Treating valve disease Flashcards
Definitive therapy for aortic stenosis
Replacement via TAVR or open surgery
Balloon valvotomy is NOT effective since the valve is calcified. Sometimes this is attempted for palliation in nonsurgical candidates who cannot do TAVI/TAVR.
Definitive therapy for mitral regurgitation
Valve replacement
Mitral regurgitation following a heart attack
Usually due to papillary muscle rupture, sometimes chordae tendinae rupture
The blood supply to the papillary muscles is the RCA.
Definitive therapy for aortic regurigtation
Valve replacement
Additonal consideration: The ostea of the coronary vessels are in the aortic valve and may be compromised in aortic regurgitation. Additional surgery is often done to revascularize w/ CABG in the same operation.
Where do you hear aortic regurgitation’s murmur best?
4th intercostal space at LSB
ie, the Tricuspid space, ironically
UNLESS it is due to aortic dissection, in which case it is best heard in the Aortic space.
Definitive therapy for mitral stenosis
Definitive treatment is replacement. . . BUT you basically get one shot.
You really want to be careful with pre-operative course. Manage with diuretics. May be afib secondary to atrial enlargement, in which case antiarrhythmics are indicated.
In mitral stenosis, the opening snap of the murmur occurs ___ the worse the disease is
In mitral stenosis, the opening snap of the murmur occurs earlier in the murmur the worse the disease is
Organic vs mechanical valves
Organic valves last less than 10 years, but need no AC
Mechanical valves greater than 20 or more years, but do need AC (Warfarin, INR 2.5-3.5)
Note that the target INR is even greater than for DVT/PE prophylaxis.
90% of tricuspid regurgitation is ___
90% of tricuspid regurgitation is secondary
In particular, secondary to chronic left-sided heart failure
The mechanism is dilation of the tricuspid valve annulus.
