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oral boards > AHA: AR > Flashcards

AHA: AR Flashcards

1
Q

class 3 recommendation(s) for AVI choice (TAVI v SAVR) in isolated severe AR

A

NOT TAVI
(3: HARM)

assuming SAVR candidate

“7. In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed.”

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2
Q

regurgitant jet width (% of LVOT) in mild AR

A

<25

%

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3
Q

vena contracta in mild AR

A

<0.3

cm

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4
Q

RVol/Vregurg in mild AR

regurgitant volume

A

<30

mL/beat

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5
Q

RF in mild AR

regurgitant fraction

A

<30

%

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6
Q

EROA in mild AR

effective regurgitant orifice area

A

<0.1

cm2

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7
Q

grade in mild AR

A

1+

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8
Q

prox abd Ao/desc Ao flow reversal in mild AR

AHA: prox abd / ASE: desc Ao

A

brief, early

only specified in ASE

AHA does not mention for mild/mod; ASE does not mention for mod

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9
Q

regurgitant jet width (% of LVOT) in moderate AR

A

25-65

%

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10
Q

vena contracta in moderate AR

A

0.3-0.6

cm

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11
Q

RVol/Vregurg in moderate AR

regurgitant volume

A

30-60

mL/beat

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12
Q

RF in moderate AR

regurgitant fraction

A

30-50

%

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13
Q

EROA in moderate AR

effective regurgitant orifice area

A

0.1-0.3

cm2

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14
Q

grade in moderate AR

A

2+

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15
Q

prox abd Ao/desc Ao flow reversal in moderate AR

AHA: prox abd / ASE: desc Ao

A

N/A

AHA does not mention for mild/mod; ASE does not mention for mod

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16
Q

regurgitant jet width (% of LVOT) in severe AR

A

≥65

%

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17
Q

vena contracta in severe AR

A

>0.6

cm

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18
Q

RVol/Vregurg in severe AR

regurgitant volume

A

≥60

mL/beat

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19
Q

RF in severe AR

regurgitant fraction

A

≥50

%

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20
Q

EROA in severe AR

effective regurgitant orifice area

A

≥0.3

cm2

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21
Q

grade in severe AR

A

3-4+

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22
Q

prox abd Ao/desc Ao flow reversal in severe AR

AHA: prox abd / ASE: desc Ao

A

holodiastolic

AHA does not mention for mild/mod; ASE does not mention for mod

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23
Q

aortic valve

regurgitant jet width (% of LVOT) <25 %

A

mild AR

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24
Q

aortic valve

vena contracta <0.3 cm

A

mild AR

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25
Q

aortic valve

RVol/Vregurg <30 mL/beat

regurgitant volume

A

mild AR

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26
Q

aortic valve

RF <30 %

regurgitant fraction

A

mild AR

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27
Q

aortic valve

EROA <0.1 cm2

effective regurgitant orifice area

28
Q

aortic valve

1+ grade regurg

29
Q

aortic valve

regurgitant jet width (% of LVOT) = 25-65 %

A

moderate AR

30
Q

aortic valve

vena contracta = 0.3-0.6 cm

A

moderate AR

31
Q

aortic valve

RVol/Vregurg = 30-60 mL/beat

regurgitant volume

A

moderate AR

32
Q

aortic valve

RF = 30-50 %

regurgitant fraction

A

moderate AR

33
Q

aortic valve

EROA = 0.1-0.3 cm2

effective regurgitant orifice area

A

moderate AR

34
Q

aortic valve

2+ grade regurg

A

moderate AR

35
Q

aortic valve

regurgitant jet width (% of LVOT) ≥65 %

36
Q

aortic valve

vena contracta >0.6 cm

37
Q

aortic valve

RVol/Vregurg ≥60 mL/beat

regurgitant volume

38
Q

aortic valve

RF ≥50 %

regurgitant fraction

39
Q

aortic valve

EROA ≥0.3 cm2

effective regurgitant orifice area

40
Q

aortic valve

3-4+ grade regurg

41
Q

Is degenerative or rheumatic AR more common?

