Acute aortic regurgitation surgical treatment: Difference between revisions
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==Overview== | ==Overview== | ||
In the case of severe acute [[aortic insufficiency]], all individuals should undergo emergency surgery if there are no absolute contraindications for surgery. | |||
In the case of severe acute [[aortic insufficiency]], all individuals should undergo emergency surgery if there are no absolute contraindications for 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 antibiotics to take effect, especially if there is [[hypotension]], [[pulmonary edema]], or low [[cardiac output]] given the high mortality associated with the acute aortic insufficiency. Instead, replacement with an [[artificial heart valve|aortic valve]] [[homograft]] should be performed if feasible. Surgical approach depends on the cause for aortic insufficiency with valve repair/replacement in cases of valvular structural abnormalities to aortic root repair/replacement in cases of aortic dissection. | |||
Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stoke 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 after load. | Patients may be temporarily managed before surgery with [[vasodilators]] such as [[nitroprusside]] and possibly [[inotropic agents]] such as [[dopamine]] or [[dobutamine]] to improve [[stoke 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 after load. | ||
Revision as of 19:00, 31 January 2012
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Aortic Regurgitation Microchapters |
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Diagnosis |
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Treatment |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Special Scenarios |
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Case Studies |
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Acute aortic regurgitation surgical treatment On the Web |
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American Roentgen Ray Society Images of Acute aortic regurgitation surgical treatment |
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Risk calculators and risk factors for Acute aortic regurgitation surgical treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.
Overview
In the case of severe acute aortic insufficiency, all individuals should undergo emergency surgery if there are no absolute contraindications for 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 antibiotics to take effect, especially if there is hypotension, pulmonary edema, or low cardiac output given the high mortality associated with the acute aortic insufficiency. Instead, replacement with an aortic valve homograft should be performed if feasible. Surgical approach depends on the cause for aortic insufficiency with valve repair/replacement in cases of valvular structural abnormalities to aortic root repair/replacement in cases of aortic dissection.
Patients may be temporarily managed before surgery with vasodilators such as nitroprusside and possibly inotropic agents such as dopamine or dobutamine to improve stoke volume and reduce left ventricular end-diastolic pressure[1]. Intra-aortic balloon pump is contraindicated as this would worsen aortic regurgitation by increasing after load.
In mild aortic insufficiency secondary to aortic dissection, valve can be repaired/replaced at the time of surgery for aortic dissection.
References
- ↑ 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 2011-04-07. Unknown parameter
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