Aortic Valve Disease Flashcards
Level of evidence A
multiple RCTs, multiple populations evaluated
Level of Evidence B
single randomized trial or nonrandomized studies
Level of evidence C
expert opinion, case studies, or “standard of care”
in biscusp AV, which leaflets are most commonly fused?
R + L
what is the most common valvular lesion in USA?
AS
what percent of population has bicusp AV?
1-2%
what is almost always associated with rheumatic AS?
MV involvement
what is the appearance of a bicusp AV on PLAX of echo?
dome shaped
do most bicusp AV become stenotic?
no
what is the key to diagnosing rheumatic AS?
MV involvement
in a young patient with bicusp AV and HTN, what should you watch out for?
coarctation and dissection
besides murmur, what doyou auscultate for SEVERE AS?
loss of A2, late ejection
Cardiac output/ Sq rt Gradient= ?
AVA
Mod AS: Jet velocity, Mean gradient, AVA
Jet velocity, Mean gradient, AVA
3-4m/s, 25-40mmHg, 1-1.5cm2
Stage of AS if at risk with sclerosis or bicuspid/congenital
A (At risk)
Stage of AS if mild to mod AS +/- diastolic dysfxn, calcification or rheumatic changes
No sxs
B (Progressive AS)
Stage of AS if no sxs, severe calcification, severe AS on echo , LVH, diastolic dysfxn
C1 (asymptomatic severe AS)
Test for Stage C1 AS
Stress
Stage of AS if severe AS, LV<50%, no sxs
C2
Stage of AS if severe w/ sxs, LVH, diastolic dysfxn, +/- PH
D1
Protocol for f/u echocardiograms in asymptomatic mild, moderate and severe AS
Q5y, 3y, annually
In AS, how much is jet velocity expected to increase per year?
0.3 m/s
In AS, how much is gradient expected to increase per year?
7mm Hg
In AS, how much is AVA expected to decrease per year?
0.1cm2
What stage is severe AS with low EF and LFLG?
D2
What stage is severe AS with preserved EF and paradoxical LFLG?
D3
What to look for on dobutamine stress to rule in true AS LFLG (not pseudo stenosis )?
Inc in gradient with dobutamine
Which trial showed no clinical, echo, CT benefit to statin in AS?
Saltire
Can you do a dobutamine study onto differentiate pseudo-AS vs real AS on a pt with normal EF?
No
Usually which side of a valve with regurgitation is a vegetation on?
Downstream
What stage of AI is severe AR without sxs and normal LVEF?
C1
What stage of AI is severe AR, no sxs, LVEF<50% or 50mm?
C2
What stage of AI is severe AR, with sxs, LV dilation, +/- LV dysfxn?
D
Finding in proximal Ao for severe AI?
Flow reversal
Vena contracta defining severe AR
> .6 cm
ERO defining severe AR
> . cm2
Medical Treatment for acute AI
Nipride (ideal)
Hydralazine
No IABP
How often do you get echo in patients with severe AI or root root dilatation?
Yearly
What is main factor that decides operative mortality for AI?
LV fxn
AI indications for Sx
Sxs (I)
LVEF < 50%
LV Dil: ESD> 50mm or EDD> 65mm
Hakai eqn in cath lab
AVA= CO/ sq rt P2P
