Valvular Disorders - Surgical mgt, Percutaneous balloon valvuloplasty
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The technique most commonly performed in the United
States, beneficial for mitral valve stenosis in younger patients and for
patients with complex
medical conditions that place them at high risk for complications of more
extensive
surgical procedures.
,Valvular Disorders - Surgical mgt, Open Commissurotomy
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○ performed with direct visualization of the valve
○ patient is under general anesthesia
Valvular Disorders - Medical mgt, Aortic Regurgitation
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○ symptomatic patient, or patients with decreased left ventricular function,
is advised to avoid
physical exertion, competitive sports, and isometric exercise
■ should be instructed to restrict sodium intake to avoid volume overload
3
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lOMoARcPSD|13414357
○ Patients with aortic regurgitation and hypertension should be treated
with dihydropyridine
calcium channel blockers (felodipine [Plendil], nifedipine [Adalat,
Procardia]) or ACE inhibitors
(captopril, enalapril, lisinopril, ramipril) to provide afterload reduction
■ calcium channel blockers diltiazem (Cardizem) and verapamil (Calan,
Isoptin) are
contraindicated as they decrease ventricular contractility and may cause
bradycardia
○ treatment of choice is aortic valve replacement or valvuloplasty,
preferably performed before left
ventricular failure occurs
○ Surgery is recommended for any patient with left ventricular dilation,
regardless of the presence
or absence of symptoms and any patient who is symptomatic
, Cardiomyopathy -Assessment, basline vitals
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■ Vital signs
■ Calculation of pulse pressure and identification of pulsus paradoxus
■ Current weight and any weight gain or loss
■ Detection by palpation of the point of maximal impulse, often shifted to
the left
■ Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds
■ Pulmonary auscultation for crackles
■ Measurement of jugular vein distention
■ Assessment of edema and its severity
Valvular Disorders - Surgical mgt, Chordoplasty
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○ is the repair of chordae tendineae
○ mitral valve is most often involved
○ Stretched, torn, or shortened chordae tendineae may cause regurgitation
■ Stretched chordae tendineae can be shortened, transposed to the other
leaflet, or
replaced with synthetic chordae
■ Torn chordae can be reattached to the leaflet
■ shortened chordae can be elongated
■ Stretched papillary muscles, may cause regurgitation, can be shortened
or relocated
Mitral Valve Prolapse
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Give this one a try later!
The technique most commonly performed in the United
States, beneficial for mitral valve stenosis in younger patients and for
patients with complex
medical conditions that place them at high risk for complications of more
extensive
surgical procedures.
,Valvular Disorders - Surgical mgt, Open Commissurotomy
Give this one a try later!
○ performed with direct visualization of the valve
○ patient is under general anesthesia
Valvular Disorders - Medical mgt, Aortic Regurgitation
Give this one a try later!
○ symptomatic patient, or patients with decreased left ventricular function,
is advised to avoid
physical exertion, competitive sports, and isometric exercise
■ should be instructed to restrict sodium intake to avoid volume overload
3
Downloaded by Sandy Newman ()
lOMoARcPSD|13414357
○ Patients with aortic regurgitation and hypertension should be treated
with dihydropyridine
calcium channel blockers (felodipine [Plendil], nifedipine [Adalat,
Procardia]) or ACE inhibitors
(captopril, enalapril, lisinopril, ramipril) to provide afterload reduction
■ calcium channel blockers diltiazem (Cardizem) and verapamil (Calan,
Isoptin) are
contraindicated as they decrease ventricular contractility and may cause
bradycardia
○ treatment of choice is aortic valve replacement or valvuloplasty,
preferably performed before left
ventricular failure occurs
○ Surgery is recommended for any patient with left ventricular dilation,
regardless of the presence
or absence of symptoms and any patient who is symptomatic
, Cardiomyopathy -Assessment, basline vitals
Give this one a try later!
■ Vital signs
■ Calculation of pulse pressure and identification of pulsus paradoxus
■ Current weight and any weight gain or loss
■ Detection by palpation of the point of maximal impulse, often shifted to
the left
■ Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds
■ Pulmonary auscultation for crackles
■ Measurement of jugular vein distention
■ Assessment of edema and its severity
Valvular Disorders - Surgical mgt, Chordoplasty
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○ is the repair of chordae tendineae
○ mitral valve is most often involved
○ Stretched, torn, or shortened chordae tendineae may cause regurgitation
■ Stretched chordae tendineae can be shortened, transposed to the other
leaflet, or
replaced with synthetic chordae
■ Torn chordae can be reattached to the leaflet
■ shortened chordae can be elongated
■ Stretched papillary muscles, may cause regurgitation, can be shortened
or relocated
Mitral Valve Prolapse
Give this one a try later!
