cirus
Forum Guru
Topics: 108
Posts: 740
|
For those who still are confused (& i was one of them), UW says that surgery is only indicated in case of NYHA( New York Heart Association) class 3 which means Dyspnea at rest, or Ischemia (in case of AS at rest)..
Plz correct if im wrong
|
| young_doc
Forum Guru
Topics: 55
Posts: 732
|
I thought it was just in any symptomatic case?
___________________
First Aid is my Bible...
|
| virgola82
Forum Guru
Topics: 85
Posts: 348
|
I am not sure but I think we should replace the valve before irreversable damages to the heart occur, like CHF or ischemia. Because changing the valve is not going to reverse the heart failure... I thought they should be replaced after first symptoms develops... But if UW says so it should be as they say...
|
| virgola82
Forum Guru
Topics: 85
Posts: 348
|
I gave a look on uptodate and think I sorted this out. It actually depends on the kind of valve problem the patient has.
For AS valve should be replaced when becomes symptomatic.
For MS, mitral valve replacement should be done in:
patients with moderate to severe mitral stenosis (mitral valve area 1.5 cm2), NYHA class III or IV symptoms, and a valve not amenable to either PMBV or open commissurotomy
patients with severe MS and pulm hypertension (Pulm sys pressure >60) if they are not candidates for PMBV or open commissurotomy
For MR, valve surgery should be done in:
any symptomatic patient with severe chronic MR if the LVEF is 30 percent and the LV end-systolic dimension is 55 mm;
If successful repair is highly likely, surgery should bo done also in patients with primary mitral valve disease (ie, not functional MR) and NYHA class III-IV symptoms plus severe LV dysfunction (LVEF <30 percent or LV end-systolic dimension >55 mm;
in asymptomatic patients who have new onset AF or pulmonary hypertension
in asymptomatic patients with an LVEF of 30 to 60 percent and/or an LV end-systolic dimension 40 mm
Mitral valve repair rather than replacement should be done if the anatomy is appropriate including patients with rheumatic mitral valve disease and mitral valve prolapse
If replacement is to be done (ie anatomy not appropriate) the choice is between bioprosthetic and mechanical valve:
-Bioprosthetic should be used for patients 65 years of age and those that are unlikely to be able to take long term warfarin
-Mechanical in patients under age 65 with A fib. They will keep taking warfaring for the a fib and the valve
-In pt under age 65 in sinus rhythm, patient preference plays a central role in the choice of valve.
For AR, the indications for valve replacement are the development of symptoms or, in asymptomatic patients, LV dysfunction as evidenced, for example, by an LVEF <50 percent, an LV end-systolic dimension >55 mm, or an LV end-diastolic dimension >75 mm
I tried to sum things up so I hope I didn't miss anything.
|
|
| |
| | | | |
