Cardiology overview valvular heart disease: Difference between revisions
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* Patients with a prosthetic mitral valve are at higher risk of thrombosis than the patient with a prosthetic valve in the aortic position. Mitral valve patients therefore need a careful bridging strategy. | * Patients with a prosthetic mitral valve are at higher risk of thrombosis than the patient with a prosthetic valve in the aortic position. Mitral valve patients therefore need a careful bridging strategy. | ||
==Indications for surgery for Mitral Stenosis according to ACC/AHA Guidelines <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>== | |||
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===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | |||
'''1.''' MV surgery (repair if possible) is indicated in patients with symptomatic (NYHA functional class III–IV) moderate or severe MS* when 1) percutaneous mitral balloon valvotomy is unavailable, 2) percutaneous mitral balloon valvotomy is contraindicated because of left atrial thrombus despite anticoagulation or because concomitant moderate to severe MR is present, or 3) the valve morphology is not favorable for percutaneous mitral balloon valvotomy in a patient with acceptable operative risk. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | |||
'''2.''' Symptomatic patients with moderate to severe MS* who also have moderate to severe MR should receive MV replacement, unless valve repair is possible at the time of surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | |||
'''1.''' MV replacement is reasonable for patients with severe MS* and severe pulmonary hypertension (pulmonary artery systolic pressure greater than 60 mm Hg) with NYHA functional class I–II symptoms who are not considered candidates for percutaneous mitral balloon valvotomy or surgical MV repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | |||
'''1.''' MV repair may be considered for asymptomatic patients with moderate or severe MS* who have had recurrent embolic events while receiving adequate anticoagulation and who have valve morphology favorable for repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]=== | |||
'''1.''' MV repair for MS is not indicated for patients with mild MS. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | |||
'''2.''' Closed commissurotomy should not be performed in patients undergoing MV repair; open commissurotomy is the preferred approach. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
Revision as of 16:05, 31 October 2011
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Cardiology Overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Bridging Therapy in the Patient with a Prosthetic Valve
- Patients with a prosthetic mitral valve are at higher risk of thrombosis than the patient with a prosthetic valve in the aortic position. Mitral valve patients therefore need a careful bridging strategy.
Indications for surgery for Mitral Stenosis according to ACC/AHA Guidelines [1]
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Class I1. MV surgery (repair if possible) is indicated in patients with symptomatic (NYHA functional class III–IV) moderate or severe MS* when 1) percutaneous mitral balloon valvotomy is unavailable, 2) percutaneous mitral balloon valvotomy is contraindicated because of left atrial thrombus despite anticoagulation or because concomitant moderate to severe MR is present, or 3) the valve morphology is not favorable for percutaneous mitral balloon valvotomy in a patient with acceptable operative risk. (Level of Evidence: B) 2. Symptomatic patients with moderate to severe MS* who also have moderate to severe MR should receive MV replacement, unless valve repair is possible at the time of surgery. (Level of Evidence: C) Class IIa1. MV replacement is reasonable for patients with severe MS* and severe pulmonary hypertension (pulmonary artery systolic pressure greater than 60 mm Hg) with NYHA functional class I–II symptoms who are not considered candidates for percutaneous mitral balloon valvotomy or surgical MV repair. (Level of Evidence: C) Class IIb1. MV repair may be considered for asymptomatic patients with moderate or severe MS* who have had recurrent embolic events while receiving adequate anticoagulation and who have valve morphology favorable for repair. (Level of Evidence: C) Class III1. MV repair for MS is not indicated for patients with mild MS. (Level of Evidence: C) 2. Closed commissurotomy should not be performed in patients undergoing MV repair; open commissurotomy is the preferred approach. (Level of Evidence: C) |
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References
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; 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". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.