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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). If the patient does not meet any of the decision pathways in the algorithm, regular monitoring is recommended and AVR is not indicated.'''
| | Shown below is an algorithm depicting the indications for [[aortic valve replacement]] (AVR) in aortic regurgitation. |
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| {{Familytree/start}} | | {{Familytree/start}} |
| {{Family tree | | | | | | | | | | | | A01 | | | | | | | | | | | | A01= '''Abnormal aortic valve'''<br> '''AND''' <br>'''Reduction in systolic opening'''}} | | {{Family tree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | }} |
| {{Family tree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | }} | | {{Family tree | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|.| }} |
| {{Family tree | | | | | B01 | | | | | | | | | | | B02 | | | | | | B01= '''Severe aortic stenosis:''' <br> '''V<sub>max</sub>≥4m/s'''<br> AND <br>'''ΔP<sub>mean</sub>≥40 mmHg''' | B02= '''V<sub>max</sub>3-3.9 m/s'''<br>AND <br>'''ΔP<sub>mean</sub>20-39 mmHg''' }} | | {{Family tree | | | | | | | B01 | | | | | | | | | | | | | | | | | | B02 | }} |
| {{Family tree | | | | | |!| | | | | | | | | | | | |!| | | | | | | }}
| | {{Family tree | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | |!| | }} |
| {{Family tree | | | | | C01 | | | | | | | | | | | C02 | | | | | | C01= Is the patient symptomatic?| C02= Is the patient symptomatic?}} | | {{Family tree | C01 | | | | | | | | | | C02 | | | | | | | | | | | | C03 | | | }} |
| {{Family tree |,|-|-|-|-|^|-|-|-|.| | | | | |,|-|-|^|-|-|.| | | | }}
| | {{Family tree | |!| | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | |,|-|^|-|.| | }} |
| {{Family tree | D01 | | | | | | D02 | | | | D03 | | | | D04 | | | D01= Yes<br> ''(Stage D1)''| D02= No <br> ''(Stage C)''| D03= Yes| D04= No<br> ''(Stage B)''}}
| | {{Family tree | |!| | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | }} |
| {{Family tree |!| | | | | | | | |`|-|.| | | |!| | | | | |!| | | | }} | | {{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} |
| {{Family tree |!| | | | | | | | | | |!| | | |!| | | | | |!| | | | }} | | {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | E08 | }} |
| {{Family tree |!|,|-|-|-|-|-|-| E01 |(| | | E02 | | | | E03 | | | E01= [[LVEF]] <50%<br> ''(Stage C2)''| E02= Is [[LVEF]] <50%?| E03= The patient is undergoing<br> another cardiac surgery}}
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| {{Family tree |!|!| | | | | | | | | |!| |,|-|^|-|.| | | |!| | | }}
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| {{Family tree |!|!|,|-|-|-|-|-| F01 |(| F02 | | F03 | | |!| | | | F01= The patient is undergoing <br>another cardiac surgery | F02= Yes| F03= No}}
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| {{Family tree |!|!|!| | | | | | | | |!| |!| | | |!| | | |!| | | }}
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| {{Family tree |!|!|!| | |,|-|-| G01 |(| G02 | | G03 | | |!| | | | G01= V<sub>max</sub>≥5m/s<br> AND <br>ΔP<sub>mean</sub>≥60 mmHg<br>''(Very severe stage C1)''<br> AND<br> Low surgical risk | G02= [[Dobutamine stress echocardiography]]: <br> Aortic valve area ≤1 cm<sup>2</sup> <br> AND <br> V<sub>max</sub>≥4 ms <br> ''(Stage D2)''| G03= Aortic valve area ≤1 cm<sup>2</sup> <br> AND <br> [[LVEF]] ≥50% <br> ''(Stage D3)''}}
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| {{Family tree |!|!|!| | |!| | | | | |!| |!| | | |!| | | |!| | | }}
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| {{Family tree |!|!|!| | |!|,|-| H01 |(| |!| | | H02 | | |!| | | | H01= Abnormal exercise treadmill test | H02= The symptoms are likely<br> the result of the [[aortic stenosis]]}}
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| {{Family tree |!|!|!| | |!|!| | | | |!| |!| | | |!| | | |!| | }} | |
| {{Family tree |!|!|!| | |!|!| | I01 |'| |!| | | |!| | | |!| | I01= ΔV<sub>max</sub>>0.3 m/s/y <br> AND <br> Low surgical risk }} | |
| {{Family tree |!|!|!| | |!|!| | |!| | | |!| | | |!| | | |!| | }}
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| {{Family tree | J01 | | J02 | | J03 | | J04 | | J05 | | J06 | J01= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]])| J02= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]])| J03= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]])| J04= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]])| J05= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]])| J06= [[AVR]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]])}} | |
| {{Family tree/end}} | | {{Family tree/end}} |
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| ===Management of Hypertension===
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| Patients with aortic stenosis who are either in stage A, stage B, or stage C should be treated for hypertension (Class I; level of evidence B).
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Indications for Aortic Valve Replacement
Shown below is an algorithm depicting the indications for aortic valve replacement (AVR) in aortic regurgitation.
| | | | | | | | | | | | | | {{{ A01 }}} | | | | | | | | | | | | |
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| | | | | | {{{ B01 }}} | | | | | | | | | | | | | | | | | | {{{ B02 }}} | {{{ }}} |
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{{{ C01 }}} | | | | | | | | | | {{{ C02 }}} | | | | | | | | | | | | {{{ C03 }}} | | | {{{ }}} |
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| | | | | {{{ D01 }}} | | {{{ D02 }}} | | {{{ D03 }}} | | {{{ D04 }}} | | {{{ D05 }}} | | {{{ D06 }}} | | {{{ D07 }}} | |
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{{{ E01 }}} | | {{{ E02 }}} | | {{{ E03 }}} | | {{{ E04 }}} | | {{{ E05 }}} | | {{{ E06 }}} | | {{{ E07 }}} | | {{{ E08 }}} | |