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| [[File:Siren.gif|30px|link=Aortic regurgitation resident survival guide]]|| <br> || <br>
| [[Aortic regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Aortic insufficiency}}
{{Aortic insufficiency}}
{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}}
==Overview==
The [[echocardiogram]] is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of aortic insufficiency. [[Echocardiography]] allows for serial assessment of [[left ventricular]] volumes which can be critical in determining the timing of [[aortic valve replacement]]. [[Aortic valve replacement]] should be performed if the [[LVEF]] is ≤ 55% or if [[left ventricular]] end-systolic dimension is > 55mm.<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202  }} </ref>


{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}, [[Varun Kumar]], M.B.B.S., [[Lakshmi Gopalakrishnan]], M.B.B.S., [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]
==Echocardiography==
 
The [[echocardiographic]] findings in severe aortic regurgitation include:<ref name="pmid12835667">{{cite journal |author=Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ |title=Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography |journal=[[Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography]] |volume=16 |issue=7 |pages=777–802 |year=2003 |month=July |pmid=12835667 |doi=10.1016/S0894-7317(03)00335-3 |url=http://linkinghub.elsevier.com/retrieve/pii/S0894731703003353 |accessdate=2011-03-02}}</ref><ref name="pmid8629648">{{cite journal| author=Desjardins VA, Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB| title=Intensity of murmurs correlates with severity of valvular regurgitation. | journal=Am J Med | year= 1996 | volume= 100 | issue= 2 | pages= 149-56 | pmid=8629648 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629648  }} </ref><ref name="pmid20708374">{{cite journal| author=Grande RD, Katz WE| title=Acute aortic regurgitation secondary to disk embolization of a Björk-Shiley prosthetic aortic valve. | journal=J Am Soc Echocardiogr | year= 2011 | volume= 24 | issue= 3 | pages= 350.e5-6 | pmid=20708374 | doi=10.1016/j.echo.2010.07.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20708374  }} </ref><ref name="pmid20117022">{{cite journal| author=Saranteas T, Christodoulaki K, Rinaki D, Kostopanagiotou G| title=Transthoracic echocardiography for the identification of acute aortic regurgitation in the intensive care unit. | journal=J Cardiothorac Vasc Anesth | year= 2011 | volume= 25 | issue= 1 | pages= 204-5 | pmid=20117022 | doi=10.1053/j.jvca.2009.11.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20117022 }} </ref>
==Overview==
The [[echocardiogram]] is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of aortic insufficiency.  Echocardiography allows for serial assessment of left ventricular volumes which can be critical in determining the timing of [[aortic valve replacement]].  Aortic valve replacement should be performed if the [[LVEF]] is ≤ 55% or if left ventricular end-systolic dimension is >55 mm.


==Echocardiographic Findings in Severe Aortic Insufficiency==
The echocardiographic findings in severe aortic regurgitation include:
* An AI color jet dimension > 60 percent of the [[left ventricular outflow tract]] ([[LVOT]]) diameter (may not be true if the jet is eccentric)
* An AI color jet dimension > 60 percent of the [[left ventricular outflow tract]] ([[LVOT]]) diameter (may not be true if the jet is eccentric)
* The pressure half-time of the regurgitant jet is < 250 [[millisecond|msec]]
* The pressure half-time of the regurgitant jet is < 250 [[millisecond|msec]]
* Early termination of the mitral inflow (due to an increase in LV pressure as a result of the AI)
* Early termination of the [[mitral]] inflow (due to an increase in [[LV]] pressure as a result of the AI)
* Early diastolic flow reversal in the [[descending aorta]].
* Early [[diastolic]] flow reversal in the [[descending aorta]]
* [[Regurgitant volume]] > 60 [[milliliter|ml]]
* Regurgitant volume > 60 [[milliliter|ml]]
* [[Regurgitant fraction]] > 55 percent
* Regurgitant fraction > 55 percent
 
[[Image:AR-Severity.JPG]]<ref name="pmid12835667">{{cite journal |author=Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ |title=Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography |journal=[[Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography]] |volume=16 |issue=7 |pages=777–802 |year=2003 |month=July |pmid=12835667 |doi=10.1016/S0894-7317(03)00335-3 |url=http://linkinghub.elsevier.com/retrieve/pii/S0894731703003353 |accessdate=2011-03-02}}</ref>
 
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Characteristics of aortic insufficiency are demonstrated by:
*Increased duration between E and A peaks.
*Fluttering of the anterior [[mitral valve]] leaflet due to AI jet turbulence.
===Echocardiography Follow-Up===
Frequency of [[echocardiograms]] in asymptomatic patients with aortic regurgitation with normal [[stroke volume]]:
* Progressive (stage B) with mild severity: every 3-5 years
* Progressive (stage B) with moderate severity: every 1-2 years
* Severe (stage C): every 6-12 months (more frequently in case of a dilating [[left ventricle]])
===Severe Aortic Insufficiency (Color Doppler)===
{{#ev:youtube|rKMGf8NrF8E}}
===Moderate Aortic Insufficiency (Color Doppler)===
{{#ev:youtube|PMliYaZ6IEU}}
===Aortic Insufficiency Combined with Stenosis (Color Doppler)===
{{#ev:youtube|J-Qs_evodww}}


