Valvular Flashcards
Supravalvular aortic stenosis location
Obstruction at aorta
Single discrete narrowing or long tubular hypoplasia
Supravalvular AS exam
Loud A2
Thrill in SSN or R carotid
Echo supravalvular AS
High velocity jet with narrowed aorta
Subvalvular AS anatomy
Discrete ridge or tunnel stenosis
Diagnosis of subvalvular AS
High doppler gradient and normal AV
Treatment for subvalvular AS
Operate for most patients
Cut-off for aorta surgery with BAV
- 5 cm
- 0 cm if FH, rapid growth, low risk
- 5 cm if AVR indicated
AS severe by exam / symptoms but not MG
Do hemodynamic Cath or further evaluation
Indications for severe AS surgery
Symptoms
EF < 50% with LVH
Very severe AS and surgical risk < 1%
Very severe AS criteria
Vel >= 5
MG >= 60
Severe MS S2-OS interval
<70
Severe MS MVA
<= 1.5
Very severe MS MVA
< 1.0
MS symptoms out of proportion to MG ->
Exercise hemodynamics
Indication for intervention pliable rheumatic MS
Class II-IV symptoms for PMBV
Can consider also is asx, PAP > 60, new-onset AF
Indication for intervention MAC MS
Class III-IV symptoms -> MVR
Acute MR treatment
Vasodilators
IABP
Surgery
Severe MR jet area
> 1/2 LA
Severe MR RV
> 60
Severe MR RF
> 50%
Severe MR ERO
> 0.4
Indications for surgery for severe chronic MR
Symptoms
EF < 60
ESD > 40
Prophylactic repair without symptoms (low operative mortality, high chance of successful repair)
Acute AR treatment
Urgent surgery for dissection or acute prosthetic AR
No IABP
Nitroprusside / inotropes
No pressers or beta blockers
Severe AR jet
> 60% LVOT diameter
Severe AR descending thoracic aorta
Holodiastolic flow reversal
Velocity > 0.2 m/s
Severe AR RV
> 60
Severe AR RF
> 55%
Severe AR indications for surgery
Symptoms
EF < 50% or abnormal
ESD > 50, EDD > 65
Severe TR echo features
Dagger shaped TR velocity, low velocity, dense signal
Systolic reversal hepatic veins
Treatment left sided mechanical valve thrombosis class III/IV symptoms
Surgery or fibrinolysis
Treatment left sided mechanical valve thrombosis class I/II symptoms
Large clot - surgery, lysis (0.8-1.0)
Small clot - lysis or UFH
Treatment right sided mechanical valve thrombosis class III/IV symptoms
Lysis
Treatment right sided mechanical valve thrombosis class I/II symptoms
Large clot - lysis
Small clot - UFH
Bioprosthetic valve thrombosis treatment class I-III
30 days of VKA then repeat imaging
Bioprosthetic valve thrombosis treatment class IV
Valve replacement or lysis
Infective endocarditis prophylaxis groups
Prosthetic valves / material for valve repair
Prior IE
Transplant with valvulopathy
CHD and unprepared cyanotic lesions, cyanotic lesions with palliative shunts or conduits, repair <= 6 months with prosthetic material, repaired lesion with residual defects
Procedures that require IE ppx
Dental procedures
Incision into active skin / STI
Incision or biopsy in respiratory tract
Drugs for IE ppx
30-60 min before procedure
Amoxicillan 2 g PO
Clindamycin 600 mg PO, IM or IV
Major Duke Criteria
Multiple Bcx+
Single coxiella burnetti+
Endocardial involvement - new regurgitation, vegetation, abscess, dehiscence
Minor Duke Criteria
Clinical predisposition Fever without alternative BCx or serologic evidence of infection not meeting major criteria Vascular phenomena Immunologic phenomena
Definite IE Duke criteira
2 major
1 major + 3 minor
5 minor
Possible IE Duke criteria
1 major + 1 minor
3 minor
Surgical indication for IE
Valve dysfunction with HF
Left sided S. aureus or fungal organisms
Heart block, abscess, destructive lesions
Persistent bacteremia or fevers >= 5 days
Recurrent emboli of persistent vegetation despite abs
Mobile veg >= 10 mm
Other surgical indications
AV prosthesis stenosis
Elevated transvalvular velocity / gradient
AT > 100 ms
EOA < 1
DI < 0.3
