Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular

Size: px
Start display at page:

Download "Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular"

Transcription

1 Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular

2 Mitral Regurgitation Anatomy Mechanisms of MR Presentation Evaluation Management Repair Replace Clip

3 Mitral Valve Anatomy Otto, NEJM 2001

4 Mechanisms of MR Primary MR Mitral annular disorders Mitral leaflet disorders Chordae tendinae dysfunction Papillary muscle dysfunction Secondary MR Valve is often normal LV dysfunction

5 Mechanisms of MR (ischemic) ASE Comprehensive Echocardiography 2016

6 Presentation Related to severity and rate of progression Gradual limitation of daily activities Exertional dyspnea / fatigue Decreased cardiac output Left ventricular failure Pulmonary hypertension Atrial fibrillation

7 Presentation AHA/ACC 2014 Valvular Heart Disease Guidelines

8 Evaluation Related to severity and rate of progression Exam: holosystolic murmur at the apex EKG: left atrial enlargement, possible RVH CXR: cardiomegaly Echo: essential Etiology and severity Start with TTE / consider TEE later

9 Severity of MR Trace, mild, moderate, severe Amount of back-flow (regurgitant volume) Mild MR Severe MR

10 Follow-up Mild MR: TTE every 3-5 years Unless symptoms change Moderate MR: TTE every 1-2 years. Severe MR: TTE every 6-12 months Dilating LV = more frequently.

11 When should we be involved? Symptomatic. Moderate or greater? Clinically unclear. Comfort.

12 Medical management of MR Primary MR: Surgery Secondary MR: Guideline-directed treatment for heart failure ACEi/ARB, beta blocker, aldosterone antagonist Resynchronization therapy Surgery

13 Surgical management of MR Once symptoms have occurred, the patient should be considered for mitral valve operation. Once the MR is severe, the patient should be considered for mitral valve operation.

14 Surgical Management of MR What about asymptomatic severe MR? Watchful waiting Early surgery

15 ACC/AHA Guidelines 2014: Primary MR MV surgery is recommended for symptomatic patients with chronic severe primary MR and LVEF >30% MV surgery is recommended for asymptomatic patients with chronic severe primary MR and LV dysfunction (LVEF 30 60% and/or LVESD >40mm) MV surgery is indicated in patients with chronic severe primary MR undergoing cardiac surgery for other reasons MV surgery is reasonable in asymptomatic patients with chronic severe primary MR with preserved LV function in whom the likelihood of success is >95% and mortality <1% MV surgery is reasonable in asymptomatic patients with chronic severe primary MR with preserved LV function with new AF or resting pulmonary HTN (PASP >50) MV surgery may be considered in symptomatic patients with chronic severe primary MR and LVEF <30% Transcatheter MV repair may be considered for severely symptomatic patients (NYHA III/IV) who have reasonable life expectancy but prohibitive surgical risk I I I IIa IIa IIb IIb B B B B B B B

16 ACC/AHA Guidelines 2014: Secondary MR MV surgery is reasonable for patients with chronic severe secondary MR who are undergoing CABG or AVR IIa C MV surgery may be considered for severely symptomatic patients (NYHA III/IV) with chronic severe secondary MR MV repair may be considered for patients with chronic moderate secondary MR who are undergoing other cardiac surgery IIb IIb B C

17 Surgery: Mitral Repair The preferred option. Benefits: Preserves functional components of native valve Avoids use of prosthetic valve, associated complications Repair vs replacement depends on anatomic cause of MR

18 Drake, NEJM 2014

19 Surgery: Mitral Repair Easiest to repair: Ruptured cord to posterior leaflet Pure mitral annular dilation Small perforation Hardest to repair: Ruptured cord to both leaflets Severe prolapse of both leaflets Extensive annular calcification (UC Irvine)

20 Surgery: Mitral Repair Predictors of Unsuccessful Repair: Severe annular calcium Extensive disease ( 3 segments) Annular dilation >50mm Scarcity of tissue in the leaflets

