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Related Concept Videos

Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention.

Fernanda Castiglioni Tessari1, Maria Antonieta Albanez A de M Lopes1,2, Carlos M Campos1,3

  • 1Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.

Frontiers in Cardiovascular Medicine
|June 28, 2023
PubMed
Summary

In patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing surgical aortic valve replacement (SAVR), a mean transaortic gradient of 25 mmHg or less is the primary predictor of mortality. Left ventricular flow reserve does not impact long-term outcomes.

Keywords:
aortic stenosiscardiac magnetic resonanceechocardiographyrisk predictionvalve surgery

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography
  • Cardiac Magnetic Resonance Imaging

Background:

  • Classical low-flow, low-gradient aortic stenosis (LFLG-AS) presents a poor prognosis and high mortality risk with current treatments.
  • There is a need for reliable risk assessment tools for LFLG-AS patients undergoing surgical aortic valve replacement (SAVR).

Purpose of the Study:

  • To identify mortality predictors in patients with classical LFLG-AS undergoing SAVR.
  • To evaluate the prognostic value of mean transaortic gradient and flow reserve in this patient population.

Main Methods:

  • Prospective study of 41 LFLG-AS patients undergoing SAVR.
  • Utilized dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR).
  • Excluded patients with pseudo-severe aortic stenosis; analyzed mortality rates at 30 days and 1 year.

Main Results:

  • The mean transaortic gradient was the sole independent predictor of mortality (HR: 0.923, p=0.019).
  • A mean transaortic gradient ≤25 mmHg was associated with significantly higher all-cause mortality (log-rank p=0.038).
  • Left ventricular flow reserve (FR) status did not show a significant difference in mortality (log-rank p=0.114).

Conclusions:

  • The mean transaortic gradient is a critical independent predictor of mortality in LFLG-AS patients undergoing SAVR.
  • A mean transaortic gradient ≤25 mmHg identifies a high-risk subgroup requiring closer monitoring or alternative treatment strategies.
  • Left ventricular flow reserve is not a reliable prognostic indicator for long-term outcomes in this cohort.