Valve Flashcards
Ava severe
Jet velocity 4 m/sec
Mean gradient 40
Valve area 1cm2
Check echo for AS
Mild 3-5 years Mod1-2 years Severe 1 year Ms mild to mod every 3/5 years severe every one years MR mod 1-2 years severe every 6 mos
As
Valsalva gradient decrease after PVC the pulse pressure increSes
As
Severe as you can do surgery with symptoms and asptomatic go stress test
AI
Pressure half time 500 is mild
200 or less is severe
AI LVdd 70 end systolic 50 or EF less than 50 Regurgitant volume 60 ml ERO 30 RBI flow 13-15 vena contracta 6 mm RF 50%
Ms
Treat if the mean PA 25 at rest or after exercise
MR surgery
Primary
Severe vena contracta 0.7 Regurgitant volume 60, RF 50% ERO 0.4
EF 30-60 LVESD 40 mm
Secondary
Persistent CHF . For secondary do only replacement as the root will keep dilating
Estimation of RAP
Ivc less than 2 cm greater than 50% collapse 0- 5 mm hg
More than 2 cm less than 50% collapse 10-20
Severe TR
Triangular V wave TV inflow velocity > 1 m /sec Systolic reversal Regurgitant volume greater than 45 ml Vena contracta 7 mm
Sptomatic severe TR
Need surgery 2 a. Only class 1 is to do at the time if the left sided valve surgery
Anti thrombotic therapy
Mechanical AVR First 3 mos INR 2.-3 or 2.5-3.5 and Asa After 3 INR 2-3 and Asa High risk AVR 2.5-3.5 MVR Asa INR 2.5-3.5
Bio. Prosthetic
AVR low risk INR 2-3 for 3 mos and Asa INR class 2a
High risk Asa and INR 2-3
MVR samething INR could be 2-3
AorticProsthetic obstruction criteria
Peak velocity greate than 4 m/sec Mean gradient greater than 35 dImentionless index less than 0.25 EOA <0.8 Accelaration time greater than 100 ms ecp
Prosthetic valve thrombus
Left side use Thrombolysis only for small clots
Right side can try Thrombolysis
As surgery
Severe ASp
Symptoms surgery No symptoms low EF surgery Normal EF increase velocity 0.3 m/ sec in a year surgery Physically active stress None of the above reeval 6-12 mos