21 Surgery: Mitral Replacement Mechanical vs bioprosthetic? Bioprosthetic if pt cannot take warfarin Bioprosthetic if age >65 Mechanical if age <65 with longstanding atrial fibrillation Bioprosthetic if <65 in NSR after detailed discussion of anticoagulation vs need for redo (St Jude, Medtronic)

22 Transcatheter Repair (MitraClip) Cobalt/chromium clip that binds mitral leaflets Approved for pts with severe primary MR Indications: Severe symptomatic HF despite medical treatment Chronic severe primary MR Favorable anatomy Reasonable life expectancy Prohibitive surgical risk (Abbott)

23 Transcatheter Repair (MitraClip) Cobalt/chromium clip that binds mitral leaflets Approved for pts with severe primary MR Contraindications: Intolerance of anticoagulation / antiplatelet therapy Active endocarditis Rheumatic valve disease Intracardiac thrombus (Abbott)

24 Transcatheter Repair (MitraClip) NEJM 2011

25 Transcatheter Repair (MitraClip)

26 Summary Follow patient s symptoms. Follow the patient s echo. Multiple treatment options. Earlier is probably better.

Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. Michael Acker, MD For the CTSN Investigators AHA November 2013

Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. Michael Acker, MD For the CTSN Investigators AHA November 2013 Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation Michael Acker, MD For the CTSN Investigators AHA November 2013 Acknowledgements Supported by U01 HL088942 Cardiothoracic

More information

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease Developed in Collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, Society

More information

Atrial Fibrillation The Basics

Atrial Fibrillation The Basics Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation

More information

Mitral valve repair current Status and the modern Sternotomy

Mitral valve repair current Status and the modern Sternotomy Mitral valve repair current Status and the modern Sternotomy David L Saint MD, FACS Tallahassee Memorial Hospital Clinical Assistant Professor Florida State University School of Medicine History of Mitral

More information

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation. DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart

More information

5. Management of rheumatic heart disease

5. Management of rheumatic heart disease 5. Management of rheumatic heart disease The fundamental goal in the long-term management of RHD is to prevent ARF recurrences, and therefore, prevent the progression of RHD, and in many cases allow for

More information

Press conference: Rheumatic Heart Disease a forgotten but devastating disease

Press conference: Rheumatic Heart Disease a forgotten but devastating disease www.worldcardiocongress.org Chairpersons: Bongani M. Mayosi Jonathan Carapetis Press conference: Rheumatic Heart Disease a forgotten but devastating disease www.worldcardiocongress.org www.worldcardiocongress.org

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

Updated Cardiac Resynchronization Therapy Guidelines

Updated Cardiac Resynchronization Therapy Guidelines The Ohio State University Heart and Vascular Center Updated Cardiac Resynchronization Therapy Guidelines William T. Abraham, MD, FACP, FACC, FAHA, FESC Professor of Medicine, Physiology, and Cell Biology

More information

How should we treat atrial fibrillation in heart failure

How should we treat atrial fibrillation in heart failure Advances in Cardiac Arrhhythmias and Great Innovations in Cardiology Torino, 23/24 Ottobre 2015 How should we treat atrial fibrillation in heart failure Matteo Anselmino Dipartimento Scienze Mediche Città

More information

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant

More information

Medical Policy Manual. Topic: Transcatheter Mitral Valve Repair Date of Origin: November 2015. Section: Surgery Last Reviewed Date: November 2015

Medical Policy Manual. Topic: Transcatheter Mitral Valve Repair Date of Origin: November 2015. Section: Surgery Last Reviewed Date: November 2015 Medical Policy Manual Topic: Transcatheter Mitral Valve Repair Date of Origin: November 2015 Section: Surgery Last Reviewed Date: November 2015 Policy No: 199 Effective Date: January 1, 2016 IMPORTANT

More information

Atrial Fibrillation Peter Santucci, MD Revised May, 2008

Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is

More information

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

More information

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013 Reference: NHS Commissioning Board Clinical Commissioning Policy Statement: Percutaneous

More information

HISTORY. Questions: 1. What diagnosis is suggested by this history? 2. How do you explain her symptoms during pregnancy?

