Station 3.7: Prosthetic valves: aortic and mitral Flashcards

Prosthetic valves: aortic and mitral

1
Q

Clinical signs

What are the clinical signs for Prosthetic valves: aortic and mitral?

Prosthetic valves: aortic and mitral

This patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardio-vascular system.

A
  • Audible prosthetic clicks (metal) on approach and scars on inspection
  • Auscultation: don’t panic!
  • Anticoagulation: bruises (metal valve) and anaemia
  1. Midline sternotomy (CABG, AVR, MVR)
  2. Lateral thoracotomy (MVR, mitral valvotomy, coarctation repair, BT shunt)
  3. Subclavicular (Pacemaker, AICD)
  4. Anticubital fossa (angiography)
    https://1drv.ms/i/s!AofDuV8g6bhQge8mQGiXMLkAjuvugw?e=hx3ECH
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2
Q

Discussion - choice of valve replacement

What are the choices of valve replacement for Prosthetic valves: aortic and mitra?

Prosthetic valves: aortic and mitral

his patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardiovascular system.

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3
Q

Discussion - Late complications

What are the choices of valve replacement for Prosthetic valves: aortic and mitra?

Prosthetic valves: aortic and mitral

his patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardiovascular system.

A
  • Thromboembolus: 1–2% per annum despite warfarin
  • Bleeding: fatal 0.6%, major 3%, minor 7% per annum on warfarin
  • Bioprosthetic dysfunction and LVF: usually within 10 years, can be treated percutaneously (valve‐in‐valve)
  • Haemolysis: mechanical red blood cell destruction against the metal valve
  • Infective endocarditis:
    ⚬ Early infective endocarditis (<-2/12 post‐op) can be due to Staphylococcus epidermidis from skin
    ⚬ Late infective endocarditis is often due to Strep. viridans by haematogenous spread
    ⚬ A second valve replacement is usually required to treat this complication
    ⚬ Mortality of prosthetic valve endocarditis approaches 60%
  • Atrial fibrillation: particularly if MVR
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