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BPT Flashcards > Valve replacement guidelines > Flashcards

Valve replacement guidelines Flashcards

1
Q

Indications for surgical management for AR

A
  • Acute severe AR
  • Symptomatic chronic severe AR
  • Asymptomatic chronic severe AR with LVEF < 55%, LVESD > 50mm, or having cardiac surgery for other indications
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2
Q

Monitoring intervals for AR

A

Mild: 3-5 years
Moderate: 1-2 years
AR C1 regurgitation: 6-12 months

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3
Q

Definition of severe AR

A

VC > 0.6cm
Holodiastolic aortic flow reversal
RVol > 60ml
RF >/ 50%
ERO >/ 0.3cm2

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4
Q

Causes of AR

A

Acute:
- IE
- Aortic dissection
- Chest trauma

Chronic:
- Bicuspid aortic valve
- CTDs
- RF
- Rheumatic diseases

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5
Q

Murmur of AR

A

Diastolic murmur with descrescendo

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6
Q

Indications for surgical management for MR

A
  • Acute primary MR
  • Acute secondary MR not responding to therapy
  • Chronic primary MR - asymptomatic (LVEF < 60% and/or LVESD > 40mm), symptomatic patients regardless of systolic function
  • Chronic secondary MR - severe and persistent symptomatic heart failure despite optimal medical therapy`
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7
Q

Causes of MR

A

Primary (organic) - direct involvement of valve leaflets or chordae tendineae
- degenerative mitral valve disease
- RF
- IE
- Ischaemic MR i.e. papillary muscle rupture

Secondary (functional) - changes to left ventricle due to valvular incompetence
- CAD or prior MI
- Dilated cardiomyopathy and left sided heart failure

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8
Q

Causes of mitral valve prolapse

A

Mostly idiopathic
Connective tissue disease - Marfan’s, Ehlers-Danlos, osteogenesis imperfecta
Fragile X syndrome
Myocardial infarction
Rheumatic heart disease
Infective endocarditis
AD PKD

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9
Q

Murmur of mitral stenosis

A

Delayed diastolic murmur with descrescendo
Accentuated with exercise

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10
Q

Murmur of mitral valve prolapse

A

Late systolic crescendo

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11
Q

Murmur of mitral regurgitation

A

Holosystolic murmur
3rd sound audible
Quiet 1st heart sound

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12
Q

Murmur of tricuspid stenosis

A

Delayed diastolic murmur with descrescendo

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13
Q

Murmur of tricuspid regurgitation

A

Holosystolic murmur
Louder on inspiration

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14
Q

Murmur of pulmonary stenosis

A

Crescendo-descrescendo ejection systolic murmur

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15
Q

Murmour of pulmonary regurgitation

A

Diastolic murmur with descrescendo

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16
Q

Causes of mitral stenosis

A

Rheumatic fever
Parachute mitral valve
Chest irradiation
Calcification of mitral valve annulus
Autoimmune disease - SLE, RA
Congenital
Degenerative aortic stenosis

17
Q

Definition of severe MS

A

Mitral valve area < 1.5cm2
Mean mitral gradient of > 5-10mmHg

18
Q

Indications for intervention for MS

A

Asymptomatic patients with MVA < 1.5cm2 with either
- PASP > 50mmHg
- New onset AF

Symptomatic patients with
- MVA < 1.5cm2
- MVA > 1.5cm2 and haemodynamically significant MS on stress test

19
Q

Preferred intervention for MS

A

Percutaneous mitral valve commissurotomy

20
Q

Indications for surgical management for MS

A

Unfavourable anatomy
Presence of left thrombus in left atrium
Mixed valvular anatomy

21
Q

Monitoring time for mitral stenosis

A

Every 3-5 yrs if MVA > 1.5cm2
Every 1-2 years if MVA < 1.5cm2
Annually if MVA < 1cm2

22
Q

Acute rheumatic fever most common valvular lesions

A

Mitral valve ~65% of cases
Aortic valve ~25% of cases
Tricuspid valve ~10% of cases

23
Q

Clinical features of acute rheumatic fever

A

Pancarditis
Valvular lesions on high pressure valves (mitral > aortic > tricuspid)
Polyarthritis, erythema marginatum, subcutaneous nodules, myocarditis
Fever
Sydenham chorea

24
Q

Causes of TR

A

Functional (or secondary) ~80% of cases
- Pulmonary HTN
- Dilated CM
- Annular dilatation (associated with AF)
- RV volume overload
Primary causes
- Direct valve injury
- Chest wall or deceleration injury trauma
- Infective endocarditis
- Ebstein anomaly
- Rheumatic valve disease
- Carcinoid syndrome
- Myxomatous degeneration
- Connective tissue disorder
- Drug induced disease

25
Q

Indications for surgical management of TR

A

Severe TR in conjunction with left sided valve surgery
Or progressive TR undergoing left sided valve surgery if tricsupid annular dilation or evidence of right sided HF

26
Q

Causes of tricuspid stenosis

A

Acquired
- Rheumatic heart disease
- Carcinoid syndrome
- SLE
- APLS
- Atrial myxoma
- Metastases from renal and ovarian tumours
- Hyper-eosinophilic syndrome
- Endomyocardial fibrosis
Congenital
- Ebstein anomaly
- Metabolic or enzymatic abnromalities
Iatrogenic
- Radiation therapy
- Medications
- PPM/ICD
- Tricuspid valve repair

27
Q

Indication for interventional management of pulmonary stenosis

A

Balloon pulmonary valvuloplasty
Commissurotomy if balloon dilatation is not possible
Asymptomatic patient with peak doppler gradient > 60mmHg
Symptomatic patients with peak doppler gradient > 50mmHg

BPT Flashcards (32 decks)

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