Valve replacement guidelines Flashcards
Indications for surgical management for AR
- Acute severe AR
- Symptomatic chronic severe AR
- Asymptomatic chronic severe AR with LVEF < 55%, LVESD > 50mm, or having cardiac surgery for other indications
Monitoring intervals for AR
Mild: 3-5 years
Moderate: 1-2 years
AR C1 regurgitation: 6-12 months
Definition of severe AR
VC > 0.6cm
Holodiastolic aortic flow reversal
RVol > 60ml
RF >/ 50%
ERO >/ 0.3cm2
Causes of AR
Acute:
- IE
- Aortic dissection
- Chest trauma
Chronic:
- Bicuspid aortic valve
- CTDs
- RF
- Rheumatic diseases
Murmur of AR
Diastolic murmur with descrescendo
Indications for surgical management for MR
- 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`
Causes of MR
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
Causes of mitral valve prolapse
Mostly idiopathic
Connective tissue disease - Marfan’s, Ehlers-Danlos, osteogenesis imperfecta
Fragile X syndrome
Myocardial infarction
Rheumatic heart disease
Infective endocarditis
AD PKD
Murmur of mitral stenosis
Delayed diastolic murmur with descrescendo
Accentuated with exercise
Murmur of mitral valve prolapse
Late systolic crescendo
Murmur of mitral regurgitation
Holosystolic murmur
3rd sound audible
Quiet 1st heart sound
Murmur of tricuspid stenosis
Delayed diastolic murmur with descrescendo
Murmur of tricuspid regurgitation
Holosystolic murmur
Louder on inspiration
Murmur of pulmonary stenosis
Crescendo-descrescendo ejection systolic murmur
Murmour of pulmonary regurgitation
Diastolic murmur with descrescendo
Causes of mitral stenosis
Rheumatic fever
Parachute mitral valve
Chest irradiation
Calcification of mitral valve annulus
Autoimmune disease - SLE, RA
Congenital
Degenerative aortic stenosis
Definition of severe MS
Mitral valve area < 1.5cm2
Mean mitral gradient of > 5-10mmHg
Indications for intervention for MS
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
Preferred intervention for MS
Percutaneous mitral valve commissurotomy
Indications for surgical management for MS
Unfavourable anatomy
Presence of left thrombus in left atrium
Mixed valvular anatomy
Monitoring time for mitral stenosis
Every 3-5 yrs if MVA > 1.5cm2
Every 1-2 years if MVA < 1.5cm2
Annually if MVA < 1cm2
Acute rheumatic fever most common valvular lesions
Mitral valve ~65% of cases
Aortic valve ~25% of cases
Tricuspid valve ~10% of cases
Clinical features of acute rheumatic fever
Pancarditis
Valvular lesions on high pressure valves (mitral > aortic > tricuspid)
Polyarthritis, erythema marginatum, subcutaneous nodules, myocarditis
Fever
Sydenham chorea
Causes of TR
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
