TY - CHAP M1 - Book, Section TI - Valvular Disease A1 - Higgins, John P. A1 - Ali, Asif A1 - Filsoof, David M. PY - 2016 T2 - Cardiology Clinical Questions, 2e AB - Table Graphic Jump Location|Download (.pdf)|PrintThe decision to refer a patient with aortic stenosis (AS) for surgery is based on the presence of symptoms, severity of AS, left ventricular function, and whether they require other surgeries involving the heart.HPI: Dyspnea with exertion, angina, syncope, or orthopnea. Sometimes patients adjust their lifestyle subconsciously to avoid exertion.PMH: Hypertension, coronary artery disease, rheumatic fever/heart disease, hyperlipidemia.PSH: Valve replacement, prior thoracotomy.FH: Congenital bicuspid aortic valve.Mid-late peaking systolic ejection murmur with radiation to carotids, paradoxically split S2, diminished carotid upstroke, evidence of heart failure (elevated JVP, rales, S3, peripheral edema).Left ventricular hypertrophy with strain pattern, left axis deviation.Echo: Assess aortic valve area, pressure across the aortic valve, morphology (e.g., calcified or bicuspid). Assess left ventricle size and function.SYM = SYMptomatic (see HPI).ASYM = ASYMptomatic.CARD-SUR = Patient is due for CARDiac SURgery for reasons other than the aortic stenosis (e.g., CABG).MOD-AS = MODerate Aortic Stenosis by echocardiography.SEV-AS = SEVere Aortic Stenosis by echocardiography = Aortic valve area ≤1.0 cm2, decreased valve opening and aortic velocity ≥4.0 m/s or mean P gradient ≥40 mm Hg.LVSD = Left Ventricular Systolic Dysfunction with ejection fraction 12 months.MOD-AS + ASYM = FOLLOWMOD-AS + ASYM + CARD-SUR = AVR/TAVRMOD-AS + SYM = AVR/TAVRMOD-AS + LVSD = LG-ASSEV-AS + ASYM = FOLLOWSEV-AS + ASYM + CARD-SUR = AVR/TAVRSEV-AS + ASYM + LVSD = AVR/TAVRSEV-AS + SYM = AVR/TAVRIn patients with severe symptomatic aortic stenosis the survival rate is 2–3 years unless AVR is performed.The most common cause of death in asymptomatic valve disease is surgery! Use careful consideration in determining if symptoms are genuinely present and integrating echocardiographic findings in deciding when to time surgery.– 1.0–2.0% of the population born with a bicuspid aortic valve.– AVR is less beneficial in patients where low ejection fraction is caused by depressed contractility compared to increased afterload. Left ventricular function may be evaluated with a dobutamine echocardiogram, which will also rule out possibility of pseudo aortic stenosis.– Mild aortic regurgitation present in 80% of patients with AS.1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary. Circulation. 2014;129(23):2440–2492.2. Carabello BA. ... SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesscardiology.mhmedical.com/content.aspx?aid=1173757617 ER -