Pulmonary regurgitation follow up: Difference between revisions
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==Follow Up== | ==Follow Up== | ||
*All [[patients]] should undergo a baseline [[transthoracic echocardiogram]] after [[PVR]].<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid20801927">{{cite journal| author=Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N et al.| title=ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 23 | pages= 2915-57 | pmid=20801927 | doi=10.1093/eurheartj/ehq249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20801927 }} </ref> | ===Post pulmonic valve replacement=== | ||
*All [[patients]] should undergo a baseline [[Standard views and measurements in transthoracic echocardiography|transthoracic echocardiogram]] after [[PVR]].<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e143-263 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref><ref name="pmid20801927">{{cite journal| author=Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N et al.| title=ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 23 | pages= 2915-57 | pmid=20801927 | doi=10.1093/eurheartj/ehq249 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20801927 }} </ref> | |||
*[[Anticoagulation]] is recommended for [[patients]] with mechanical valves and [[aspirin]] for [[patients]] with [[bioprosthetic valves]].<ref name="pmid22561653">{{cite journal| author=Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR| title=Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. | journal=Eur J Cardiothorac Surg | year= 2012 | volume= 42 | issue= 1 | pages= e1-8 | pmid=22561653 | doi=10.1093/ejcts/ezs219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22561653 }} </ref> | *[[Anticoagulation]] is recommended for [[patients]] with mechanical valves and [[aspirin]] for [[patients]] with [[bioprosthetic valves]].<ref name="pmid22561653">{{cite journal| author=Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR| title=Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. | journal=Eur J Cardiothorac Surg | year= 2012 | volume= 42 | issue= 1 | pages= e1-8 | pmid=22561653 | doi=10.1093/ejcts/ezs219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22561653 }} </ref> | ||
*[[Oral anticoagulation therapy|Oral anticoagulation]] among patients with [[Bioprosthetic valves|bioprosthetic valve]]<nowiki/>s is recommended only when other indications such as atrial arrhythmia or prior thromoembolic event are present. | *[[Oral anticoagulation therapy|Oral anticoagulation]] among patients with [[Bioprosthetic valves|bioprosthetic valve]]<nowiki/>s is recommended only when other indications such as atrial arrhythmia or prior thromoembolic event are present. | ||
*All [[patients]] are advised for a lifelong follow up to assess the [[valve|valvular]] morphology and [[RV]] [[systolic function]]. | *All [[patients]] are advised for a lifelong follow up to assess the [[valve|valvular]] morphology and [[RV]] [[systolic function]]. | ||
===Surveillance=== | |||
*Rapid [[RV|right ventricular]] (RV) dilatation has been reported to be associated with restrictive [[right ventricle]] (RV) physiology on initial MRI assessment. Therefore among [[patients]] with restrictive [[right ventricle]] (RV) physiology, optimal time for [[pulmonary valve]] implantation may be determined by careful follow-up.<ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref> | *Rapid [[RV|right ventricular]] (RV) dilatation has been reported to be associated with restrictive [[right ventricle]] (RV) physiology on initial MRI assessment. Therefore among [[patients]] with restrictive [[right ventricle]] (RV) physiology, optimal time for [[pulmonary valve]] implantation may be determined by careful follow-up.<ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref> | ||
*Upon surveillance among [[patients]] with [[PR]] monitoring [[right ventricle|right ventricular]] dilatation and its sequelae holds more significance than the [[PR|regurgitation]] itself. Simple features demonstrating [[RV]] dilatation can be observed on the physical exam or history. [[CXR]], [[echocardiography]] and [[MRI]] should assess [[RV]] dilatation on [[patient]] visits.<ref name="pmid17569817">{{cite journal |vauthors=Chaturvedi RR, Redington AN |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–9 |date=July 2007 |pmid=17569817 |pmc=1994453 |doi=10.1136/hrt.2005.075234 |url=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:31, 6 August 2020
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2], Aravind Kuchkuntla, M.B.B.S[3]
Overview
Follow up of patients with pulmonic regurgitation requires regular echocardiographic monitoring after PVR, oral anticoagulation in patients with mechanical or bioprosthetic valves and lifelong follow up to monitor pulmonary valve morphology and RV function.[1]
Follow Up
Post pulmonic valve replacement
- All patients should undergo a baseline transthoracic echocardiogram after PVR.[1][2]
- Anticoagulation is recommended for patients with mechanical valves and aspirin for patients with bioprosthetic valves.[3]
- Oral anticoagulation among patients with bioprosthetic valves is recommended only when other indications such as atrial arrhythmia or prior thromoembolic event are present.
- All patients are advised for a lifelong follow up to assess the valvular morphology and RV systolic function.
Surveillance
- Rapid right ventricular (RV) dilatation has been reported to be associated with restrictive right ventricle (RV) physiology on initial MRI assessment. Therefore among patients with restrictive right ventricle (RV) physiology, optimal time for pulmonary valve implantation may be determined by careful follow-up.[4]
- Upon surveillance among patients with PR monitoring right ventricular dilatation and its sequelae holds more significance than the regurgitation itself. Simple features demonstrating RV dilatation can be observed on the physical exam or history. CXR, echocardiography and MRI should assess RV dilatation on patient visits.[5]
References
- ↑ 1.0 1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N; et al. (2010). "ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)". Eur Heart J. 31 (23): 2915–57. doi:10.1093/eurheartj/ehq249. PMID 20801927.
- ↑ Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR (2012). "Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair". Eur J Cardiothorac Surg. 42 (1): e1–8. doi:10.1093/ejcts/ezs219. PMID 22561653.
- ↑ Shin, Yu Rim; Jung, Jo Won; Kim, Nam Kyun; Choi, Jae Young; Kim, Young Jin; Shin, Hong Ju; Park, Young-Hwan; Park, Han Ki (2016). "Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging". European Journal of Cardio-Thoracic Surgery. 50 (3): 464–469. doi:10.1093/ejcts/ezw049. ISSN 1010-7940.
- ↑ Chaturvedi RR, Redington AN (July 2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.