Aortic insufficiency stages: Difference between revisions

Revision as of 18:47, 5 March 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, Aortic insufficiency has 4 stages based on the valve's anatomy and hemodynamics and the patients symptoms.

Stages ^[1]

STAGE	DEFINITION	VALVE ANATOMY	VALVE HEMODYNAMICS	HEMODYNAMIC CONSEQUENCES	SYMPTOMS
A	At risk of AR	❑ Bicuspid valve ❑ Valve sclerosis ❑ History of rheumatic fever ❑ Infective endocarditis	❑ None	❑ None	❑ None
B	Progressive AR	❑ Mild-to-moderate calcification ❑ Rheumatic valve changes ❑ Dilated aortic sinuses ❑ Infective endocarditis	❑ Mild AR: ❑ Jet width <25% of LVOT ❑ Vena contracta <0.3 cm ❑ RVol <30 mL/beat; RF <30% ❑ ERO <0.10 cm² ❑ Angiography grade 1+ ❑ Moderate AR: ❑ Jet width 25%–64% of LVOT ❑ Vena contracta 0.3–0.6 cm ❑ RVol 30–59 mL/beat ❑ RF 30%–49% ❑ ERO 0.10–0.29 cm² ❑ Angiography grade 2+	❑ Normal LV systolic function ❑ Normal LV volume or mild LV dilation	❑ None
C	Asymptomatic severe AR	❑ Calcific aortic valve disease ❑ Rheumatic valve changes ❑ Dilated aortic sinuses ❑ Infective endocarditis with abnormal leaflet closure	❑ Severe AR ❑ Jet width ≥65% of LVOT ❑ Vena contracta >0.6 cm; ❑ Holodiastolic flow reversal in the proximal abdominal aorta ❑ RVol ≥60 mL/beat; ❑ RF ≥50%; ❑ ERO ≥0.3 cm2; ❑ Angiography grade 3+ to 4+;	❑ C1: Normal LVEF and mild to moderate LV dilatation ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation	❑ None ❑ Exercise testing to confirm symptom status
D	Symptomatic severe AR	❑ Calcific aortic valve disease ❑ Rheumatic valve changes ❑ Dilated aortic sinuses ❑ Infective endocarditis with abnormal leaflet closure	❑ Severe AR ❑ Jet width ≥65% of LVOT ❑ Vena contracta >0.6 cm; ❑ Holodiastolic flow reversal in the proximal abdominal aorta ❑ RVol ≥60 mL/beat; ❑ RF ≥50%; ❑ ERO ≥0.3 cm2; ❑ Angiography grade 3+ to 4+;	❑ May occur with normal systolic function or decreased function ❑ Presence of moderate to severe LV dilatation	❑ Exertional dyspnea ❑ Exertional angina ❑ HF symptoms

AR indicates aortic regurgitation; ERO, effective regurgitant orifice; HF, heart failure; IE, infective endocarditis; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; LVOT, left ventricular outflow tract; RF, regurgitant fraction; and RVol, regurgitant volume.

References

↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.

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[1] "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.

[1]

@@ Line 50: / Line 50: @@
 |-
 | C
-| Asymptomatic severe [[aortic stenosis|AS]]
+| Asymptomatic severe [[AR]]
-| ❑ Severe leaflet calcification or congenital stenosis with severely reduced opening
+| ❑ Calcific aortic valve disease  <br> ❑ Rheumatic valve changes
-| ❑ Vmax ≥ 4 m/s or  mean ΔP ≥ 40 mmHg <br> ❑  Very severe [[aortic stenosis|AS]] is a Vmax ≥ m/s or mean ΔP ≥ 60 mmHg
+<br> ❑  Dilated aortic sinuses <br>  ❑ [[Infective endocarditis]] with abnormal leaflet closure
-| ❑ LV diastolic dysfunction <br> ❑ Mild LVH <br> ❑ Normal LVEF
+| ❑ Severe [[AR]]
+: ❑ Jet width ≥65% of LVOT
+: ❑ [[Vena contracta]] >0.6 cm;
+: ❑ Holodiastolic flow reversal in the proximal abdominal aorta
+: ❑ RVol ≥60 mL/beat;
+: ❑ RF ≥50%;
+: ❑ ERO ≥0.3 cm2;
+: ❑ [[Aortography|Angiography]]  grade 3+ to 4+;
+| ❑ C1: Normal [[LVEF]] and mild to moderate LV dilatation <br> ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation
 | ❑ None <br> ❑ Exercise testing to confirm symptom status
 |-
 | D
-| Symptomatic severe high-gradient [[aortic stenosis|AS]]
+| Symptomatic severe [[AR]]
-| ❑ Severe leaflet calcification or congenital stenosis with severely reduced opening
+| ❑ Calcific aortic valve disease  <br> ❑ Rheumatic valve changes
-| ❑ Vmax ≥ 4 m/s or  mean ΔP ≥ 40 mmHg <br> ❑  AVA ≤ 1.0 cm² but may be larger with mixed [[aortic stenosis|AS]] and [[AR]]
+<br> ❑  Dilated aortic sinuses <br>  ❑ [[Infective endocarditis]] with abnormal leaflet closure
-| ❑ LV [[diastolic dysfunction]] <br> ❑ [[LVH]] <br> ❑ May present with [[pulmonary hypertension]]
+| | ❑ Severe [[AR]]
-| ❑ Exertional [[dyspnea]] or decreased exercise tolerance <br> ❑ Exertional [[angina]] <br> ❑ Exertional [[syncope]] or presyncope
+: ❑ Jet width ≥65% of LVOT
+: ❑ [[Vena contracta]] >0.6 cm;
+: ❑ Holodiastolic flow reversal in the proximal abdominal aorta
+: ❑ RVol ≥60 mL/beat;
+: ❑ RF ≥50%;
+: ❑ ERO ≥0.3 cm2;
+: ❑ [[Aortography|Angiography]]  grade 3+ to 4+;
+| ❑ May occur with normal systolic function or decreased function <br> ❑ Presence of moderate to severe LV dilatation
+| ❑ Exertional [[dyspnea]]  <br> ❑ Exertional [[angina]] <br> ❑ [[HF]] symptoms
 |}
-AVA: Aortic valve area;  LV: Left ventricle
+AR indicates aortic regurgitation; ERO, effective regurgitant orifice; HF, heart failure; IE, infective endocarditis; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; LVOT, left ventricular outflow tract; RF, regurgitant fraction; and RVol, regurgitant volume.
 ==References==

Aortic insufficiency stages: Difference between revisions

Revision as of 18:47, 5 March 2014

Overview

Stages [1]

References

Navigation menu

Stages ^[1]