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{{Family tree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | A01= What is the severity of the aortic regurgitation?}} | {{Family tree | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | A01= What is the severity of the aortic regurgitation?}} | ||
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|.| }} | {{Family tree | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|.| }} | ||
{{Family tree | | | | | | | B01 | | | | | | | | | | | | | | | | | | B02 | B01= <div style="float: left; text-align: center; width:12em"> '''Severe regurgitation''' </div> <div style="float: left; text-align: left; width: 15em; line-height: 150%"> <br> ❑ Vena contracta >0.6 cm <br> ❑ | {{Family tree | | | | | | | B01 | | | | | | | | | | | | | | | | | | B02 | B01= <div style="float: left; text-align: center; width:12em"> '''Severe regurgitation''' </div> <div style="float: left; text-align: left; width: 15em; line-height: 150%"> <br> ❑ Vena contracta >0.6 cm <br> ❑ Doppler jet width ≥ 65% of LVOT <br> ❑ Regurgitant volume ≥60 mL/beat <br> ❑ Regurgitant fraction ≥50% <br> ❑ Effective regurgitant orifice ≥ 0.30 cm² <br> ❑ Holodiastolic flow reversal in the proximal abdominal aorta <br> ❑ [[Left ventricle]] dilatation</div>| B02= <div style="float: left; text-align: center; width:18em">'''Progressive regurgitation''' ([[Aortic regurgitation stages|Stage B]]) </div> <div style="float: left; text-align: left; line-height: 150%"> '''Mild''' <br> ❑ Vena contracta <0.3 cm <br> ❑ Doppler jet width <25% of LVOT <br> ❑ Regurgitant volume <30 mL/beat <br> ❑ Regurgitant fraction <30% <br> ❑ Effective regurgitant orifice <0.10 cm² </div>}} | ||
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | |!| | }} | {{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | |!| | }} | ||
Revision as of 03:25, 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.
| 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) Mild ❑ Vena contracta <0.3 cm ❑ Doppler jet width <25% of LVOT ❑ Regurgitant volume <30 mL/beat ❑ Regurgitant fraction <30% ❑ Effective regurgitant orifice <0.10 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% LVESD > 50mm (Stage C2) | LVEF ≥ 50% LVEDD > 65mm Low surgical risk | LVEF ≥ 50% LVESD ≤ 50mm 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) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||