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
echocardigraphy
- severity classification by AHA
- severity classification (mild / moderate / severe)
- low gradient definition
- low gradient DDx
- severity classification by AHA
- severity classification (mild / moderate / severe)
- parameter of aortic stenosis
- 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
- definition of high gradient severe AS
definition of high gradient severe AS
- low flow high 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
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
