Valvular heart disease board review Flashcards
4stages of VHD
A at risk
B progressive
C. severe asx c1 compensated LV or RV C2 deccomistated LV or RV
d. Severe sx
CHF AHA stages of HF
NYHA classes /CCS
A. at risk
B. asx with chf
C. sx
D. refractory
I. asx
II. Mild limitations - >1 flight, > 2 blocks
III. mod limitations - 1 flight of stairs or 2 blocks
IIII.Severe limitations - at rest, limited activity
Frequecny of echo follow up for VHD
Stage B 3-5 years Stage C 6 mo to 1 year.
STS risk given high risk
> 8%
How many frailty on katz make someone high risk
What about prohibitive risk
2 or more
> 50% n1 year predicted risk of death
AVA index associated with severe
< 0.6
SV index for low flow
< 35 ml/M2
What can mask a high gradient with AS
HTN (need to control bp) needs to be less than 140 for accurate assessment
TAVR vs SAVR GL recs based on risk
Low risk SAVR Class I
Intermediate risk SAVR Class I , TAVR IIa
High risk SAVR or TAVR class I
Prohibitive risk TAVR class I
How to decided TAVR vs. SAVR for intermiediate risk
Class I SAVR and Class IIa TAVR, Need heart team decision
AI surgical replacement
severe at and sx or asx and severe LV dilation SVESD > 50 mm / 25 indexed or LVEDD > 65 (note for MR its only 40 mm ESD)
in asx pt with AI do you give someone a ACEor ARB
No need unless htn or sx with severe dz
problem with BB and AR
longer diasotolic interval with slower HR and then get more AR. (slow stenotic lesions and keep regurgitant lesions fast.)
What size ventrical can you replace the AV in an asx individual; with severe AR
- 5 cm EsD or 25 cm indexed , 65 EDD
- what is the most common fusion for BAV
- this leads to dilatation
Second most common type of BAV?
right and left
of the tubular portion bc jet blows ant and to the right
right and non cusps (this is assocaiated with a higher location of the aortaopthy tubular to arch)
PAtient not a candidate for BAV for their MS important board point
Can do MV BAV in an asx patient
Need to be NYHA III or IV this is the only deisease when don’t need to be NYHA class II and that is bc of high mortality and f need for repelacment.
- yes if MVA is < 1.
Mod MR and Severe MS MVA of 1.4 cm 2 and patient is sob but went 8 min on bruce
wait until class 3 or develop PH or afib, control HR
Always the right answer when its availible
mitral valve repair
Compacted vs. noncompacted myocardium size
2:1 ratio
wilkins score cut off for mitral BAV
<= 8 optimal outcome with bav
guideline rec for MV repair or replace if severe fMR and cardiac surgery
- ***mFMR and other CTS, will be asked this
IIA
IIB!
how large is an enlarged Triculspid annular dimention in diastole on the 4 chamber view
40 mm or > 21 mm/m2
Class I indication for Tricuspid surgery
IIa
referred for conocmiant left valve surgery nwith severe TR. (repairs)
IIa - repeari TV server for severe secondary TR if annular dilation > 40 or indexed 21 mm or hx of right sided HR.
Note these are left sided valve surgeries not cabg
when can do TV surgery in setting of primary tr
in patient with refractory sx. IIa and severe primary TR.
What severeity of oprimary MR will allow you to replace /repair the mitral valve
Mneumonic
Symptomatic severe MR
Severe MR = VC > 0.7 R vol > 60 ml ERO > 0.4 LV dilatation RF > 50%
Menumonic 7 - VC 0,7 6 rvo 60 ml 5 RF 50% 4 0.4 \+ LV dilatation LVESD > 4.0 mm *caviat surgery in low EF MV may be dangerous.
What EF can go to OR with severe MR <=-60 or LVESD > 40
also note if EF > 60 and LVSD < 4 but > 95% chance of successful repain and mortality less than 1% can go tosurgy if asx. otherwise monitor.
Class I indications for surgery for I.E. prior to completeion of course of abx.
- Valve dysfunction causing symptomatic CHF
- left sided endocariditis caused by staph arusus fungus or other highly resisitant organic
- Abcess or inidications of abcess ie heart block
4, persitiant infection > 5 days bacterime/fevers despite appropriate abx
protthetic valve IR + replalpsing infecitons
IE with recurrent emboli and perisitent veg (iia)
naitice IE with mobile veg > 1 cm (10 mm) in length (thing on is a IIb) not indiciated
If have staph endocariditis and have a ppm without involvement what is the rec
complete removal of the AICD regardless of evidience IIa
Class I inf they show sigs of involvement
surgery on TV for I.E.
only if symtomtic HF, abcess, perisistnet infection, prosthetic with relpapsing infection.
after valve placed how often need echo
not until 10 years there after yearly or with sx (this is insane)
recs for AC with biorpsotetic bvalve
3 months or 6 months if low bleeding risk in addition to asa. (note only for mitral)
mechanical AVR without hifh risk don’t need briding.
don’t need briging
two times cannot use doacs
mechanical valves and > mod MS with AF (that is it). If no AF or stroke hx no need to AC Mod AS.
Thrombosis vs. emergency surgyery for thrombosed valve
if CHF NYHA III/iv emergency sugery (class I) if <= 0.8 and No severe CHF fibrinolysis, if > 0.8 surgery
