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: ❑ Every 1 - 2 years for moderate regurgitation </div> }} | : ❑ Every 1 - 2 years for moderate regurgitation </div> }} | ||
{{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | |!| | }} | {{Family tree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | |!| | }} | ||
{{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | | | | | E07 | E01= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E02= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E03= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E04= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])| E05= AVR ([[ACC AHA guidelines classification scheme|Class IIb]])| E06= Monitor the patient | {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | | | | | E07 | E01= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E02= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E03= AVR ([[ACC AHA guidelines classification scheme|Class I]])| E04= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])| E05= AVR ([[ACC AHA guidelines classification scheme|Class IIb]])| E06= Monitor the patient: <br> ❑ Perform a periodic echocardiogram every 6 - 12 months ([[ACC AHA guidelines classification scheme|Class I, level of evidence C]])| E07= AVR ([[ACC AHA guidelines classification scheme|Class IIa]])}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
==Acute AR== | ==Acute AR== | ||
Revision as of 16:15, 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.
Abbreviations: LVEF: left ventricular ejection fraction; LVEDD: left ventricular end diastolic diameter; LVESV: left ventricular end systolic diameter
| 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) ❑ Vena contracta <0.6 cm ❑ Regurgitant volume <60 mL/beat ❑ Regurgitant fraction <50% ❑ Effective regurgitant orifice <0.30 cm² | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient symptomatic? | Is the patient undergoing another surgery? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes (Stage D) | No (Stage C) | No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ LVEF<50% (Stage C2) | ❑ The patient is undergoing another surgery | ❑ LVEF ≥ 50% AND ❑ LVESD > 50mm (Stage C2) | ❑ LVEF ≥ 50% AND ❑ LVEDD > 65mm AND ❑ Low surgical risk | ❑ LVEF ≥ 50% AND ❑ LVESD ≤ 50mm AND ❑ LVEDD ≤ 65mm | Monitor the patient periodically ❑ Control hypertension preferably with
(Class I; Level of Evidence: B)
❑ Perform a periodic echocardiogram (Class I; Level of Evidence:B)
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| AVR (Class I) | AVR (Class I) | AVR (Class I) | AVR (Class IIa) | AVR (Class IIb) | Monitor the patient: ❑ Perform a periodic echocardiogram every 6 - 12 months (Class I, level of evidence C) | AVR (Class IIa) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acute AR
| What is the cause of acute AR? | |||||||||||||||||||||||||||||
| Infective endocarditis | Aortic dissection | ||||||||||||||||||||||||||||
Does the patient have AR related heart failure symptoms? | Emergent surgery[1] | ||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||
Schedule for early aortic valve replacement (Class I, level of evidence B)[1][2] Click here for more details | |||||||||||||||||||||||||||||
- ↑ 1.0 1.1 "http://circ.ahajournals.org/content/121/13/e266.full". External link in
|title=(help) - ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=ignored (help)