Aortic insufficiency stages: Difference between revisions
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| style="background: #4479BA; color: #F8F8FF"|A | | style="background: #4479BA; color: #F8F8FF"|'''A''' | ||
| At risk of [[AR]] | | At risk of [[AR]] | ||
| • Bicuspid valve <br> • Valve [[sclerosis]] <br> • History of [[rheumatic fever]] <br> • [[Infective endocarditis]] | | • Bicuspid valve <br> • Valve [[sclerosis]] <br> • History of [[rheumatic fever]] <br> • [[Infective endocarditis]] | ||
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|- | |- | ||
| style="background: #4479BA; color: #F8F8FF"|B | | style="background: #4479BA; color: #F8F8FF"|'''B''' | ||
| Progressive [[AR]] | | Progressive [[AR]] | ||
| • Mild-to-moderate calcification <br> • Rheumatic valve changes <br> • Dilatation of aortic sinuses <br> • [[Infective endocarditis]] | | • Mild-to-moderate calcification <br> • Rheumatic valve changes <br> • Dilatation of aortic sinuses <br> • [[Infective endocarditis]] | ||
| • Mild | | • '''Mild''': | ||
: • Jet/LVOT <25% | : • Jet/LVOT <25% | ||
: • [[Vena contracta]] <0.3 cm | : • [[Vena contracta]] <0.3 cm | ||
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: • Effective regurgitant orifice <0.10 cm² | : • Effective regurgitant orifice <0.10 cm² | ||
: • [[Aortography|Angiography]] grade 1+ | : • [[Aortography|Angiography]] grade 1+ | ||
<br> • Moderate | <br> • '''Moderate''': | ||
: • Jet/LVOT: 25%–64% | : • Jet/LVOT: 25%–64% | ||
: • [[Vena contracta]] 0.3–0.6 cm | : • [[Vena contracta]] 0.3–0.6 cm | ||
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| style="background: #4479BA; color: #F8F8FF"|C | | style="background: #4479BA; color: #F8F8FF"|'''C''' | ||
| Asymptomatic severe | | Asymptomatic severe | ||
| • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Bicuspid valve <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | | • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Bicuspid valve <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | ||
| • Severe | | • Severe | ||
: • Jet/LVOT ≥65% | : • Jet/LVOT ≥65% | ||
: • [[Vena contracta]] >0.6 cm; | : • [[Vena contracta]] >0.6 cm; | ||
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: • Effective regurgitant orifice ≥0.3 cm2; | : • Effective regurgitant orifice ≥0.3 cm2; | ||
: • [[Aortography|Angiography]] grade 3+ to 4+; | : • [[Aortography|Angiography]] grade 3+ to 4+; | ||
| • C1: Normal [[LVEF]] and mild to moderate LV dilatation <br> <br> | | • '''C1:''' Normal [[LVEF]] and mild to moderate LV dilatation <br> <br> | ||
---- | ---- | ||
• C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation | • '''C2:''' abnormal LV systolic function with decreased LVEF or severe LV dilatation | ||
| • None <br> • Exercise testing to confirm symptom status | | • None <br> • Exercise testing to confirm symptom status | ||
|- | |- | ||
| style="background: #4479BA; color: #F8F8FF"|D | | style="background: #4479BA; color: #F8F8FF"|'''D''' | ||
| Symptomatic severe [[AR]] | | Symptomatic severe [[AR]] | ||
| • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | | • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | ||
| | • Severe | | | • Severe | ||
: • Jet/LVOT ≥65% | : • Jet/LVOT ≥65% | ||
: • [[Vena contracta]] >0.6 cm; | : • [[Vena contracta]] >0.6 cm; | ||
Revision as of 20:06, 9 April 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, hemodynamics and the patients symptoms.
Stages
Shown below is a table summarizing the stages of aortic regurgitation (AR) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease. [1]
Abbreviations: AR: aortic regurgitation; 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; Jet/LVOT : jet width and LVOT ratio
| 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 • Dilatation of aortic sinuses • Infective endocarditis |
• Mild:
|
• Normal LV systolic function • Normal LV volume or mild LV dilation |
• None |
| C | Asymptomatic severe | • Calcific aortic valve disease • Rheumatic valve changes • Bicuspid valve • Dilated aortic sinuses • Infective endocarditis with abnormal leaflet closure |
• Severe
|
• 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
|
• May occur with normal systolic function or decreased function • Presence of moderate to severe LV dilatation |
• Exertional dyspnea • Exertional angina • HF symptoms
|
References
- ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.