HISTORY. Questions: 1. What diagnosis is suggested by this history? 2. How do you explain her symptoms during pregnancy? HISTORY 33-year-old woman. CHIEF COMPLAINT: months duration. Dyspnea, fatigue and nocturnal wheezing of six PRESENT ILLNESS: At ages 5 and 9, she had migratory arthritis. At age 29, in the third trimester

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

Transcatheter Mitral Valve Repair

Transcatheter Mitral Valve Repair MEDICAL POLICY POLICY RELATED POLICIES POLICY GUIDELINES DESCRIPTION SCOPE BENEFIT APPLICATION RATIONALE REFERENCES CODING APPENDIX HISTORY Transcatheter Mitral Valve Repair Number 2.02.30 Effective Date

More information

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,

More information

Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015

Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015 Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015 Disclaimer I have no relationships to disclose Do we have a cure for Atrial Fibrillation? The short

More information

Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations. Danny Dvir, MD On behalf of VIVID registry investigators

Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations. Danny Dvir, MD On behalf of VIVID registry investigators Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations Danny Dvir, MD On behalf of VIVID registry investigators Introduction Bioprosthetic valves are increasingly implanted in open-heart surgeries.

More information

Minimally Invasive Mitral Valve Surgery

Minimally Invasive Mitral Valve Surgery Minimally Invasive Mitral Valve Surgery Stanford Health Care offers leading, superior options in cardiac surgery, including the latest techniques and research for Minimally Invasive Cardiac surgery. Advanced

More information

Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease Keynote Lecture Series Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease Tirone E. David Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,

More information

Management of Atrial Fibrillation in Heart Failure

Management of Atrial Fibrillation in Heart Failure Disadvantages of AV Junction Ablation Persistent AFib- no AV synchrony Ongoing risk of thromboembolism Life-long dependency on pacemaker Comparison of LA Ablation vs. AVN Ablation LA Ablation AVN Ablation

More information

Palpitations & AF. Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust

Palpitations & AF. Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust Palpitations & AF Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust Palpitations Frequent symptom Less than 50% associated with arrhythmia

More information

Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of Post-Operative Mitral Annuloplasty Ring and Prosthetic Valve Dehiscence

Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of Post-Operative Mitral Annuloplasty Ring and Prosthetic Valve Dehiscence Journal of the American College of Cardiology Vol. 53, No. 17, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.12.059

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

TAVR: A New Treatment Option for Aortic Stenosis. Alexis Auger, MSN, NP-BC

TAVR: A New Treatment Option for Aortic Stenosis. Alexis Auger, MSN, NP-BC TAVR: A New Treatment Option for Aortic Stenosis Alexis Auger, MSN, NP-BC 22nd Annual Northeast Regional Nurse Practitioner Conference May 6-8, 2015 DISCLOSURES There has been no commercial support or

More information

ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014

ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014 ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014 Facts 4 million or so people have atrial fibrillation 16 billion dollars spent yearly in USA 30% of strokes attributable to AF and AFL 3-5

More information

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1

More information

The debate: Should all AF patients see an EP consultant?

The debate: Should all AF patients see an EP consultant? The debate: Should all AF patients see an EP consultant? Pre-debate show of hands in favour of the motion The argument for the motion: Dr Nick Kelland The argument against the motion: Dr Andy McCoye Discussion

More information

9/5/14. Objectives. Atrial Fibrillation (AF)

9/5/14. Objectives. Atrial Fibrillation (AF) Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three

More information

Management of the Patient with Aortic Stenosis undergoing Non-cardiac Surgery

Management of the Patient with Aortic Stenosis undergoing Non-cardiac Surgery Management of the Patient with Aortic Stenosis undergoing Non-cardiac Surgery Srinivasan Rajagopal M.D. Assistant Professor Division of Cardiothoracic Anesthesia Objectives Describe the pathophysiology

More information

Atrial Fibrillation Management Across the Spectrum of Illness

Atrial Fibrillation Management Across the Spectrum of Illness Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,

More information

Heart Failure Outpatient Clinical Pathway

Heart Failure Outpatient Clinical Pathway Heart Failure Outpatient Clinical Pathway PHASE 1: PHASE 2: PHASE 3: PHASE 4: Initial Consult and Treatment Optimization of Therapy Reassessment and Further Optimization Maintenance I. Provider II. Consults

More information

Atrial Fibrillation An update on diagnosis and management

Atrial Fibrillation An update on diagnosis and management Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.

