Investigation of aortic regurgitation by surgical therapy, Biology

Assignment Help:

Q. Investigation of aortic regurgitation by Surgical Therapy?

The recommendation for Aortic valve replacement is only for those patients with Severe AR. If patients with mild AR have LV dilatation, dysfunction and symptoms-other causes need to be evaluated and ruled out. If there is uncertainty about the severity of AR-it needs to confirmed with angiographic or any other modality.

In patients with Severe AR with good LV function and symptoms of NYHA Class III-IV or angina Canadian class II or more, surgery is indicated. In patients with NYHA Class II dyspnoea exercise testing is useful. If onset of dyspnoea is recent or patient's LV size and LV
function reach threshold values, i.e., LVEF < 50 per cent or LVEDD about 75 mm or LVESD about 55 mm - surgery is indicated.

AVR is indicated in all symptomatic patients NYHA Class II, III, IV and systolic dysfunction with EF 25 - 49 per cent. In patients with EF < 25 per cent and LVESD more than 60 mm surgery carries high risk. LV dysfunction may be irreversible and post operative morbidity is high. Patients with LV dysfunction do well if the duration of LV dysfunction is short or show improvement with intense vasodilatation, inotropic or diuretic therapy. Clinical judgement should be based on the fact that medical management alone carries very high mortality.

In patients with severe AR and no symptoms, LVEF < 50 per cent, LVEDD > 75 mm or LVESD > 55 mm are indications for surgery. Two consecutive measurements may be obtained in short duration before proceeding with surgery or findings may be confirmed in these asymptomatic patients, by 2 different modalities. AVR is also indicated in patients approaching these LV dimension if they have progressive increase in LV size or any evidence of decreasing exercise tolerance. These dimensions should be tailored to patient's body size but no guidelines are available. Patients with concomitant CAD, Hypertension or other valve disease are also likely to be more symptomatic even with smaller LV size.

Indications for surgery should not be based on the operative techniques used. When aortic root dilatation is equal to or more than 50 mm root reconstruction should accompany aortic valve replacement.

Severity of pre-operative symptoms or reduced exercise tolerance, severity of left ventricular systolic dysfunction and duration of LV dysfunction-all predict post-operative survival and recovery of LV systolic function.


Related Discussions:- Investigation of aortic regurgitation by surgical therapy

Chemiosmosis, Chemiosmosis is the process by which the ATP is produced in ...

Chemiosmosis is the process by which the ATP is produced in inner membrane of a mitochondrion. It is the electron transport system transfers protons from the inner compartment to

Gametes, examples of gametes

examples of gametes

Explain how a human eye is working for the body, Explain how a human eye is...

Explain how a human eye is working for the body. Every tissue in the body requires basic components which are either derived from the body itself or we acquire them from extern

Embryology, what is the fertilization?

what is the fertilization?

Define chlorophyll - natural colourant, Chlorophyll Chlorophyll is the...

Chlorophyll Chlorophyll is the porphyrin most widely used as a natural colourant. Its widespread occurrence in photosynthetic  tissue and its breakdown character have prompted

Hearing equilibrium, EQUILIBRIU M - Cristae and maculae are concerned ...

EQUILIBRIU M - Cristae and maculae are concerned with equilibrium. 1 .       DYNAMIC EQUILIBRIUM - Cristare detect turning or rotational movement of head ( angular ac

Explain about the biuret method, Explain about the Biuret Method? The B...

Explain about the Biuret Method? The Biuret reaction was one of first colorimetric assays developed for protein estimation. It is most often used in applications requiring a fa

Locomotion in amoeba, Locomotion Continuous formation of new  pseudopod...

Locomotion Continuous formation of new  pseudopodia keeps amoeba in constant locomotion .This is called  amoeboid  movement .It  occurs  in many  other  protozoans , in  amoebo

Define role in glucose, Define Role in Glucose, Lipid and Nucleic Acid Meta...

Define Role in Glucose, Lipid and Nucleic Acid Metabolism? Chromium leads to a decrease in blood glucose concentration in people with elevated glucose levels and an increase in

What are enzyme cofactors, What are enzyme cofactors? Some enzymes requ...

What are enzyme cofactors? Some enzymes require other associated molecules to work. These molecules are known as enzyme cofactors and they can be, for example, organic ions lik

Write Your Message!

Captcha
Free Assignment Quote

Assured A++ Grade

Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!

All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd