Valvular Disease Flashcards
Aortic valve dz: types, incidence
root requirements
bicuspid- 1-2%- most do not stenos- ass ao root, coarct
rheumatic- requires mv involvement
if root >4.5 cm, replace with @ time of surg,<4.0 do not replace
Aortic stenosis: phys findings
more severe: becomes later peaking then obscures second heart sound
echo findings for severe AS
mean grad >40mmHg
peak >4m/sec
a1xv1/v2=v2
AS equations
Gorlin: CO/ HRxSEPx44.3x sqr gradient
Hakki: CO/ sqr gradient
AS symptom survival
angina: 5 yrs
syncope: 3 yrs
chf: 2 yrs
AI measurements echo:
vena contracta .6 severe
t1/2: 450 mild
LVOT >60% (unless eccentric)
ao reversal of flow: inital velocity >.6m/sec and .2 m/sec holodiastolic severe
Acute AI findings:
physical findings may not be present, lv not dilated
echo may have diastolic MR
AI surg indications
for chronic
lv dilating ES>55 ED >75
echo eval of mitral stenosis
planimetry ok/ p1/2 time good
mild 1.5-2.0
mod 1-1.5
severe< 1.0
physical exam mitral stenosis
dias murmur
opening snap of ms correlates with la pressure therefore, earlier os then higher pressure
Wilkins score
leaf thickening leaf mobility leaflet calicification subvalvular thickening best score 4, worst 16 if less than 8 favorable valvulplasty
Padial score
mv scoring- more emphasis on leaflet calcification
pressure 1/2 time
220/ t1/2
longer filling more stenosis
mr area quantification
40% severe
rather crude measurement
MR regurg oriface area
40 severe
indication for MR surgery
severe with any symptoms med rx of EF55 chordal preservation unlikely asymptomatic severe low risk severe mr with dys ef40
ischemic mr success
28% return with 3-4+ mr @ 6 mths
with ischemic mr
pulmonic stenosis grading
mild 4m/sec
endocarditis
2 culture> 12 hr apart, persistant pos culture
veg (oscil mass in path of regurg)
new regurg
partial dehiscence
abcess ; minor:heart condition, drug use, fever, immunolog., vasc phenom
abx prophylaxisis
only high risk
prev endocarditis, prosth valve, unrepaired cyanotic, card transplant with regurg lesion
anticoag for prosthetic valves
risks factors?
low dose asa in bio and mechanical
comadin 2-3.0 mech avr with no rf
risk factors (afib, prev thromboembolic, hypercoag, low ef)
all others 2.5-3.5 inr
embolic event with prosthetic valve
inf goal inr 2-3 then increase to 2.5-3.5
if 2.5-3.5 then increase to 3.5-4.5
prosthetice valve
if bileaf avr, no risk factors, no bridge
other mechanical valves or with rf need bridge
hemolysis prosthetic valves
labs
increased ldh
micro anemia
schistocytes
decreased haptoglobin