More information

MitraClip. benefit in heart failure patients? No conflict of interest

MitraClip. benefit in heart failure patients? No conflict of interest MitraClip Magnus Settergren MD, PhD Unit for PCI/GUCH Department of Cardiology Karolinska University Hospital Stockholm, Sweden benefit in heart failure patients? No conflict of interest Burden of Valvular

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic

More information

Heart Sounds and Murmurs. Objectives. Valves. Wright, 2012 1

Heart Sounds and Murmurs. Objectives. Valves. Wright, 2012 1 Heart Sounds and Murmurs Wendy L. Wright, MS, RN, ARNP, FNP, FAANP Family Nurse Practitioner Owner Wright & Associates Family Healthcare Partner Partners in Healthcare Education 1 Objectives Upon completion

More information

on behalf of the AUGMENT-HF Investigators

on behalf of the AUGMENT-HF Investigators One Year Follow-Up Results from AUGMENT-HF: A Multicenter Randomized Controlled Clinical Trial of the Efficacy of Left Ventricular Augmentation with Algisyl-LVR in the Treatment of Heart Failure* Douglas

More information

Diagnostic and Therapeutic Procedures

Diagnostic and Therapeutic Procedures Diagnostic and Therapeutic Procedures Diagnostic and therapeutic cardiovascular s are central to the evaluation and management of patients with cardiovascular disease. Consistent with the other sections,

More information

COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION

COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION Question: How should the EGBS Coverage Guidance regarding ablation for atrial fibrillation be applied to the Prioritized List? Question source: Evidence

More information

Mille in Italia e oltre: ABC per il clinico sulle indicazioni e sull implementazione in rete del Sistema MitraClip

Mille in Italia e oltre: ABC per il clinico sulle indicazioni e sull implementazione in rete del Sistema MitraClip Mille in Italia e oltre: ABC per il clinico sulle indicazioni e sull implementazione in rete del Sistema MitraClip Anna Sonia Petronio MD, FESC Head of Cardiac Catheterization Laboratory Cardiothoracic

More information

Atrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015

Atrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015 Atrial Fibrillation: Drugs, Ablation, or Benign Neglect Robert Kennedy, MD October 10, 2015 Definitions 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary.

More information

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease Accepted Manuscript 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease Rick A. Nishimura, MD, MACC, FAHA Catherine M. Otto, MD, FACC, FAHA Robert O. Bonow, MD, MACC, FAHA

More information

Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke.

Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke. Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke. Favoriteplus.com www.heartrhythmcharity.org.uk www.forbes.com Victor J. Mazza, MD Assistant Professor of Medicine Cardiology,

More information

Atrial Fibrillation The High Risk Obese Patient

Atrial Fibrillation The High Risk Obese Patient Atrial Fibrillation The High Risk Obese Patient Frederick Schaller, D.O.,F.A.C.O.I. Professor and Vice Dean Touro University Nevada A 56 year old male with a history of hypertension and chronic stable

More information

Perioperative Cardiac Evaluation

Perioperative Cardiac Evaluation Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project

More information

Heart valve repair and replacement

Heart valve repair and replacement 16 Heart valve repair and replacement 222 Valvular heart disease can be treated in a variety of ways: valve replacement, in which an artificial (prosthetic) heart valve is implanted surgically to replace

More information

Atrial Fibrillation and Heart Failure: A Cause or a Consequence

Atrial Fibrillation and Heart Failure: A Cause or a Consequence Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November

More information

5. Diagnosis and management of rheumatic heart disease

5. Diagnosis and management of rheumatic heart disease 5. Diagnosis and management of rheumatic heart disease Introduction Chronic rheumatic valvular heart disease is the long-term result of ARF. It is a disease of poverty and disadvantage. In Australia, the

