Acute aortic regurgitation surgical treatment: Difference between revisions

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__NOTOC__
#Redirect [[Aortic regurgitation surgery indications#Indications for Surgery for Acute Aortic Regurgitation]]
{{Aortic insufficiency}}
{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
 
==Overview==
Severe acute [[aortic insufficiency]] requires emergency surgery if there are no absolute contraindications to surgery.
 
==Surgery==
===Timing of Emergency Surgery===
Acute severe aortic insufficiency may cause death due to [[pulmonary edema]], [[ventricular arrhythmias]], [[electromechanical dissociation]], or [[circulatory collapse]]. Individuals with [[bacteremia]] with [[aortic valve]] [[endocarditis]] should not wait for treatment with [[antibiotic]]s to take effect, especially if there is [[hypotension]], [[pulmonary edema]], or low [[cardiac output]] given the high mortality associated with the acute [[aortic insufficiency]].
===Type of Surgery===
Replacement with an [[artificial heart valve|aortic valve]] [[homograft]] should be performed if feasible. The surgical approach depends upon the cause of aortic insufficiency. [[Aortic valve replacement]] or repair may be needed in cases of valvular structural abnormalities and [[aortic root]] repair/replacement may be needed in cases of [[aortic dissection]].
===Preoperative Medical Therapy===
Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stroke volume]] and reduce left ventricular end-diastolic pressure.<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |title=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 |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2011-04-07}}</ref> [[Intra-aortic balloon pump]] is contraindicated as this would worsen aortic regurgitation by increasing [[afterload]].
 
===Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection===
In mild aortic insufficiency secondary to [[aortic dissection]], the [[aortic valve]] can be repaired/replaced at the time of surgery for [[aortic dissection]].
===[[Aortic insufficiency surgical therapy|Aortic Insufficiency Surgical Therapy]]===
 
==References==
{{reflist|2}}
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Valvular heart disease]]
[[Category:Congenital heart disease]]
[[Category:Surgery]]
[[Category:Cardiac surgery]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date]]
{{WH}}
{{WS}}

Latest revision as of 15:31, 6 January 2015