Acute aortic regurgitation surgical treatment: Difference between revisions
No edit summary |
Hardik Patel (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Aortic insufficiency}} | {{Aortic insufficiency}} | ||
{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | |||
{{CMG}}; | |||
==Overview== | ==Overview== | ||
Severe acute [[aortic insufficiency]] requires emergency surgery if there are no absolute contraindications to surgery. | Severe acute [[aortic insufficiency]] requires emergency surgery if there are no absolute contraindications to surgery. | ||
==Timing of Emergency Surgery== | ==Surgery== | ||
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 | ===Timing of Emergency Surgery=== | ||
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]]. | |||
==Type of Surgery== | ===Type of Surgery=== | ||
Replacement with an [[artificial heart valve|aortic valve]] [[homograft]] should be performed if feasible. The surgical approach depends | 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]]. | ||
===Preoperative Medical Therapy=== | |||
==Medical Therapy== | Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stoke 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]]. | ||
Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stoke 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> | ===Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection=== | ||
In mild aortic insufficiency secondary to [[aortic dissection]], the [[aortic valve]] can be repaired/replaced at the time of surgery for [[aortic dissection]]. | |||
==Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection== | ===[[Aortic insufficiency surgical therapy|Aortic Insufficiency Surgical Procedure]]=== | ||
In mild aortic insufficiency secondary to [[aortic dissection]], the valve can be repaired/replaced at the time of surgery for aortic dissection. | |||
==[[Aortic insufficiency surgical therapy|Aortic Insufficiency Surgical Procedure]]== | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[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]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 15:44, 1 February 2013
|
Aortic Regurgitation Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Acute Aortic regurgitation |
|
Chronic Aortic regurgitation |
|
Special Scenarios |
|
Case Studies |
|
Acute aortic regurgitation surgical treatment On the Web |
|
American Roentgen Ray Society Images of Acute aortic regurgitation surgical treatment |
|
Risk calculators and risk factors for Acute aortic regurgitation surgical treatment |
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.
Overview
Severe acute aortic insufficiency requires emergency surgery if there are no absolute contraindications to surgery.
Surgery
Timing of Emergency Surgery
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 antibiotics to take effect, especially if there is hypotension, pulmonary edema, or low cardiac output given the high mortality associated with the acute aortic insufficiency.
Type of Surgery
Replacement with an 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.
Preoperative Medical Therapy
Patients may be temporarily managed before surgery with vasodilators such as nitroprusside and possibly inotropic agents such as dopamine or dobutamine to improve stoke volume and reduce left ventricular end-diastolic pressure.[1] Intra-aortic balloon pump is contraindicated as this would worsen aortic regurgitation by increasing afterload.
Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection
In mild aortic insufficiency secondary to aortic dissection, the aortic valve can be repaired/replaced at the time of surgery for aortic dissection.
Aortic Insufficiency Surgical Procedure
References
- ↑ 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 (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. Retrieved 2011-04-07. Unknown parameter
|month=ignored (help)