More information

Dynamic Auscultation of Heart Sounds and Murmurs. Acknowledgement. Disclosures Real or Potential Conflicts of Interest

Dynamic Auscultation of Heart Sounds and Murmurs. Acknowledgement. Disclosures Real or Potential Conflicts of Interest Dynamic Auscultation of Heart Sounds and Murmurs W. Lane Edwards, Jr., MSN, ARNP, ANP Hospitalist Group of Southwest Florida Affiliate Professor of Nursing, University of Alaska at Anchorage Acknowledgement

More information

Atrial Fibrillation Based on ESC Guidelines. Moshe Swissa MD Kaplan Medical Center

Atrial Fibrillation Based on ESC Guidelines. Moshe Swissa MD Kaplan Medical Center Atrial Fibrillation Based on ESC Guidelines Moshe Swissa MD Kaplan Medical Center Epidemiology AF affects 1 2% of the population, and this figure is likely to increase in the next 50 years. AF may long

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,

More information

The road to mitral valve repair with live 3D transesophageal echocardiography (TEE)

The road to mitral valve repair with live 3D transesophageal echocardiography (TEE) Clinical applications The road to mitral valve repair with live 3D transesophageal echocardiography (T) R.M. Lang I.S. Salgo A.C. Anyanwu D.H. Adams Professor of Medicine; Director, Noninvasive Cardiac

More information

CTA OF THE EXTRACORONARY HEART

CTA OF THE EXTRACORONARY HEART CTA OF THE EXTRACORONARY HEART Charles White MD Director of Thoracic Imaging Department of Radiology University of Maryland NO DISCLOSURES CWHITE@UMM.EDU CARDIAC CASE DISTRIBUTION Coronary CTA 30% ED chest

More information

Antiplatelet and Antithrombotics From clinical trials to guidelines

Antiplatelet and Antithrombotics From clinical trials to guidelines Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories

More information

Dysfunction of aortic valve prostheses

Dysfunction of aortic valve prostheses Dysfunction of aortic valve prostheses Kai Andersen Oslo University Hospital Rikshospitalet, Norway Dysfunction of aortic valve prostheses Kai Andersen Oslo University Hospital Rikshospitalet, Norway No

More information

How do you decide on rate versus rhythm control?

How do you decide on rate versus rhythm control? Heart Rhythm Congress 2014 How do you decide on rate versus rhythm control? Dr Ed Duncan Consultant Cardiologist & Electrophysiologist Define Rhythm Control DC Cardioversion Pharmacological AFFIRM study

More information

Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity

Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity Jean-Luc MONIN, MD, PhD Henri Mondor University Hospital Créteil, FRANCE Disclosures : None 77-year-old woman, mild dyspnea

More information

9th Christmas. Echo. International Course on Perioperative and Critical Care. Echocardiography. 19-20 December 2008 Courtyard by Marriott Brussels

9th Christmas. Echo. International Course on Perioperative and Critical Care. Echocardiography. 19-20 December 2008 Courtyard by Marriott Brussels 9th Christmas Test yourself! Basic course Pre- and Post-course exam Image regognition testing Echo Advanced course Simulated exam for the European Accreditation in Adult Transesophageal Echocardiography

More information

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015 Death (%) Mortality (%) 9/16/2015 DISCLOSURE Atrial Fibrillation Management An Evidence-based Approach Jonathon Adams, MD, FHRS Relevant Financial Relationship(s) None Off Label Usage None OBJECTIVES What

More information

Atrial Fibrillation 2012: Latest Approaches to Diagnosis, Treatment, and Stroke Prevention

Atrial Fibrillation 2012: Latest Approaches to Diagnosis, Treatment, and Stroke Prevention Atrial Fibrillation 2012: Latest Approaches to Diagnosis, Treatment, and Stroke Prevention Michael G. Clark, PA-C, MPAS, Ph.D., AACC Fisher Cardiology and Electrophysiology Bedford, Texas Disclosures Speakers

More information

The author has no disclosures

The author has no disclosures Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author

More information

Universitätsklinik für Kardiologie. Test. Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1

