简介:Inprimarymitralregurgitationthereareanatomicabnormalitiesofthemitralvalvecausingbackwardflow,placingahemodynamicburdenontheleftventricle.Ifthisburdenissevereandprolonged,itleadstoleftventriculardamage,heartfailure,anddeath.Thepreferredtherapyisrestorationofmitralcompetencethroughmitralvalverepair,whichissaferthanmitralvalvereplacement.Whenrepairisperformedinatimelyfashion,lifespancanbereturnedtothatofanormalindividual.Triggersfortimelyrepairincludetheonsetofsymptomsandevidenceofleftventriculardysfunctionasdeterminedbyejectionfractionfallingtoward60%and/orend-systolicdimensionincreasingtoward40mm.
简介:Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.