Characteristics of aortic insufficiency are demonstrated by:
== 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines<ref name="pmid33332150">{{cite journal| author=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F | display-authors=etal| title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 143 | issue= 5 | pages= e72-e227 | pmid=33332150 | doi=10.1161/CIR.0000000000000923 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33332150  }}</ref> ==
* Increased duration between E and A peaks
* Fluttering of the anterior mitral valve leaflet due to AI jet turbulence


===Severe Aortic Insufficiency Video 1===
{{#ev:googlevideo|4226733785410043550}}


In addition to verifying the existence, severity, and causation of acute AR, TTE or TEE is crucial for assessing LV size and systolic function, imaging the aortic root, and identifying whether there is quick equilibration of the aortic and LV diastolic pressures. 1,2 A considerably increased LV end-diastolic pressure is indicated by a short deceleration time on the aortic flow velocity curve and early mitral valve closure. The AR velocity curve's pressure half-time of about 300 ms shows that the aorta and LV diastolic pressures equilibrated quickly. A rapid semiquantitative estimation of the regurgitant fraction can be made by comparing the degree of holodiastolic flow reversal in the aortic arch with the forward systolic flow.


===Severe Aortic Insufficiency Video 2===
{{#ev:googlevideo|3075471538892457393}}


===Moderate Aortic Insufficiency (Color Doppler)===
TEE is useful for intraoperative assessment of aortic valve function both before and after the surgical operation and can be employed in situations when CT imaging is not an option. TEE has a sensitivity of 98% to 100% and a specificity of 95% to 100%, whereas TTE has only 60% to 80% sensitivity and 60% to 80% specificity for the diagnosis of Type A3 aortic dissection.


{{#ev:youtube|zMD3o0L5SlA}}
==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)<ref>{{Cite web  | last =  | first =  | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher =  | date =  | accessdate = 4 March 2014 }}</ref>==
{{#ev:youtube|3W_YX_GbpK8}}


==ACC/AHA 2008 Guidelines for Management of Patients with Valvular Heart Disease - Echocardiography in Aortic Insufficiency (DO NOT EDIT) <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>==
===Diagnosis and Follow Up===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[TTE]] is indicated in patients with signs or symptoms of AR (stages A to D) for accurate diagnosis of the cause of regurgitation, regurgitant severity, and [[LV]] size and [[systolic]] function, and for determining clinical outcome and timing of valve intervention. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) ''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[TTE]] is indicated in patients with dilated [[aortic sinus]]es or [[ascending aorta]] or with a [[bicuspid aortic valve]] (stages A and B) to evaluate the presence and severity of AR. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) ''<nowiki>"</nowiki>
|}


==2008 Focused Update Incorporated into the 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
===Echocardiography (DO NOT EDIT)<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===
{|class="wikitable"
{|class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Echocardiography]] is indicated to confirm the presence and severity of acute or chronic [[AR]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Echocardiography]] is indicated to confirm the presence and severity of acute or chronic [[AR]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Echocardiography]] is indicated for diagnosis and assessment of the cause of chronic [[AR]] (including valve morphology and aortic root size and morphology) and for assessment of [[LV hypertrophy]], dimension (or volume), and [[systolic]] function. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Echocardiography]] is indicated for diagnosis and assessment of the cause of chronic [[AR]] (including valve morphology and aortic root size and morphology) and for assessment of [[LV hypertrophy]], dimension (or volume), and [[systolic]] function. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Echocardiography]] is indicated in patients with an enlarged [[aortic root]] to assess [[regurgitation]] and the severity of aortic dilatation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Echocardiography]] is indicated in patients with an enlarged [[aortic root]] to assess [[regurgitation]] and the severity of aortic dilatation. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' [[Echocardiography]] is indicated for the periodic re-evaluation of [[LV]] size and function in asymptomatic patients with severe [[AR]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' [[Echocardiography]] is indicated for the periodic re-evaluation of [[LV]] size and function in asymptomatic patients with severe [[AR]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' [[Radionuclide angiography]] or [[magnetic resonance imaging]] is indicated for the initial and serial assessment of [[LV]] volume and                                             function at rest in patients with [[AR]] and suboptimal echocardiograms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' [[Echocardiography]] is indicated to re-evaluate mild, moderate, or severe [[AR]] in patients with new or changing symptoms. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' [[Echocardiography]] is indicated to re-evaluate mild, moderate, or severe [[AR]] in patients with new or changing symptoms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[CME Category::Cardiology]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Valvular heart disease]]
[[Category:Congenital heart disease]]
[[Category:Surgery]]
[[Category:Cardiac surgery]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date]]

Latest revision as of 13:00, 8 December 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]; Usama Talib, BSc, MD [4]

Overview

The echocardiogram is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of aortic insufficiency. Echocardiography allows for serial assessment of left ventricular volumes which can be critical in determining the timing of aortic valve replacement. Aortic valve replacement should be performed if the LVEF is ≤ 55% or if left ventricular end-systolic dimension is > 55mm.[1]

