Indications for surgery in patients with severe MR include which of the following?
a. Asymptomatic patients without prior history of CHF
b. LV EF_60%
c. LV end-diastolic diameter _30mm
d. LV end-systolic diameter _30mm
Answer b:
Class III or IV symptoms, transient heart failure, or LV dysfunction should lead to prompt consideration of surgery. Severe LV enlargement appears associated with the occurrence of sudden death and does not preclude an excellent postoperative result and therefore is a widely accepted indication of surgery.
According to the 2006 ACC/AHA guidelines, patients with symptomatic (NYHA classes II–IV) chronic severe MR should be considered for surgery even in the absence of
severe LV dysfunction (EF_30% or end-systolic dimension _55 mm). Asymptomatic patients should be considered for surgery if the EF is _60%, the end systolic diameter is _45 mm, or there is pulmonary HTN (defined as a PA systolic pressure _50 mmHg at rest or _60 mmHg with exercise), or new onset AF.
In those patients who are asymptomatic with preserved LV systolic function (EF_60%) and an end systolic diameter _40 mm, surgery should not be routinely considered unless a high likelihood of valve repair is present.
a. Asymptomatic patients without prior history of CHF
b. LV EF_60%
c. LV end-diastolic diameter _30mm
d. LV end-systolic diameter _30mm
Answer b:
Class III or IV symptoms, transient heart failure, or LV dysfunction should lead to prompt consideration of surgery. Severe LV enlargement appears associated with the occurrence of sudden death and does not preclude an excellent postoperative result and therefore is a widely accepted indication of surgery.
According to the 2006 ACC/AHA guidelines, patients with symptomatic (NYHA classes II–IV) chronic severe MR should be considered for surgery even in the absence of
severe LV dysfunction (EF_30% or end-systolic dimension _55 mm). Asymptomatic patients should be considered for surgery if the EF is _60%, the end systolic diameter is _45 mm, or there is pulmonary HTN (defined as a PA systolic pressure _50 mmHg at rest or _60 mmHg with exercise), or new onset AF.
In those patients who are asymptomatic with preserved LV systolic function (EF_60%) and an end systolic diameter _40 mm, surgery should not be routinely considered unless a high likelihood of valve repair is present.
