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Revision as of 15:30, 3 September 2014

Abbreviations: LVEF: left ventricular ejection fraction; LVESD: left ventricular end systolic diameter; MR: mitral regurgitation; PASP: Pulmonary artery systolic pressure

Primary MR

What is the severity of MR?

Severe MR

❑ Severe MVP with loss of coaptation
❑ RHD with loss of central coaptation
❑ Left ventricular dilation
❑ Regurgitation fraction ≥ 50%
❑ Regurgitation volume ≥ 60ml
❑ Effective regurgitation orifice ≥ 0.4cm²

❑ Vena contracta ≥ 0.7cm

Progressive MR
(Stage B)

❑ Severe MVP with normal coaptation
❑ RHD with normal coaptation
❑ No Left ventricular dilation
❑ Regurgitation fraction < 50%
❑ Regurgitation volume < 60ml
❑ Effective regurgitation orifice < 0.4cm²

❑ Vena contracta < 0.7cm

Is the patient symptomatic?

Yes
(Stage D)

No
(Stage C)

Is the LVEF>30%?

LVEF 30-60%
OR
LVESD≥40 mm
(Stage C2)

LVEF>60%
AND
LVESD<40 mm
(Stage C1)

New onset atrial fibrillation
OR
PASP>50 mmHg
(Stage C1)

Is the likelihood of success for the valve repair >95% and the expected mortality <1%?

No

Yes

No

Mitral valve surgery (Class IIb)

Mitral valve surgery (Class I)

Mitral valve repair (Class IIa)

Periodic monitoring

@@ Line 1: / Line 1: @@
-<span style="font-size:85%">'''Abbreviations:''' '''LVEF:''' left ventricular ejection fraction; '''MR:''' mitral regurgitation; '''PASP:''' Pulmonary artery systolic pressure </span>
+<span style="font-size:85%">'''Abbreviations:''' '''LVEF:''' left ventricular ejection fraction; '''LVESD:''' left ventricular end systolic diameter; '''MR:''' mitral regurgitation; '''PASP:''' Pulmonary artery systolic pressure </span>
 {{Family tree/start}}
@@ Line 26: / Line 26: @@
 {{ Family tree | | | D01 | | | | | | D02 | | | | | | |!| D01= Yes <br> ''(Stage D)''| D02= No <br> ''(Stage C)''}}
 {{ Family tree | | | |!| | | |,|-|-|-|+|-|-|-|.| | | |!| }}
-{{ Family tree | | | E01 | | E02 | | E03 | | E04 | | |!| E01= Is the LVEF>30%?| E02= LVEF 30-60% <br> OR <br> LVESV≥40 mm <br> ''(Stage C2)''| E03= LVEF>60% <br> AND <br> LVESV<40 mm <br> ''(Stage C1)''| E04= New onset AF<br> OR <br> PASP>50 mmHg <br> ''(Stage C1)''}}
+{{ Family tree | | | E01 | | E02 | | E03 | | E04 | | |!| E01= Is the [[LVEF]]>30%?| E02= [[LVEF]] 30-60% <br> OR <br> LVESD≥40 mm <br> ''(Stage C2)''| E03= [[LVEF]]>60% <br> AND <br> LVESD<40 mm <br> ''(Stage C1)''| E04= New onset [[atrial fibrillation]]<br> OR <br> PASP>50 mmHg <br> ''(Stage C1)''}}
 {{ Family tree | |,|-|^|-|.| |!| | | | |!| |!| | | | |!| }}
-{{ Family tree | |!| | | |!| |!| | | | | F00 | | | | |!| F00= Is the likelihood of success for the valve repair >95% and the expected mortality <1%?}}
+{{ Family tree | |!| | | |!| |!| | | | | F00 | | | | |!| F00= <div style="float: left; text-align: left; width:15em ">Is the likelihood of success for the valve repair >95% and the expected mortality <1%? </div>}}
 {{ Family tree | |!| | | |!| |!| | |,|-|-|^|-|.| | | |!| }}
 {{ Family tree | F01 | | F02 |!| | F03 | | | F04 | | |!| F01= No| F02= Yes| F03= Yes| F04= No}}
 {{ Family tree | |!| | | | |!|!| | |!| | | | |!| | | |!| }}
-{{ Family tree | G01 | | | G02 | | G03 | | | G04 | | G05 | G01= Mitral valve surgery (Class IIb)| G02= Mitral valve surgery (Class I)| G03= Mitral valve repair (Class IIa)|G04= Periodic monitoring| G05= Periodic monitoring}}
+{{ Family tree | G01 | | | G02 | | G03 | | | G04 | | G05 | G01= [[Mitral valve surgery]] (Class IIb)| G02= [[Mitral valve surgery]] (Class I)| G03= [[Mitral valve repair]] (Class IIa)|G04= Periodic monitoring| G05= Periodic monitoring}}
 {{ Family tree/end}}

Sandbox Rim: Difference between revisions

Revision as of 15:30, 3 September 2014

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