Pulmonary regurgitation follow up: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pulmonic regurgitation}} | {{Pulmonic regurgitation}} | ||
{{CMG}}{{AE}}{{AA}}, {{AKI}} | {{CMG}}{{AE}}{{AA}}, {{AKI}}, {{JA}} | ||
==Overview== | ==Overview== | ||
Follow up of patients with [[pulmonic regurgitation]] requires regular [[echocardiographic]] monitoring after [[PVR]] | Follow up of the [[patients]] with [[pulmonic regurgitation]] requires regular [[echocardiographic]] monitoring after [[PVR]]. [[Oral anticoagulation therapy|Oral anticoagulation]] among patients with [[Bioprosthetic valves|bioprosthetic valve]]<nowiki/>s is recommended only when other indications such as [[atrial arrhythmia]] or prior [[thromboembolic]] event are present. Upon surveillance among [[patients]] with [[PR]] monitoring [[right ventricle|right ventricular]] dilatation and its sequelae holds more significance than the [[PR|regurgitation]] itself. | ||
==Follow Up== | ==Follow Up== | ||
[[Patients]] with [[PR]] (moderate-severe), especially post [[TOF]] repair should typically have an annual follow-up with a [[cardiologist]] with expertise in Adult [[CHD]]. The frequency may also be determined by the degree of residual abnormalities.<ref name="WarnesWilliams2008">{{cite journal|last1=Warnes|first1=Carole A.|last2=Williams|first2=Roberta G.|last3=Bashore|first3=Thomas M.|last4=Child|first4=John S.|last5=Connolly|first5=Heidi M.|last6=Dearani|first6=Joseph A.|last7=del Nido|first7=Pedro|last8=Fasules|first8=James W.|last9=Graham|first9=Thomas P.|last10=Hijazi|first10=Ziyad M.|last11=Hunt|first11=Sharon A.|last12=King|first12=Mary Etta|last13=Landzberg|first13=Michael J.|last14=Miner|first14=Pamela D.|last15=Radford|first15=Martha J.|last16=Walsh|first16=Edward P.|last17=Webb|first17=Gary D.|title=ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary|journal=Circulation|volume=118|issue=23|year=2008|pages=2395–2451|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.108.190811}}</ref> | |||
===Post pulmonic valve replacement=== | ===Post pulmonic valve replacement=== | ||
*All [[patients]] should undergo a baseline [[Standard views and measurements in transthoracic echocardiography|transthoracic echocardiogram]] after [[PVR]].<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid20801927">{{cite journal| author=Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N et al.| title=ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 23 | pages= 2915-57 | pmid=20801927 | doi=10.1093/eurheartj/ehq249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20801927 }} </ref> | *All [[patients]] should undergo a baseline [[Standard views and measurements in transthoracic echocardiography|transthoracic echocardiogram]] after [[PVR]].<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid20801927">{{cite journal| author=Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N et al.| title=ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 23 | pages= 2915-57 | pmid=20801927 | doi=10.1093/eurheartj/ehq249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20801927 }} </ref> | ||
*[[Anticoagulation]] is recommended for [[patients]] with mechanical valves and [[aspirin]] for [[patients]] with [[bioprosthetic valves]].<ref name="pmid22561653">{{cite journal| author=Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR| title=Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. | journal=Eur J Cardiothorac Surg | year= 2012 | volume= 42 | issue= 1 | pages= e1-8 | pmid=22561653 | doi=10.1093/ejcts/ezs219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22561653 }} </ref> | *[[Anticoagulation]] is recommended for [[patients]] with mechanical valves and [[aspirin]] for [[patients]] with [[bioprosthetic valves]].<ref name="pmid22561653">{{cite journal| author=Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR| title=Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. | journal=Eur J Cardiothorac Surg | year= 2012 | volume= 42 | issue= 1 | pages= e1-8 | pmid=22561653 | doi=10.1093/ejcts/ezs219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22561653 }} </ref> | ||
*[[Oral anticoagulation therapy|Oral anticoagulation]] among patients with [[Bioprosthetic valves|bioprosthetic valve]]<nowiki/>s is recommended only when other indications such as atrial arrhythmia or prior | *[[Oral anticoagulation therapy|Oral anticoagulation]] among patients with [[Bioprosthetic valves|bioprosthetic valve]]<nowiki/>s is recommended only when other indications such as [[atrial arrhythmia]] or prior [[thromboembolic]] event are present. | ||
*All [[patients]] are advised for a lifelong follow up to assess the [[valve|valvular]] morphology and [[RV]] [[systolic function]]. | *All [[patients]] are advised for a lifelong follow up to assess the [[valve|valvular]] morphology and [[RV]] [[systolic function]]. | ||
===Surveillance=== | ===Surveillance=== | ||
