Aortic stenosis follow up
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Resident Survival Guide |
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis follow up On the Web |
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American Roentgen Ray Society Images of Aortic stenosis follow up |
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Risk calculators and risk factors for Aortic stenosis follow up |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Follow up is recommended for all patients with operated and unoperated aortic stenosis. Asymptomatic patients with aortic stenosis should undergo follow up since aortic stenosis is an ongoing disease that progresses with time. In fact, asymptomatic patients should undergo follow up every 1 year, 3 years and 5 years in case of severe, moderate and mild aortic stenosis respectively.[1]
Follow-Up
Frequency of echocardiograms in asymptomatic patients with aortic stenosis with normal stroke volume:
- Progressive (stage B) with mild severity (Vmax 2.0-2.9 m/s): every 3-5 years
- Progressive (stage B) with moderate severity (Vmax 3.0-3.9 m/s): every 1-2 years
- Severe (stage C) (Vmax>4 m/s): every 6-12 months
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[2]
Diagnostic Testing - Routine Follow-Up
| Class I |
| "1. Periodic monitoring with TTE is recommended in asymptomatic patients with known valvular heart disease at intervals depending on valve lesion, severity, ventricular size, and ventricular function. (Level of Evidence:C) " |
2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[3]
Recommendations for Key Issues to Evaluate and Follow-Up (DO NOT EDIT) [3]
| Class I |
| "1. Lifelong cardiology follow-up is recommended for all patients with aortic valve disease (AS or AR). (Level of Evidence: A)" |
| "2. Serial imaging assessment of aortic root anatomy is recommended for all patients with BAV, regardless of severity. The frequency of imaging would depend on the size of the aorta at initial assessment: if less than 40 mm, it should be reimaged approximately every 2 years; if greater than or equal to 40 mm, it should be reimaged yearly or more often as progression of root dilation warrants or whenever there is a change in clinical symptoms or findings. (Level of Evidence: B)" |
| "3. Prepregnancy counseling is recommended for women with AS who are contemplating pregnancy. (Level of Evidence: B)" |
| "4. Patient referral to a pediatric cardiologist experienced in fetal echocardiography is indicated in the second trimester of pregnancy to search for cardiac defects in the fetus. (Level of Evidence: C)" |
| "5. Women with BAV and ascending aorta diameter greater than 4.5 cm should be counseled about the high risks of pregnancy. (Level of Evidence: C)" |
| "6. Patients with moderate to severe AS should be counseled against competitive athletics and strenuous isometric exercise. (Level of Evidence: B)" |
| "7. Echocardiographic screening for the presence of BAV is recommended for first-degree relatives of patients with BAV. (Level of Evidence: B)" |
References
- ↑ Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. 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 Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
- ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
- ↑ 3.0 3.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.