Car tyres warrant replacement every 20,000 km or so .Its batteries do require periodic attention. Human heart , which runs non stop from womb to tomb . . . deserves how much ? Unfortunately no one (What about your cardiologist?) can provide a flawless lifetime maintenance contract to this restless bio-mechanical pump ! Fortunately still, God has created this wonder organ ,that can with stand the stress of life for nearly 10 decades . . . if we live a proper life !
However ,there are many areas in heart that are prone for mechanical stress even if it’s structurally normal .These are the zones where the relatively fixed parts rub against the dynamic zones .The joint between inflows ,outflows to the respective ventricle are at risk . Aortic root, along with the leaflets and annulus formed by the fibrous skeleton is delicately close to the critical part of the conduction system namely the branching portion of AV node and His Purkinje.The process of degeneration is linked to age, valvular abnormality and genetic and systemic metabolic profile also seem to matter in few .(Hypercalcemia and cardiac calcification ?)
Importance of the interface between Aortic valve and AV conduction system in the current Era
Degenerative aortic valve disease along with the adjacent conduction system of elderly is going to be a key cardiovascular disease in the future as the population is aging .We have made a big step forward in tackling this with innovative percutaneous aortic valve implantation (TAVI) . However ,the artificial valve is positioned vulnerablely close to conduction system and incidence of complete heart block either during implantation or follow up is high and a permanent pacemaker seems to be an integral part of this procedure for many.
Heart seen from behind , Mitral annulus to left and tricuspid valve ring to the right .
Dr.S.Venkatesan MD 