AHA 2020 Valve Guidelines Flashcards
What is 4 grade system for scoring valve disease?
A: At risk
B: Progressive
C: Severe asymptomatic
D: Severe symptomatic
Echo follow up for surgical tissue valve? mechanical? TAVR?
Baseline, 5 years, 10 years then annually
Baseline
Baseline and annually
Echo surveillance for MV repair? transcatheter?
Baseline, 1 year then 2-3y?
Baseline and annually
Rheumatic fever secondary prevention? 3 antibiotic regimens?
- 10 years until over 40 years (What ever longer)
- Pen G every 4 weeks, Sulfadiazine 1g orally once daily, Pen V 200mg bid
Secondary prevention for rheumatic fever if no residual valve disease? without carditis at all?
- 10 year until age 21
- 5 year until age 21
Describe the three kinds of severe AS
D1: Severe and high gradient
D2: Symptomatic LFLG with reduced EF (AVA < 1, Vmax < 4m/s), LVEF < 50%
D3: Symptomatic/Paradoxical: as above but normal EF and SVI < 35
What medication may reduce mortality in patients post TAVI?
ACEi/ARB (Class 2a)
All indications for AVR in asymptomatic AS? (7)
- Other OR (Class 1 Severe, IIb Moderate)
- LVEF < 50% (Class 1)
- Decreased BP or exercise capacity on EST (Class 2a)
- BNP 3x normal (Class 2a)
- Vmax > 5 m/s (Class 2a)
- Decreased LVEF to < 60% in 3 serial studies (Class 2a)
- Progression > 0.3 m/s/yr (Class 2a)
7 reasons to pick tissue valve over mechanical?
- Age > 65
- Patient Preference
- Inabililty to anticoagulate
- Avoid PPM (TAVI ERO > SAVR for given valve size)
- Access to surgical center for reintervention
- Access to center for VIV
- Limited access to medical center for VKA monitoring
When to choose SAVR instead of TAVR? (4)
< 65y with LE > 20y
> 80 or LE < 10y -> TAVR
TAVR > SAVR for high surgical risk
What Life Expectancy do you need for TAVI?
12 months
4 measures of high surgical risk for TAVI?
- STS > 8%
- 2 or more frailty measures
- 1-2 or more organ systems with
- Possible Procedure specific impediment
What blood pressure target for severe AR?
- 140mmhg
3 class 2 indications for AR?
- LVESD > 50
- 3 serial echo that show LV dilation up to LVEDD > 65, or LVEF decrease to low normal range (55-60%)
- Moderate for CVSx
What % of patients with BAV will have an affected FDR?
20-30%
4 indications for intervention in BAV Aortopathy?
- > 5.5
- > 5 with following:
- fam hx dessection
- Growth > 0.5cm/year
- Coarctation
- 4.5 underoing OHS
What is MVA cut off for severe MS? PHT?
MVA < 1.5 cm2
> 150ms
what is rate of progression for MS?
0.1 cm/yr
3 indications for OAC in MS?
Recurrent emboli
AF
LA thrombus
Class 1 indication for MVR/Balloon valvuloplasty?
-MVA < 1.5cm with symptoms and <2+ MR and LA thrombus
Class II indications for MS intervention?
- Asymptomatic with MVA < 1.5 with elevated pulmonary pressures or new Afib
- Symptomatic non severe MS that is hemodynamically significant (PCWP > 25, MV MG > 15mmg during exercise)
3 class one indications for MVR in patients with severe MR?
- Symptomatic
- LVEF < 60%
- LVESD > 40mm
Name 2 class 2 indications for MVR in MR?
- > 95% chance of repair <1% mortality
- Progressive increase in LV size or decrease EF
LVESD and PASP cut off for TEER for MR? LVEF range?
< 70 mmhg
< 70 LVESD
20-50%