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===Indications for Aortic Valve Replacement=== | ===Indications for Aortic Valve Replacement=== | ||
Shown below is an algorithm depicting the indications for [[aortic valve replacement]] (AVR) in chronic aortic regurgitation. | Shown below is an algorithm depicting the indications for [[aortic valve replacement]] (AVR) in chronic aortic regurgitation. | ||
'''Abbreviations:''' '''LVEF:''' left ventricular ejection fraction; '''LVEDD:''' left ventricular end diastolic diameter; '''LVESV:''' left ventricular end systolic diameter | |||
{{Familytree/start}} | {{Familytree/start}} | ||
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{{Family tree | C01 | | | | | | | | | | C02 | | | | | | | | | | | | C03 | | |C01= Yes <br> (Stage D)| C02=No <br> (Stage C)| C03= Is the patient undergoing<br> another surgery?}} | {{Family tree | C01 | | | | | | | | | | C02 | | | | | | | | | | | | C03 | | |C01= Yes <br> (Stage D)| C02=No <br> (Stage C)| C03= Is the patient undergoing<br> another surgery?}} | ||
{{Family tree | |!| | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | |,|-|^|-|.| | }} | {{Family tree | |!| | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | |,|-|^|-|.| | }} | ||
{{Family tree | |!| | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= ❑ LVEF<50% <br> (Stage C2)|D02=❑ The patient is undergoing another surgery| D03= ❑ [LVEF]] ≥ 50% <br>AND <br> ❑ LVESD > 50mm <br>(Stage C2)| D04= ❑ [[LVEF]] ≥ 50% <br>AND <br> ❑ LVEDD > 65mm <br>AND <br> ❑ Low surgical risk| D05= ❑ [[LVEF]] ≥ 50% <br>AND <br> ❑ LVESD ≤ 50mm <br>AND <br> ❑ LVEDD ≤ 65mm| D06= No| D07= Yes}} | {{Family tree | |!| | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= ❑ LVEF<50% <br> (Stage C2)|D02=❑ The patient is undergoing another surgery| D03= ❑ [[LVEF]] ≥ 50% <br>AND <br> ❑ LVESD > 50mm <br>(Stage C2)| D04= ❑ [[LVEF]] ≥ 50% <br>AND <br> ❑ LVEDD > 65mm <br>AND <br> ❑ Low surgical risk| D05= ❑ [[LVEF]] ≥ 50% <br>AND <br> ❑ LVESD ≤ 50mm <br>AND <br> ❑ LVEDD ≤ 65mm| D06= No| D07= Yes}} | ||
{{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | E08 | E01= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E02= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E03= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E04= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])| E05= AVR ([[ACC AHA guidelines classification scheme|Class IIb]])| E06= Monitor the patient periodically| E07= Monitor the patient periodically| E08= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])}} | {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | E08 | E01= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E02= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E03= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E04= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])| E05= AVR ([[ACC AHA guidelines classification scheme|Class IIb]])| E06= Monitor the patient periodically| E07= Monitor the patient periodically| E08= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 03:37, 21 July 2014
Indications for Aortic Valve Replacement
Shown below is an algorithm depicting the indications for aortic valve replacement (AVR) in chronic aortic regurgitation.
Abbreviations: LVEF: left ventricular ejection fraction; LVEDD: left ventricular end diastolic diameter; LVESV: left ventricular end systolic diameter
| What is the severity of the aortic regurgitation? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Severe regurgitation ❑ Vena contracta >0.6 cm ❑ Doppler jet width ≥ 65% of LVOT ❑ Regurgitant volume ≥60 mL/beat ❑ Regurgitant fraction ≥50% ❑ Effective regurgitant orifice ≥ 0.30 cm² ❑ Holodiastolic flow reversal in the proximal abdominal aorta ❑ Left ventricle dilatation | Progressive regurgitation (Stage B) ❑ Vena contracta <0.6 cm ❑ Regurgitant volume <60 mL/beat ❑ Regurgitant fraction <50% ❑ Effective regurgitant orifice <0.30 cm² | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient symptomatic? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes (Stage D) | No (Stage C) | Is the patient undergoing another surgery? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ LVEF<50% (Stage C2) | ❑ The patient is undergoing another surgery | ❑ LVEF ≥ 50% AND ❑ LVESD > 50mm (Stage C2) | ❑ LVEF ≥ 50% AND ❑ LVEDD > 65mm AND ❑ Low surgical risk | ❑ LVEF ≥ 50% AND ❑ LVESD ≤ 50mm AND ❑ LVEDD ≤ 65mm | No | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| AVR (Class I) | AVR (Class I) | AVR (Class I) | AVR (Class IIa) | AVR (Class IIb) | Monitor the patient periodically | Monitor the patient periodically | AVR (Class IIa) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||