aortic stenosis    

History

- survival เป็นอย่างไรเมื่อมีอาการต่อไปนี้

 

survival เป็นอย่างไรเมื่อมีอาการต่อไปนี้

physical examination

- physical examination of AS

 

physical examination of AS

classification

- etiology

 

 

etiology of AS

- valvular AS

- subvalvular AS

- supravalvular AS

pathogenesis

- pathogenesis of AS

- pathogenesis of true severe AS

- pathogenesis of pseudosevere AS

 

 

pathogenesis of AS

   

pathogenesis of true severe AS

   

pathogenesis of pseudosevere AS

investigation

- preop CAG

- CT coronary angiography

- echocardiography

- exercise stress test

- low-dose dobutamine stress test

** low-dose dobutamine stress test indication

** ทำไมต้องทำ low-dose dobutamine stress test

** low dose dobutamine stress test ทำอย่างไร

** การแปลผล dobutamine stress test

** กลุ่ม lack of contractile reserve คือ

   

preop CAG

- indication preop CAG

 

 

indication preop CAG >> cardiac catheterization

CT angiography

- indication CT coronary angiography

  indication CT coronary angiography

echocardigraphy

- severity classification by AHA

- severity classification (mild / moderate / severe)

- type of severe AS

- low gradient definition

- low gradient DDx

- severity classification by AHA

- severity classification (mild / moderate / severe)

- parameter of aortic stenosis

- type of severe AS

- low gradient definition

- low gradient DDx

severity classification by AHA

- A = at risk of AS

- B = progressive AS

- C1 = asymptomatic severe AS

- C2 = asymptomatic severe AS with LV dysfunction

- D1 = symptomatic severe AS with high gradient AS

- D2 = symptomatic severe AS with classification LFLG

- D3 = symptoamtic severe AS with paradoxical LFLG

 

severity classification (mild / moderate / severe)

- aortic valve area

- mean pressure gradient

- aortic jet velocity

 

parameter of aortic stenosis

- LVEF

- aortic V max

- mean pressure gradient

- aortic valve area

- aortic valve area index

- stroke volume index

 

type of severe AS

- high gradient severe AS

- low gradient severe AS

high gradient severe AS

- definition of high gradient severe AS

 

definition of high gradient severe AS

- low flow high gradient severe AS

low gradient severe AS

- definition of low gradient severe AS

- low gradient DDx

 

definition of low gradient severe AS

- low flow low gradient severe AS (classical LFLG AS)

- low flow low gradient severe AS with LVEF > 50% (paradoxical LFLG AS)

- normal flow low gradient severe AS (NFLG AS)

   

low gradient DDx

- severe AS with LV dysfunction

- severe AS with normal LV function with small LV chamber

- pseudostenosis (moderate AS with myocardial disease)

exercise stress test

- indication exercise stress test

- การแปลผล exercise stress test

 

indication exercise stress test

- asymtomatic severe AS

   

การแปลผล exercise stress test

low-dose dobutamine stress test

- low-dose dobutamine stress test indication

- ทำไมต้องทำ low-dose dobutamine stress test

- low dose dobutamine stress test ทำอย่างไร

- การแปลผล dobutamine stress test

- กลุ่ม lack of contractile reserve คือ

 

 

low-dose dobutamine stress test indication

   

ทำไมต้องทำ low-dose dobutamine stress test

- การทำ sx ใน pseudostenosis สัมพันธ์กับการเกิด high mortality

    low dose dobutamine stress test ทำอย่างไร
    การแปลผล dobutamine stress test
    กลุ่ม lack of contractile reserve คืออะไร

Treatment

- medication

- surgery

- TAVR

- balloon dilatation

   

medication

- medication รักษาอะไรบ้าง

 

medication รักษาอะไรบ้าง

surgery

- indication surgery by recommedation grading AHA

- indication surgery

- indication surgery in symptomatic severeAS

- indication surgery in asymptomatic severe AS

- indication surgery in asymptomatic moderate AS

- indication open AVR

 

indication surgery by recommedation grading AHA

- class I

** symptomatic severe AS

** asymptomatic severe AS with other cardiac surgery or LVEF < 50%

- class IIa

** symptomatic severe AS

** asymptomatic severe AS

- class IIb

** asymptomatic severe AS

 

 

indication surgery

- severe AS

** symptomatic AS with absence of comorbidity

** asymptomatic severe AS

LVEF < 50%

LVEF > 50%

- positive exercise stress test

- presence of risk factor

- other cardiac surgery

- V masx > 5 m/s or dP > 60 mmHg

- d Ao velocity rise 0.3 m/s/yr

- moderate AS

** symptomatic moderate AS

LVEF > 50% with AVA < 1 cm2

LVEF < 50% with AVA < 1 cm2 post DSE with Vmax > 4 m/s

 

asymptomatic moderate AS with other cardiac surgery

   

indication surgery in symptomatic severeAS

- high flow high gradient severe AS

- low flow low gradient severe AS

   

indication surgery in asymptomatic severe AS

   

indication surgery in asymptomatic moderate AS

   

indication open AVR

TAVR

- indication TAVR

 

indication TAVR

- indication AVR with high risk sx

- indication AVR with predicted post TAVR survival > 12 mo

balloon dilatation

- indication balloon dilatation

 

indication balloon dilatation

- severe AS with bridge to AVR

- severe AS with refractory pulmonary edema or cardiogenic shock

complication

- complication of balloon dilatation

 

complication of balloon dilatation

follow up

- follow up อย่างไร

- การ f/u AS ว่าบ่อยแค่ไหน เมื่อแบ่งตาม severity

   
   

follow up อย่างไร

- asymptomatic severe AS >> f/u q 6 mo

- significant calcification, mild and moderate AS >> f/u q 1 yr

- mild AS with no calcification >> f/u q 1 yr

   

การ f/u AS ว่าบ่อยแค่ไหน เมื่อแบ่งตาม severity

- v max > 4 m/s >> f/u q 6 mo-1 yr

- v max 3-3.9 m/s >> f/u q 1-2 yr

- v max 2-2.9 m/s >> f/u q 3-5 yr