Valvular Heart Disease Flashcards
Aortic regurgitation: causes
° CUSP, aortic root ascending aortic geometry
°Degenerative tri/backspin AR most common
°
AS : care plan
ECHO: high gradient aortic stenosis
Mean gradient > 40mmhg
Peak velocity > 4.0m/s
Valve area < 1m/s or < 0.6m/s
ECHO : Low flow, low gradient aortic stenosis
Mean gradient < 40mmhg
Valve area < 1m/s
LVEF < 50%
SVi <35ml/m2
Low flow, low gradient aortic stenosis: additional evaluation
CCT assessment of the degree of valve calcification provides important additional information [thresholds(Agatston units) for severe aortic stenosis:
men>3000, women>1600=highly likely;
men>2000,women>1200=likely;
men<1600,women <800=unlikely]
Normal flow, low gradient aortic stenosis
° Mean gradient < 40mmhg
° Valve area < 1cm2
° LVEF > 50%
° SVi > 35ml/m2
Additional diagnostic and prognostic parameters AS : DVI
Resting Doppler velocity index = LVTI:AV jet
a value <0.25 suggests that severe aortic stenosis is highly likely
Does not require LVOT measurement
Additional diagnostic and prognostic parameters AS : global longitudinal strain
A threshold of 15% identity patients with severe asymptomatic AS
Additional diagnostic and prognostic parameters AS : TOE
TOE allowse valuation of concomitant mitral valve disease and maybe of value for periprocedural imaging during TAVI and SAVR
Additional diagnostic and prognostic parameters AS : NP
Natriuretic peptides predict symptom-free survival and outcome in normal and low-flow severe aortic stenosis.
Additional diagnostic and prognostic parameters AS : CCT
provides information concerning the anatomy of the aortic root and ascending aorta,andthe extentand distribution of valve and vascular calcification, and feasibility of vascular access. Quantification of valvecalcificationpredictsdisease progression and clinicalevents and maybe useful when combined with geometric assessment of valve area in assessing the severity of aortic stenosis in patients with low valve gradient
Additional diagnostic and prognostic parameters AS :CMR
which can be detected and quantified myocardial fibrosis
Additional diagnostic and prognostic parameters AS : coronary angio
Essential prior TAVI & SAVR determine the potentialneed for concomitant revascularization
TAVI diagnostic workup
Cct
i) aortic valveanatomy,(ii)annularsizeandshape
(iii) extent and distribution of valve and vascular calcification,
(iv) risk of coronary ostial obstruction,
(v) aortic root dimensions,
(vi) optimal fluoroscopic projections for valve deployment,and
(vii) feasibility of vascular access (femoral, subclavian,axillary,carotid,transcavalortransapical)
Clinical,anatomical and procedural factors that influence the choice of treatment modality for an individual patient
Indications for intervention (SAVR or TAVI): symptomatic AS
Intervention is recommended in symptomatic patients with high gradient aortic stenosis, regardless of LVEF
Indications for intervention (SAVR or TAVI): low gradient
Intervention is recommended when severe aortic stenosis is confirmed by stress echocardiography & when reduced ejection fraction is predominantly caused by excessive afterload
2 Indications for intervention (SAVR or TAVI)
Asymptomatic
Intervention is recommended in asymptomatic patients with severe aortic stenosis and impaired LV function of no other cause
and those who are asymptomatic during normal activities but develop symptoms during exercise testing
Valve morphology by echo
Management of severe AS
Mode of intervention with AS
AR echocardiography
Recommendations on indications for surgery in (A) severe aortic regurgitation and (B) aortic root or tubular ascending aortic aneurysm (irrespective of the severity of aortic regurgitation)
Medical treatment for AR
ACI
ARBS
Bblocker
