3.6 ± 0.2 2.4 ± 1
31 4.0 2.0 2.3
Carpentier - Edwards stented bioprosthesis 27 6 ± 2 1.7 ± 0.3 98 ± 28
29 4.7 2 ± 1.76 ± 92 ± 14 12:27
4.4 31 ± 2 92 ± 1:54 ± 0:15 19
6 33 ± 3 93 ± 12
Carpentier - Edwards pericardial stented Bioprosthesis 27 3.6 1.6 100
29 5:25 2:36 ± 1.67 ± 0.3 110 ± 15
31 4:05 1:53 ± 0.83 ± 0.1 90 ± 11
23 1.0 0.8 80
Hancock I ( or NOS ) stented bioprosthesis 27 10 ± 4 5 ± 2 1.3 ± 0.8
29 7 ± 3 2:46 ± 0.79 115 ± 20 1.5 ± 0.2
31 4 ± 0.86 4.86 ± 1.69 95 ± 17 1.6 ± 0.2
33 3 2 ± 3.87 ± 2 90 ± 12 1.9 ± 0.2
Hancock II stented bioprosthesis 27 2:21 ± 0:14
29 2.77 ± 0:11
31 2.84 ± 0.1
33 3:15 ± 0:22
Hancock pericardial stented bioprosthesis 29 2.61 ± 1:39 1:42 ± 0:14 105 ± 36
31 3:57 1:02 1:51 ± 0:27 ± 81 ± 23
Ionescu - Shiley stented bioprosthesis 25 4.87 ± 1.43 ± 1:08 ± 0:15 93 11
27 3:21 1:31 ± 0:24 ± 0.82 100 ± 28
29 3:22 0:57 ± 1:38 ± 0.2 85 ± 8
31 ± 0.9 1.45 ± 3.63 100 ± 36 00:06
Ionescu - Shiley low profile stented bioprosthesis 29 3:31 1:36 ± 0.96 ± 0.25 80 ± 30
31 2.74 ± 0:37 1:33 ± 0:14 ± 79 15
Stented pericardial bioprosthesis Labcor - Santiago 25 8.7 4.5 97 2.2
27 5.6 ± 2.3 2.8 ± 1.5 85 ± 18 ± 2:12 0:48
29 ± 6.2 2.1 ± 1.3 80 ± 3 34 ± 0.73 2:11
Medtronic Intact Porcine stented bioprosthesis 29 3.5 ± 1.6 ± 0:51 0:22
31 ± 4.2 1.6 ± 1:44 0:26
33 4 ± 1.3 1.4 ± 0:24
35 3.2 ± 1.77 1.3 ± 0.5
Stented bioprosthesis Mitroflow 25 6.9 2.0 90
27 3:07 0.91 ± 1.5 90 ± 20
29 ± 3.5 1.43 ± 1.65 102 ± 21 12:29
31 3.85 ± 0.81 91 ± 1:32 ± 0:26 22
Stentless quadrileaflet bovine pericardial bioprosthesis Stentless 26 2.2 1.7 ± 1.6 103 ± 31 1.7
28 1:58 ± 0.25 1.7 ± 0.6
30 1:42 0:32 ± 2.3 ± 0.4
Wessex stented bioprosthesis 29 3.69 ± 0.61 1.66 ± 83 ± 19 00:17
31 3:31 1:41 ± 0.83 ± 0.25 80 ± 21
|}
|}


Related valve dysfunction in bioprostheses
==Related valve dysfunction in bioprostheses==
In Stentless bioprosthesis proximal joint of the prosthesis may loosen , causing blood between aortic wall and valve can come . When valve thrombosis there arises an increase in the gradient and an increase in the back flow ( leakage ) due to the larger mass, to enable the valve closes slowly.
 
In Stentless bioprosthesis proximal joint of the prosthesis may loosen , causing blood between aortic wall and valve can come . When valve thrombosis there arises an increase in the gradient and an increase in the back flow (leakage) due to the larger mass, to enable the valve closes slowly.


==References==
==References==
Nilofer
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