Mitral regurgitation cardiac catheterization: Difference between revisions
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| [[File:Siren.gif|30px|link=Mitral regurgitation resident survival guide]]|| <br> || <br> | | [[File:Siren.gif|30px|link=Mitral regurgitation resident survival guide]]|| <br> || <br> | ||
| [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
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==Overview== | ==Overview== | ||
Left ventriculography and hemodynamic assessment by cardiac catheterization might be useful to evaluate mitral regurgitation when the results of the non-invasive testing are insufficient. In addition, cardiac catheterization might be performed when there is lack of correlation between the clinical findings and the results of the non-invasive testing in order to rule out cardiac etiologies or pulmonary hypertension as the cause of the patient's symptoms. In patients with mitral regurgitation who have risk factors for coronary artery disease, such as advanced age, hypercholesterolemia, and hypertension, or when there is a suspicion that mitral regurgitation is ischemic in origin, coronary angiography should be performed before surgery. | Left ventriculography and hemodynamic assessment by cardiac catheterization might be useful to evaluate mitral regurgitation when the results of the non-invasive testing are insufficient.<ref name="pmid22547754">{{cite journal| author=Nishimura RA, Carabello BA| title=Hemodynamics in the cardiac catheterization laboratory of the 21st century. | journal=Circulation | year= 2012 | volume= 125 | issue= 17 | pages= 2138-50 | pmid=22547754 | doi=10.1161/CIRCULATIONAHA.111.060319 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22547754 }} </ref> In addition, cardiac catheterization might be performed when there is lack of correlation between the clinical findings and the results of the non-invasive testing in order to rule out cardiac etiologies or pulmonary hypertension as the cause of the patient's symptoms.ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline 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. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> In patients with mitral regurgitation who have risk factors for coronary artery disease, such as advanced age, hypercholesterolemia, and hypertension, or when there is a suspicion that mitral regurgitation is ischemic in origin, coronary angiography should be performed before surgery. | ||
==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline 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. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref>== | ==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline 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. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref>== | ||
Revision as of 02:41, 3 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed A. Sbeih, M.D. [2]
Overview
Left ventriculography and hemodynamic assessment by cardiac catheterization might be useful to evaluate mitral regurgitation when the results of the non-invasive testing are insufficient.[1] In addition, cardiac catheterization might be performed when there is lack of correlation between the clinical findings and the results of the non-invasive testing in order to rule out cardiac etiologies or pulmonary hypertension as the cause of the patient's symptoms.ref name="pmid24589852">Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline 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". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852. </ref> In patients with mitral regurgitation who have risk factors for coronary artery disease, such as advanced age, hypercholesterolemia, and hypertension, or when there is a suspicion that mitral regurgitation is ischemic in origin, coronary angiography should be performed before surgery.
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[2]
Recommendations for Chronic Primary Mitral Regurgitation
Cardiac Catheterization Recommendations
| Class IIa |
| "1. Exercise hemodynamics with either doppler echocardiography or cardiac catheterization is reasonable in symptomatic patients with chronic primary mitral regurgitation (MR) where there is a discrepancy between symptoms and the severity of MR at rest (stages B and C). (Level of Evidence: B) " |
Exercise Testing Recommendations
| Class IIa |
| "1. Exercise treadmill testing can be useful in patients with chronic primary mitral regurgitation to establish symptom status and exercise tolerance (stages B and C). (Level of Evidence: C" |
Recommendations for Chronic Secondary Mitral Regurgitation
| Class I |
| "1.Noninvasive imaging (stress nuclear/positron emission tomography, CMR, or stress echocardiography), cardiac CT angiography, or cardiac catheterization, including coronary arteriography, is useful to establish etiology of chronic secondary MR (stages B to D) and/or to assess myocardial viability, which in turn may influence management of functional MR. (Level of Evidence: C)" |
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [3]
Cardiac Catheterization Indications (DO NOT EDIT) [3]
| Class I |
| "1. Left ventriculography and hemodynamic measurements are indicated when noninvasive tests are inconclusive regarding severity of MR, LV function, or the need for surgery.(Level of Evidence: C) " |
| "2. Hemodynamic measurements are indicated when pulmonary artery pressure is out of proportion to the severity of MR as assessed by noninvasive testing.(Level of Evidence: C) " |
| "3. Left ventriculography and hemodynamic measurements are indicated when there is a discrepancy between clinical and noninvasive findings regarding severity of MR.(Level of Evidence: C) " |
| "4. Coronary angiography is indicated before mitral valve repair or mitral valve replacement in patients at risk for CAD.(Level of Evidence: C) " |
| Class III |
| "1. Left ventriculography and hemodynamic measurements are not indicated in patients with MR in whom valve surgery is not contemplated.(Level of Evidence: C) " |
Sources
- 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [3]
References
- ↑ Nishimura RA, Carabello BA (2012). "Hemodynamics in the cardiac catheterization laboratory of the 21st century". Circulation. 125 (17): 2138–50. doi:10.1161/CIRCULATIONAHA.111.060319. PMID 22547754.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline 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". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ 3.0 3.1 3.2 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
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