*Rapid [[RV|right ventricular]] (RV) dilatation has been reported to be associated with restrictive [[right ventricle]] (RV) physiology on initial MRI assessment. Therefore among [[patients]] with restrictive [[right ventricle]] (RV) physiology, optimal time for [[pulmonary valve]] implantation may be determined by careful follow-up.<ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref> | *Rapid [[RV|right ventricular]] (RV) dilatation has been reported to be associated with restrictive [[right ventricle]] (RV) physiology on initial [[MRI]] assessment. Therefore among [[patients]] with restrictive [[right ventricle]] (RV) physiology, optimal time for [[pulmonary valve]] implantation may be determined by careful follow-up.<ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref> | ||
*Upon surveillance among [[patients]] with [[PR]] monitoring [[right ventricle|right ventricular]] dilatation and its sequelae holds more significance than the [[PR|regurgitation]] itself. Simple features demonstrating [[RV]] dilatation can be observed on the physical exam or history. [[CXR]], [[echocardiography]] and [[MRI]] | *Upon surveillance among [[patients]] with [[PR]] monitoring [[right ventricle|right ventricular]] dilatation and its sequelae holds more significance than the [[PR|regurgitation]] itself. Simple features demonstrating [[RV]] dilatation can be observed on the physical exam or history. [[CXR]], [[echocardiography]] and [[MRI]] may assess [[RV]] dilatation on [[patient]] visits.<ref name="pmid17569817">{{cite journal |vauthors=Chaturvedi RR, Redington AN |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–9 |date=July 2007 |pmid=17569817 |pmc=1994453 |doi=10.1136/hrt.2005.075234 |url=}}</ref> The gold standard for [[RV]] volume determination and quantification of [[PR]] is [[MRI]].<ref name="pmid17569817">{{cite journal |vauthors=Chaturvedi RR, Redington AN |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–9 |date=July 2007 |pmid=17569817 |pmc=1994453 |doi=10.1136/hrt.2005.075234 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 01:02, 7 August 2020
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2], Aravind Kuchkuntla, M.B.B.S[3], Javaria Anwer M.D.[4]
Overview
Follow up of the patients with pulmonic regurgitation requires regular echocardiographic monitoring after PVR. Oral anticoagulation among patients with bioprosthetic valves is recommended only when other indications such as atrial arrhythmia or prior thromboembolic event are present. Upon surveillance among patients with PR monitoring right ventricular dilatation and its sequelae holds more significance than the regurgitation itself.
Follow Up
Patients with PR (moderate-severe), especially post TOF repair should typically have an annual follow-up with a cardiologist with expertise in Adult CHD. The frequency may also be determined by the degree of residual abnormalities.[1]
Post pulmonic valve replacement
- All patients should undergo a baseline transthoracic echocardiogram after PVR.[2][3]
- Anticoagulation is recommended for patients with mechanical valves and aspirin for patients with bioprosthetic valves.[4]
- Oral anticoagulation among patients with bioprosthetic valves is recommended only when other indications such as atrial arrhythmia or prior thromboembolic event are present.
- All patients are advised for a lifelong follow up to assess the valvular morphology and RV systolic function.
Surveillance
- Rapid right ventricular (RV) dilatation has been reported to be associated with restrictive right ventricle (RV) physiology on initial MRI assessment. Therefore among patients with restrictive right ventricle (RV) physiology, optimal time for pulmonary valve implantation may be determined by careful follow-up.[5]
- Upon surveillance among patients with PR monitoring right ventricular dilatation and its sequelae holds more significance than the regurgitation itself. Simple features demonstrating RV dilatation can be observed on the physical exam or history. CXR, echocardiography and MRI may assess RV dilatation on patient visits.[6] The gold standard for RV volume determination and quantification of PR is MRI.[6]
References
- ↑ Warnes, Carole A.; Williams, Roberta G.; Bashore, Thomas M.; Child, John S.; Connolly, Heidi M.; Dearani, Joseph A.; del Nido, Pedro; Fasules, James W.; Graham, Thomas P.; Hijazi, Ziyad M.; Hunt, Sharon A.; King, Mary Etta; Landzberg, Michael J.; Miner, Pamela D.; Radford, Martha J.; Walsh, Edward P.; Webb, Gary D. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary". Circulation. 118 (23): 2395–2451. doi:10.1161/CIRCULATIONAHA.108.190811. ISSN 0009-7322.
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N; et al. (2010). "ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)". Eur Heart J. 31 (23): 2915–57. doi:10.1093/eurheartj/ehq249. PMID 20801927.
- ↑ Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR (2012). "Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair". Eur J Cardiothorac Surg. 42 (1): e1–8. doi:10.1093/ejcts/ezs219. PMID 22561653.
- ↑ Shin, Yu Rim; Jung, Jo Won; Kim, Nam Kyun; Choi, Jae Young; Kim, Young Jin; Shin, Hong Ju; Park, Young-Hwan; Park, Han Ki (2016). "Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging". European Journal of Cardio-Thoracic Surgery. 50 (3): 464–469. doi:10.1093/ejcts/ezw049. ISSN 1010-7940.
- ↑ 6.0 6.1 Chaturvedi RR, Redington AN (July 2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.