Valve Disease Flashcards
Aetiology of AS
<70yrs = bicuspid and rheumatic >70yrs = degenerative and bicuspid
Grading of severity of AS
ECG: LVH
TTE: Severe = valve area <1 or mean gradient >40
Concern with low flow severe AS where poor LV function –> low valve gradient due to poor output. Low dose dobutamine challenge or balloon valvuloplasty can be used to assess
Sign of poor prognosis with AS
HEART FAILURE +++
2nd = syncope 3rd = angina
Prognosis for AS
If asymptomatic SCD = <1% annually. BUT must do exercise assessment to determine if really asymptomatic
If symptomatic then 5yr survival is <50% = intervention is required
Surgical mortality for AS
1% for patients under 70yrs
4-8% for patients > 80yrs
What about balloon valvuloplasty?
Children = benefit
Adults = buy time or to assess symptom benefit for high risk surgical patients
Indications for AS surgery
Symptomatic severe AS
Severe AS and having other cardiac surgery
Surgical Vs TAVI replacement
Surgical = mainstay of treatment
TAVI = high surgical risk (>10% mortality) but have suitable anatomy and life expectancy >1yr and likely to have symptomatic benefit
Medical management = poor life expectancy due to comorbidities
Complications of TAVI?
BLEEDING +++
Vascular injury
30 day mortality = 10%
Causes of AR?
Acute severe = dissection or endocarditis –> emergent surgery
Chronic = HTN, Degeneration due to AS, previous endocarditis, bicuspid and Marfans
Mortality from AR?
Chronic severe symptomatic AR - mortality = 10-20%/yr
Chronic severe Asymptomatic AR + LV dysfunction = 20%/yr
Clinical signs of AS?
Low diastolic BP, high SBP
Duration of murmur = severity
S3
LVF
What surgery for AR?
Valve replacement usually
May have valve repair but expect to reoperate
Surgical indications for AR?
Severe symptomatic AR
Asymptomatic with LVEF<50%
Having other heart surgery
Asymptomatic with normal EF but dilated LV
What about aortic root surgery?
Marfans with root >50
Bicuspid >50 with risk factors
Everything else at >55