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Chapter 52: Prosthetic Heart Valves

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A 62-year-old man with a prior history of infective endocarditis and a porcine aortic bioprosthesis that was implanted 12 weeks ago attended the cardiology clinic for a routine visit. At the clinic, a complete evaluation was unremarkable, including anticoagulation adherence, clinical questioning, physical examination, 12-lead ECG, and transthoracic echocardiography for the assessment of ventricular and prosthetic valve function. Which of the following actions would be the most appropriate at this time?

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A. Discharge the patient from the clinic

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B. Discharge the patient from the clinic with family physician follow-up

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C. Discharge the patient from the clinic and advise him to get in touch if symptoms occur

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D. Follow the patient for another year, and if he is stable, discharge him with family physician follow-up

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E. None of the above

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The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 52) At 6 to 12 weeks after surgery, a complete evaluation including clinical history and examination, 12-lead ECG, and transthoracic echocardiography should be performed to assess functional status, blood pressure and rhythm, ventricular function, prosthetic valve function, gradients, and any paravalvular regurgitation, and anticoagulation adherence should be reviewed. Consensus guidelines recommend annual and symptom-triggered follow-up by a cardiologist for life, with the aim of detecting prosthesis dysfunction and the progression of other valvular heart disease. Follow-up solely by a family physician or as needed is not sufficient (options A, B, C, D).

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A 62-year-old man with a prior history of infective endocarditis and a porcine aortic bioprosthesis that was implanted 12 weeks ago attended the cardiology clinic for a routine visit. At the clinic, a complete evaluation was unremarkable, including anticoagulation adherence, clinical questioning, physical examination, 12-lead ECG, and transthoracic echocardiography for the assessment of ventricular and prosthetic valve function.

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Having undergone an echocardiogram before and shortly after his aortic valve replacement surgery, the patient would like to know when the next echocardiogram will be scheduled. Which of the following statements about the use of transthoracic echocardiography after the bioprosthetic valve replacement is false?

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A. Should be performed annually after the 10th postoperative year

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B. Should be performed annually after the fifth postoperative year

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C. Should be performed annually after the second or third postoperative year in patients who are at higher risk of accelerated valve dysfunction

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D. Should be performed sooner if new symptoms occur

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E. All of the above

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The answer is A....

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