Aortic stenosis general approach: Difference between revisions
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*Patients undergoing [[aortic valve replacement]] and having co-existing multi-vessel [[coronary artery disease]] should have concomitantly [[CABG]].<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=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). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref> | *Patients undergoing [[aortic valve replacement]] and having co-existing multi-vessel [[coronary artery disease]] should have concomitantly [[CABG]].<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=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). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref> | ||
; Shown below is an algorithm showing the management of symptomatic and asymptomatic patients with aortic stenosis<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=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). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref> | ; Shown below is an algorithm showing the management of symptomatic and asymptomatic patients with aortic stenosis<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=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). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref>: | ||
[[Image:Management_of_Aortic_Stenosis.png|center|550px|Management of patients with aortic stenosis]] | [[Image:Management_of_Aortic_Stenosis.png|center|550px|Management of patients with aortic stenosis]] | ||
; Shown below is an algorithm showing a more detailed approach to patients with low flow, low gradient aortic stenosis | ; Shown below is an algorithm showing a more detailed approach to patients with low flow, low gradient aortic stenosis: | ||
[[Image:Management_of_LGLFAS.png |center|500px|Approach to patients with low flow, low gradient aortic stenosis]] | [[Image:Management_of_LGLFAS.png |center|500px|Approach to patients with low flow, low gradient aortic stenosis]] | ||
Revision as of 16:47, 7 January 2013
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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 general approach On the Web |
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American Roentgen Ray Society Images of Aortic stenosis general approach |
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Directions to Hospitals Treating Aortic stenosis general approach |
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Risk calculators and risk factors for Aortic stenosis general approach |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]; Rim Halaby
Overview
Once a patient becomes symptomatic with aortic stenosis, aortic valve replacement should be performed as long as the patient can tolerate surgery and has no co-morbidities. If severe left ventricular dysfunction is present in the setting of aortic stenosis, it is of utmost importance to differentiate between true severe aortic stenosis and pseudo-severe aortic stenosis as these two entities have different pathophysiologies and different outcomes after aortic valve replacement. Medical therapy reduces symptoms but does not prolong life. If a patient has extensive co-morbidities, transcatheter aortic valve implantation can be considered. Aortic valvuloplasty can be considered in those patients who are too sick for surgery or transcatheter aortic valve implantation.
General Approach
- The normal aortic valve has an orifice area of 4 cm2. Aortic stenosis is a progressive pathology that becomes usually symptomatic when the area decreases to 1 cm2. Once symptomatic, the most effective treatment for aortic stenosis is aortic valve replacement.
- Almost all symptomatic patients should undergo aortic valve replacement. One important exception is in the case of severe aortic stenosis with ventricle dysfunction where extensive testing should be done to differentiate between true severe aortic stenosis and pseudo-severe aortic stenosis. Patients with true severe low flow low gradient aortic stenosis benefit from aortic valve replacement, whereas patients with pseudo-severe low flow low gradient aortic stenosis might not benefit from aortic valve replacement and have higher operative mortality.
- Asymptomatic patients should be followed up yearly for any new onset of symptoms. No treatment has been proven to delay the progression of aortic stenosis. Follow up with an echocardiography should be done every 1, 3, 5 years in severe, moderate and mild aortic stenosis respectively.
- Patients undergoing aortic valve replacement and having co-existing multi-vessel coronary artery disease should have concomitantly CABG.[1]
- Shown below is an algorithm showing the management of symptomatic and asymptomatic patients with aortic stenosis[1]
- Shown below is an algorithm showing a more detailed approach to patients with low flow, low gradient aortic stenosis
Available Therapeutic Options
- Aortic stenosis surgery via aortic valve replacement
- Transcatheter aortic valve implantation
- Percutaneous aortic balloon valvotomy (PABV) or aortic valvuloplasty
- Medical management
References
- ↑ 1.0 1.1 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.