A

neither
~50/50

42
Q

indication(s) for intervention in moderate AR

A
  • concomitant <3 surg (2a)
    regardless of sx status

“In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable.”

43
Q

indication(s) for intervention in moderate AR

(1)

A
  • concomitant <3 surg (2a)
    regardless of sx status

“In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable.”

44
Q

indication(s) for intervention in asx moderate AR

A
  • concomitant <3 surg (2a)
    regardless of sx status

“In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable.”

45
Q

indication(s) for intervention in sx moderate AR

A
  • concomitant <3 surg (2a)
    regardless of sx status

“In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable.”

46
Q

indication(s) for intervention in sx severe AR

A

YES
severe + sx = indicated
(1)

regardless of EF

“1. In symptomatic patients with severe AR (Stage
D), aortic valve surgery is indicated regardless
of LV systolic function.” (1)

47
Q

indication(s) for intervention in sx severe AR

(1)

A

YES
severe + sx = indicated
(1)

regardless of EF

“1. In symptomatic patients with severe AR (Stage
D), aortic valve surgery is indicated regardless
of LV systolic function.” (1)

48
Q

indication(s) for intervention in asx severe AR

A
  • EF≤55% if no other cause identified (1)
  • concomitant <3 surg (1)
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

OR if low-risk AND EF>55%:
- BUT progressive ↓ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

49
Q

mgmt of asx severe AR + EF=55%

A

AVR
- EF≤55% if no other cause identified (1)

50
Q

mgmt of asx severe AR + concomitant <3 surg

A

AVR
- concomitant <3 surg (1)

51
Q

mgmt of asx severe AR + EF=65% + LVESD=55mm

A

AVR
- EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

52
Q

indication(s) for intervention in asx severe AR

(5)

A
  • EF≤55% if no other cause identified (1)
  • concomitant <3 surg (1)
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

OR if low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

53
Q

class 1 indication(s) for intervention in asx severe AR

(2)

A
  • EF≤55% if no other cause identified (1)
  • concomitant <3 surg (1)
54
Q

class 2 indication(s) for intervention in asx severe AR

A
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

OR if low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

55
Q

class 1 indication(s) for intervention in asx severe AR

A
  • EF≤55% if no other cause identified (1)
  • concomitant <3 surg (1)
56
Q

class 2 indication(s) for intervention in asx severe AR

(3)

A
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

OR if low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

57
Q

class 2b indication(s) for intervention in asx severe AR

A

low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

58
Q

class 2a indication(s) for intervention in asx severe AR

A
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)
59
Q

class 2a indication(s) for intervention in asx severe AR

(1)

A
  • EF>55% BUT LVESD>50mm / 25mm/m2 (2a)
60
Q

class 2b indication(s) for intervention in asx severe AR

(2)

A

low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

61
Q

indication(s) for intervention in severe AR

A
  • sx (1)
  • asx + EF≤55% if no other cause identified (1)
  • concomitant <3 surg (1)
    regardless of sx status
  • asx + EF>55% BUT LVESD>50mm / 25mm/m2 (2a)

OR asx + low-risk AND EF>55%:
- BUT progressive ￬ EF on 3 studies to 55-60% (2b)
- BUT progressive ￪ LVEDD on 3 studies to >65mm (2b)

62
Q

LVESD threshold for intervention on severe AR

A

> 50mm / 25mm/m2
(in asx with EF>55%)

63
Q

LVEDD threshold for intervention on severe AR

A

>65mm
(progressive on 3 studies
in asx + low-risk AND EF>55%)

64
Q

ONLY indication for intervention in moderate AR

A
  • concomitant <3 surg (2a)
    regardless of sx status
65
Q

class 3 recommendation for severe AR intervention

A

NOT TAVI
(3: HARM)

assuming SAVR candidate

“7. In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed.”

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