Echocardiography

The echocardiographic findings in severe aortic regurgitation include:[2][3][4][5]

  • An AI color jet dimension > 60 percent of the left ventricular outflow tract (LVOT) diameter (may not be true if the jet is eccentric)
  • The pressure half-time of the regurgitant jet is < 250 msec
  • Early termination of the mitral inflow (due to an increase in LV pressure as a result of the AI)
  • Early diastolic flow reversal in the descending aorta
  • Regurgitant volume > 60 ml
  • Regurgitant fraction > 55 percent
Aortic Regurgitation M Mode

Characteristics of aortic insufficiency are demonstrated by:

  • Increased duration between E and A peaks.
  • Fluttering of the anterior mitral valve leaflet due to AI jet turbulence.

Echocardiography Follow-Up

Frequency of echocardiograms in asymptomatic patients with aortic regurgitation with normal stroke volume:

  • Progressive (stage B) with mild severity: every 3-5 years
  • Progressive (stage B) with moderate severity: every 1-2 years
  • Severe (stage C): every 6-12 months (more frequently in case of a dilating left ventricle)

Severe Aortic Insufficiency (Color Doppler)

{{#ev:youtube|rKMGf8NrF8E}}

Moderate Aortic Insufficiency (Color Doppler)

{{#ev:youtube|PMliYaZ6IEU}}

Aortic Insufficiency Combined with Stenosis (Color Doppler)

{{#ev:youtube|J-Qs_evodww}}


2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[6]

In addition to verifying the existence, severity, and causation of acute AR, TTE or TEE is crucial for assessing LV size and systolic function, imaging the aortic root, and identifying whether there is quick equilibration of the aortic and LV diastolic pressures. 1,2 A considerably increased LV end-diastolic pressure is indicated by a short deceleration time on the aortic flow velocity curve and early mitral valve closure. The AR velocity curve's pressure half-time of about 300 ms shows that the aorta and LV diastolic pressures equilibrated quickly. A rapid semiquantitative estimation of the regurgitant fraction can be made by comparing the degree of holodiastolic flow reversal in the aortic arch with the forward systolic flow.


TEE is useful for intraoperative assessment of aortic valve function both before and after the surgical operation and can be employed in situations when CT imaging is not an option. TEE has a sensitivity of 98% to 100% and a specificity of 95% to 100%, whereas TTE has only 60% to 80% sensitivity and 60% to 80% specificity for the diagnosis of Type A3 aortic dissection.

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[7]

Diagnosis and Follow Up

Class I
"1. TTE is indicated in patients with signs or symptoms of AR (stages A to D) for accurate diagnosis of the cause of regurgitation, regurgitant severity, and LV size and systolic function, and for determining clinical outcome and timing of valve intervention. (Level of Evidence: B) "
"2. TTE is indicated in patients with dilated aortic sinuses or ascending aorta or with a bicuspid aortic valve (stages A and B) to evaluate the presence and severity of AR. (Level of Evidence: B) "

2008 Focused Update Incorporated into the 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)[8]

Echocardiography (DO NOT EDIT)[8]

Class I
"1. Echocardiography is indicated to confirm the presence and severity of acute or chronic AR. (Level of Evidence: B)"
"2. Echocardiography is indicated for diagnosis and assessment of the cause of chronic AR (including valve morphology and aortic root size and morphology) and for assessment of LV hypertrophy, dimension (or volume), and systolic function. (Level of Evidence: B)"
"3. Echocardiography is indicated in patients with an enlarged aortic root to assess regurgitation and the severity of aortic dilatation. (Level of Evidence: B)"
"4. Echocardiography is indicated for the periodic re-evaluation of LV size and function in asymptomatic patients with severe AR. (Level of Evidence: B)"
"5. Radionuclide angiography or magnetic resonance imaging is indicated for the initial and serial assessment of LV volume and function at rest in patients with AR and suboptimal echocardiograms. (Level of Evidence: B)"
"6. Echocardiography is indicated to re-evaluate mild, moderate, or severe AR in patients with new or changing symptoms. (Level of Evidence: B)"

References

  1. ↑ Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
  2. ↑ Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)
  3. ↑ Desjardins VA, Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB (1996). "Intensity of murmurs correlates with severity of valvular regurgitation". Am J Med. 100 (2): 149–56. PMID 8629648.
  4. ↑ Grande RD, Katz WE (2011). "Acute aortic regurgitation secondary to disk embolization of a Björk-Shiley prosthetic aortic valve". J Am Soc Echocardiogr. 24 (3): 350.e5–6. doi:10.1016/j.echo.2010.07.001. PMID 20708374.
  5. ↑ Saranteas T, Christodoulaki K, Rinaki D, Kostopanagiotou G (2011). "Transthoracic echocardiography for the identification of acute aortic regurgitation in the intensive care unit". J Cardiothorac Vasc Anesth. 25 (1): 204–5. doi:10.1053/j.jvca.2009.11.015. PMID 20117022.
  6. ↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).
  7. ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
  8. ↑ 8.0 8.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

Template:WH Template:WS CME Category::Cardiology

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