Cardiac Valve Surgery Indications

Aortic Stenosis:

Radiation can cause.

Symptoms: Syncope, CHF or chest pain.

Signs: Pulsus Tordus. [Tip to remember: Pulsus TordAS].

Crescendo-Decrescendo murmur radiating to the Carotids.

Slow carotid upstroke [Brisk Carotid Upstroke in HOCM].

S2 can have Paradoxical Split or S4 can happen if severe AS.

Surgery: EF less than 50%, 40mm Gradient, Jet speed 4ms, 1cm2.

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Aortic Regurgitation:

Do valve surgery if LV is enlarged: End Systolic Dimension is more than 50mm or if End Diastolic Dimension is more than 65mm.

If LV is less than 40mm in End Systolic Dimension or if less than 60mm in End Diastolic Dimension, we can follow up with ECHO in 6-12months.

Surgery: End systolic size more than 50mm, End Diastolic size more than 65mm or if AR plus EF less than 50% plus symptoms.

Follow up with ECHO in 6-12months if LV End systolic size 40mm-End diastolic size 60mm.

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Mitral Stenosis:

Rheumatic fever can cause.

Symptoms: Hemoptysis.

Signs: Loud S1, Opening Snap, Mid Diastolic Murmur, Left heart boarder straightening.

Surgery: When valve area is less than 1.5cm2.

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Mitral Regurgitation:

Surgery: If EF less than 60% or Pulmonary HTN, AFib or other symptoms.

Do you know size of LV beyond which surgery is required for MR?.

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Valve DiseaseIndication for surgery
Aortic StenosisEF <50%, 40mm Gradient, Jet speed 4ms, 1cm2.
Aortic RegurgitationEnd systolic size more than 50mm, End Diastolic size more than 65mm or if AR plus EF less than 50% plus symptoms.
Mitral Stenosis When valve area is less than 1.5cm2
Mitral Regurgitation If EF < 60% or Pulmonary HTN, AFib or other symptoms
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