Track 7: Valvular general approach and guidelines Flashcards
Stages of valvular heart disease
Patient with risk factors for development of VHD
Stage A
Patient with progressive VHD (mild to moderate severity and asx
Stage B
Asx patient with severe VHD in whom the LV or RV remains compensated
Asx patient with severe VHD with decompensation of the LV or RV
Stage C1
Stage C2
What is the difference between VHD stage C1 and stage C2
Both have severe VHD and are asx
C1 LV and RV remain compensated
C2 decompensation of LV and RV
What is the difference between VHD stage C and stage D
Stage C are asx severe
Stage D are sx severe
Patients who have developed sxs as a result of severe VHD
Stage D
Outline the stages of VHD A-D with one line descriptors
A: At risk
B: Progressive
C: Asx severe
D: Symptomatic severe
Key TTE measurements for stenotic lesions
- Max velocity
- Mean gradient
- Valve area
Key TTE measurements for regurgitant lesions
Calculation of regurgitant orifice area, volume, and fraction
Color doppler imaging
Surveillance TTE in progressive (Stage B) AS
Surveillance TTE in severe asx (Stage C1) AS
- Every 3-5 years (mild severity, Vmax 2.0-2.9 m/s)
- Every 1-2 years (moderate severity, Vmax 3.0-3.9 m/s)
- C1: Every 6-12 months (Vmax ≥ 4 m/s)
Surveillance TTE in progressive (Stage B) AR
Surveillance TTE in Severe asx (Stage C1) AR
- Every 3-5 years (mild severity)
- Every 1-2 years (moderate severity)
-C1: Every 6-12 months
- C1, dilating LV: more frequently
Surveillance TTE in progressive (Stage B) MS
Surveillance TTE in severe asx (Stage C1) MS
- Every 3-5 years (MV area > 1.5cm2)
-C1: Every 1-2 years (MV area 1.0-1.5 cm2)
-C1: Every year (MV area < 1.0 cm2)
Surveillance TTE in progressive (Stage B) MR
Surveillance TTE in severe asx (Stage C1) MR
- Every 3-5 years (mild severity)
- Every 1-2 years (moderate severity)
-C1: every 6-12 months
-C1, dilating LV: more frequently
Risk of developing IE is highest in what populations?
- Prosthetic valve
- Prior IE
- Congenital heart disease with residual flow disturbance
VKA verus DOAC in concomitant VHD and AF
VKA:
- Rheumatic MS
- Mechanical valve
- Bioprosthetic valve < 3 months ago
DOAC alternative:
- Bioprosthetic ≥ 3 months ago
- Native VHD (excluding rheumatic MS)
Postoperative AF after VHD intervention is associated with increased stroke and mortality irrespective of
CHA2DS2VASc score
MC complication early after surgical valve replacement is
Postoperative AF
Prevalence and timeline of postoperative AF after surgical valve replacement
Occurs in up to 1/3 of patients within 3 months of surgery
Name some of the possible complications after valve replacement surgery (8)
- # 1 postoperative AF
- Stroke
- Vascular and bleeding complications
- Pericarditis
- Heart block requiring temporary or permanent pacing (especially after AVR)
- HF
- Renal dysfunction
- Infection
Name some of the possible complications after transcatheter valvular intervention (5)
- Permanent pacing need
- Paravalvular leak
- Stroke
- Vascular complications
- Residual valve dysfunction
Hemodynamic severity for AS is best calculated by
- Transaortic max velocity
- Mean pressure gradient
Stage A AS
**At risk of AS **
- BAV, other congenital valve anomaly, aortic valve sclerosis
- Aortic Vmax <2 m/s, normal leaflet motion
- No hemodynamic consequences
- No sxs
Stage B AS
Progressive AS
- Mild-mod leaflet calcification/fibrosis of bicuspid or trileaflet valve w/ some reduction in systolic motion OR rheumatic valve changes with comissural fusion
- Mild AS: Aortic vmax 2.0-2.9 m/s or mean gradient < 20 mmHg
- Moderate AS: Aortic Vmax 3.0-3.9 m/s or mean gradient 20-39 mmHg
- Early LV diastolic dysfunction may be present
- Normal LVEF
- Asx