Acute aortic regurgitation surgical treatment: Difference between revisions
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'''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | ||
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The surgical treatment of choice for aortic insufficiency is [[aortic valve replacement]]. This is currently an open-heart procedure, requiring the individual to be placed on [[cardiopulmonary bypass]]. | The surgical treatment of choice for aortic insufficiency is [[aortic valve replacement]]. This is currently an open-heart procedure, requiring the individual to be placed on [[cardiopulmonary bypass]]. | ||
Revision as of 19:04, 19 March 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
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The surgical treatment of choice for aortic insufficiency is aortic valve replacement. This is currently an open-heart procedure, requiring the individual to be placed on cardiopulmonary bypass.
Acute Aortic Insufficiency
In the case of severe acute aortic insufficiency, all individuals should undergo surgery if there are no absolute contraindications for surgery. Individuals with bacteremia with aortic valve endocarditis should not wait for treatment with antibiotics to take effect, given the high mortality associated with the acute aortic insufficiency. Instead, replacement with an aortic valve homograft should be performed if feasible.
Chronic Aortic Insufficiency
Surgical treatment is controversial in asymptomatic patients. Surgery may be recommended if the ejection fraction falls below 50% or in the face of progressive and severe left ventricular dilatation. For both groups of patients, surgery before the development of worse aortic insufficiency ejection fracture/LV systolic dilatation, is expected to reduce the risk of sudden death, and is associated with lower peri-operative mortality.
| Symptoms | Ejection fraction | Other information |
|---|---|---|
| NYHA class III - IV | ≥ 50 % | |
| NYHA class II | ≥ 50 % | Progression of symptoms or worsening parameters on echocardiography |
| CHA class ≥ II angina | ≥ 50 % | |
| Regardless of symptoms | 25 - 49 % | |
| Cardiac surgery for other cause (ie: CAD, other valvular disease, ascending aortic aneurysm) | ||
Severe aortic insufficiency in patient after aortic valve replacement 1
<googlevideo>-3829359717394053857&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 2
<googlevideo>-1139143783733805104&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 3
<googlevideo>-7501177211861270942&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 4
<googlevideo>-4027195456056520519&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 5
<googlevideo>3983126063629833286&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 6
<googlevideo>5313961274473108141&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 7
<googlevideo>-1049019986268408841&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 8
<googlevideo>1577454681656420080&hl=en</googlevideo>
References
- ↑ "ACC/AHA 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 (Committee on Management of Patients with Valvular Heart Disease)". J. Am. Coll. Cardiol. 32 (5): 1486–588. 1998. PMID 9809971.