Cardiology overview valvular heart disease
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Cardiology Overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Bridging Therapy in the Patient with a Prosthetic Valve
- Patients with a prosthetic mitral valve are at higher risk of thrombosis than the patient with a prosthetic valve in the aortic position. Mitral valve patients therefore need a careful bridging strategy.
Indications for surgery for Mitral Stenosis according to ACC/AHA Guidelines [1]
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Class I1. Mitral valve surgery (repair if possible) is indicated in patients with symptomatic (NYHA functional class III–IV) moderate or severe mitral stenosis when
2. Symptomatic patients with moderate to severe mitral stenosis who also have moderate to severe mitral regurgitation should receive Mitral valve replacement, unless valve repair is possible at the time of surgery. (Level of Evidence: C) Class IIa1. Mitral valve replacement is reasonable for patients with severe mitral stenosis and severe pulmonary hypertension (pulmonary artery systolic pressure greater than 60 mm Hg) with NYHA functional class I–II symptoms who are not considered candidates for percutaneous mitral balloon valvotomy or surgical mitral valve repair. (Level of Evidence: C) Class IIb1. Mitral valve repair may be considered for asymptomatic patients with moderate or severe mitral stenosis who have had recurrent embolic events while receiving adequate anticoagulation and who have valve morphology favorable for repair. (Level of Evidence: C) Class III1. Mitral valve repair for mitral stenosis is not indicated for patients with mild stenosis. (Level of Evidence: C) 2. Closed commissurotomy should not be performed in patients undergoing mitral valve repair; open commissurotomy is the preferred approach. (Level of Evidence: C) |
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References
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 focused update incorporated into the ACC/AHA 2006 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 (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.