Bicuspid aortic stenosis cardiac catheterization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Usama Talib, BSc, MD [3]

ACC/AHA Guidelines for Evaluation and Monitoring of Asymptomatic Adolescents or Young Adults with Aortic Stenosis by Cardiac Catheterization[1]

Class I

1. Cardiac catheterization for the evaluation of aortic stenosis (AS) is an effective diagnostic tool in the asymptomatic adolescent or young adult when results of Doppler echocardiography are equivocal regarding severity of AS or when there is a discrepancy between clinical and noninvasive findings regarding severity of AS. (Level of Evidence: C)

2. Cardiac catheterization is indicated in the adolescent or young adult with AS who has symptoms of angina, syncope, or dyspnea on exertion if the Doppler mean gradient is > 30 mm Hg or the peak velocity is > 3.5 m per second (peak gradient greater than 50 mm Hg). (Level of Evidence: C)

3. Cardiac catheterization is indicated in the asymptomatic adolescent or young adult with AS who develops T-wave inversion at rest over the left precordium if the Doppler mean gradient is > 30 mm Hg or the peak velocity is > 3.5 m per second (peak gradient > 50 mm Hg). (Level of Evidence: C)

Class IIa

1. Cardiac catheterization for the evaluation of AS is a reasonable diagnostic tool in the asymptomatic adolescent or young adult who has a Doppler mean gradient > 40 mm Hg or a peak velocity > 4 m per second (peak gradient greater than 64 mm Hg). (Level of Evidence: C)

2. Cardiac catheterization for the evaluation of AS is reasonable in the adolescent or young adult who has a Doppler mean gradient > 30 mm Hg or a peak velocity > 3.5 m per second (peak gradient > 50 mm Hg) if the patient is interested in athletic participation or becoming pregnant, or if the clinical findings and the Doppler echocardiographic findings are disparate. (Level of Evidence: C)

References

  1. 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 (2008). "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". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)

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