心脏瓣膜病主动脉瓣返流

ContinuingMedicalImplementation bridgingthecaregap ValvularHeartDiseaseAorticRegurgitation ContinuingMedicalImplementation bridgingthecaregap AorticRegurgitation EtiologyPhysicalExaminationAssessingSeverityNaturalHistoryPrognosisTimingofSurgery ContinuingMedicalImplementation bridgingthecaregap AorticRegurgitation Etiology AnyconditionsresultinginincompetentaorticleafletsCongenitalBicuspidvalveAortopathyCysticmedialnecrosisCollagendisorders e g Marfan s Ehler DanlosOsteogenesisimperfectaPseudoxanthomaelasticum AcquiredRheumaticheartdiseaseDilatedaorta e g hypertension DegenerativeConnectivetissuedisordersE g ankylosingspondylitis rheumatoidarthritis Reiter ssyndrome Giant cellarteritis Syphilis chronicaortitis AcuteAI aorticdissection infectiveendocarditis trauma ContinuingMedicalImplementation bridgingthecaregap AorticRegurgitation Symptoms Dyspnea orthopnea PNDChestpain Nocturnalangina exertionalangina diastolicaorticpressureandincreasedLVEDPthus coronaryarterydiastolicflow Withextremereductionsindiastolicpressures e g 40 mayseeangina ContinuingMedicalImplementation bridgingthecaregap PeripheralSignsofSevereAorticRegurgitation Quincke ssign capillarypulsationCorrigan ssign waterhammerpulseBisferienspulse AS AR AR DeMusset ssign systolicheadbobbingMueller ssign systolicpulsationofuvula Durosier ssign femoralretrogradebruitsTraube ssign pistolshotfemoralsHill ssign BPLowerextremity BPUpperextremityby 20mmHg mildAR 40mmHg modAR 60mmHg severeAR ContinuingMedicalImplementation bridgingthecaregap AorticRegurgitation PhysicalExam WidenedpulsepressureSystolic diastolic pulsepressureHighpitched blowing decrescendodiastolicmurmuratLSBBestheardatend expiration leaningforwardHands Kneeposition S1S2S1 ContinuingMedicalImplementation bridgingthecaregap CentralSignsofSevereAorticRegurgitation Apex EnlargedDisplacedHyper dynamicPalpableS3Austin Flintmurmur Aorticdiastolicmurmurlengthcorrelateswithseverity chronicAR inacuteARmurmurshortensasAorticDP LVEDPinacuteAR mitralpre closure ContinuingMedicalImplementation bridgingthecaregap AssessingSeverityofAR AssessseveritybyimpactonperipheralsignsandLV peripheralsigns severity LV severityS3Austin FlintLVHradiologicalcardiomegaly ContinuingMedicalImplementation bridgingthecaregap AorticRegurgitation NaturalHistory Asymptomatic YNormalLVfunction goodprognosis ProgressiontosymptomsorLVdysfunction10 BonowRO etal JACC 1998 32 1486 TX Medical SurgeryBEFORELVdysfunction ContinuingMedicalImplementation bridgingthecaregap EchoIndicationsforValveReplacementinAsymptomaticAR MR ContinuingMedicalImplementation bridgingthecaregap IndicationforValveReplacementinAorticRegurgitation ACC AHAClassISymptomaticpatientswithpreservedLVF LVEF 50 AsymptomaticpatientswithmildtomoderateLVdysfunction EF25 49 PatientsundergoingCABG aorticorothervalvularsurgeryACC AHAClassIIaAsymptomaticpatientswithpreservedLVEFbutsevereLVdilatation EDD 75mmorESD 55mm ContinuingMedicalImplementation bridgingthecaregap IndicationforValveReplacementinAorticRegurgitation ACC AHAClassIIbPatientswithsevereLVdysfunction EF0 50 andprogressiveLVdilata tionwhenthedegreeofdilatationismoderatelysevere EDD70