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Assessment |
· History · Examination · Non-invasive investigations: ECG, TTE, CXR · Semi-invasive investigations: CT, MRI · Invasive investigations: TOE, catheter · MDT for every patient needing surgery |
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Severity |
· Grades A, B, C, D o Symptoms o Valve anatomy o Valve dysfunction o Ventricular dysfunction o Upstream complications § LV -> PHTN § RV -> kidney, liver |
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Anticoagulation |
· Non-valvular AF: o If CHADSVASC ≥2: warfarin or NOAC o If HASBLED score high: consider withholding · Valvular AF: warfarin · Metal mitral valve: warfarin INR 2.5-3.5 · Metal aortic valve: warfarin INR 2-3 |
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Valve disease |
· Aims: o Prevent irreversible damage to ventricles o Prevent pulmonary hypertension o Prevent irreversible damage to organs o Repair vs replacement · Aortic stenosis: o Symptoms o Exercise-induced hypotension o LV systolic dysfunction (TTE, BNP) o Very severe stenosis · Regurgitant valves: o Symptoms o LV dilation or dysfunction o If secondary to ventricular dysfunction: treat that first · Miscellaneous o Mixed valve disease: attend to the worst lesion o Better treatments = lower threshold o i.e. expanding indications for percutaneous treatment |
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Infective endocarditis |
· Blood cultures then antibiotics · TTE ±TOE · Multi-disciplinary team: surgeon + cardiologist + ID · Early surgery if o Heart failure o Certain pathogens o Recurrent emboli or big vegetation · Delay surgery >4/52 if o Terrible stroke |
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Pregnancy |
· If severe MS or AS: o TAVR pre-conception is ideal o TAVR during pregnancy is possible · If needing anticoagulation: LMWH with Xa levels |
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