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| __NOTOC__
| | #Redirect [[Aortic regurgitation surgery indications#Indications for Surgery for Acute Aortic Regurgitation]] |
| {{Aortic insufficiency}}
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| {{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
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| ==Overview==
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| Severe acute [[aortic insufficiency]] requires emergency surgery if there are no absolute contraindications to surgery.
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| ==Surgery==
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| ===Timing of Emergency Surgery===
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| Acute severe aortic insufficiency may cause death due to [[pulmonary edema]], [[ventricular arrhythmias]], [[electromechanical dissociation]], or [[circulatory collapse]]. Individuals with [[bacteremia]] with [[aortic valve]] [[endocarditis]] should not wait for treatment with [[antibiotic]]s to take effect, especially if there is [[hypotension]], [[pulmonary edema]], or low [[cardiac output]] given the high mortality associated with the acute [[aortic insufficiency]].
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| ===Type of Surgery===
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| Replacement with an [[artificial heart valve|aortic valve]] [[homograft]] should be performed if feasible. The surgical approach depends upon the cause of aortic insufficiency. [[Aortic valve replacement]] or repair may be needed in cases of valvular structural abnormalities and [[aortic root]] repair/replacement may be needed in cases of [[aortic dissection]].
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| ===Preoperative Medical Therapy===
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| Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stroke volume]] and reduce left ventricular end-diastolic pressure.<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |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=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2011-04-07}}</ref> [[Intra-aortic balloon pump]] is contraindicated as this would worsen aortic regurgitation by increasing [[afterload]].
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| ===Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection===
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| In mild aortic insufficiency secondary to [[aortic dissection]], the [[aortic valve]] can be repaired/replaced at the time of surgery for [[aortic dissection]].
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| ===[[Aortic insufficiency surgical therapy|Aortic Insufficiency Surgical Therapy]]===
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| ==References==
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| {{reflist|2}}
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| [[Category:Disease]]
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| [[Category:Cardiology]]
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| [[Category:Valvular heart disease]]
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| [[Category:Congenital heart disease]]
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| [[Category:Surgery]]
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| [[Category:Cardiac surgery]]
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| [[Category:Emergency medicine]]
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| [[Category:Intensive care medicine]]
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| [[Category:Up-To-Date cardiology]]
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| [[Category:Up-To-Date]]
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| {{WH}}
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| {{WS}}
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