Universitätsklinik für Kardiologie. Test. Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1 Test Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1 Heart Failure - Definition European Heart Journal (2008) 29, 2388 2442 Akute Herzinsuffizienz Diagnostik und

More information

Nursing Care and Considerations for Patients with Atrial Fibrillation. Kris Kinghorn RN, MSN, ANP-BC

Nursing Care and Considerations for Patients with Atrial Fibrillation. Kris Kinghorn RN, MSN, ANP-BC Nursing Care and Considerations for Patients with Atrial Fibrillation Kris Kinghorn RN, MSN, ANP-BC Case Study 66 y/o female (Mrs. Olus A. Blader) Admitted with c/o palpitations and lightheadedness PMH:

More information

UPMC HEALTH PLAN MANAGEMENT OF HEART FAILURE WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION: CLINICAL PRACTICE GUIDELINE

UPMC HEALTH PLAN MANAGEMENT OF HEART FAILURE WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION: CLINICAL PRACTICE GUIDELINE General Statement on UPMC Health Plan Clinical Practice Guidelines: UPMC Health Plan develops clinical practice guidelines to support the practice of evidence-based medicine. The guidelines are from recognized

More information

Difficult Cases in Atrial Fibrillation. Ascot Cardiology GP Symposium April 2014

Difficult Cases in Atrial Fibrillation. Ascot Cardiology GP Symposium April 2014 Difficult Cases in Atrial Fibrillation Ascot Cardiology GP Symposium April 2014 Atrial Fibrillation 1-2% general population 40-50yrs

More information

May 1 6, 2016 Loews Atlanta Hotel Atlanta, GA PRELIMINARY PROGRAM AT A GLANCE

May 1 6, 2016 Loews Atlanta Hotel Atlanta, GA PRELIMINARY PROGRAM AT A GLANCE Sunday, May 1 7:00-8:30 pm Image Optimization Workshop: 2D Echocardiography Moderators: Fabio De Vasconelos Papa, MD; Mark A. Taylor, MD : Annemarie Thompson, MD Speakers: Gregg S. Hartman, MD Lori B.

More information

Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs

Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose Warfarin vs the NOACs Dr. Lori McIntosh D.O. Board Certified Neurologist Objectives Be able to list the current options of

More information

38 year old female with mild obesity. She is planning an exercise program to loose weight. She has no other known risk factors for CAD.

38 year old female with mild obesity. She is planning an exercise program to loose weight. She has no other known risk factors for CAD. Stress Testing: Wael A. Jaber, MD,FACC 38 year old female with mild obesity She is planning an exercise program to loose weight. She has no other known risk factors for CAD. You recommend: A. Exercise

More information

Provider Checklist-Outpatient Imaging. Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469)

Provider Checklist-Outpatient Imaging. Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469) Provider Checklist-Outpatient Imaging Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469) Medical Review Note: Per InterQual, if any of the following are present,

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION

STROKE PREVENTION IN ATRIAL FIBRILLATION STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients

More information

Surgeons Role in Atrial Fibrillation

Surgeons Role in Atrial Fibrillation Atrial Fibrillation Surgeons Role in Atrial Fibrillation Steven J Feldhaus, MD, FACS 2015 Cardiac Symposium September 18, 2015 Stages of Atrial Fibrillation Paroxysmal (Intermittent) Persistent (Continuous)

More information

Heart Disorders Glossary

Heart Disorders Glossary Heart Disorders Glossary ABG (Arterial Blood Gas) Test: A test that measures how much oxygen and carbon dioxide are in the blood. Anemia: A condition in which there are low levels of red blood cells in

More information

Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease

Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease Heart Failure Center Hadassah University Hospital Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease Israel Gotsman MD The Heart Failure Center, Heart Institute Hadassah University

More information

Potential Causes of Sudden Cardiac Arrest in Children

Potential Causes of Sudden Cardiac Arrest in Children Potential Causes of Sudden Cardiac Arrest in Children Project S.A.V.E. When sudden death occurs in children, adolescents and younger adults, heart abnormalities are likely causes. These conditions are

More information

Heart Murmurs. Outline. Basic Pathophysiology

Heart Murmurs. Outline. Basic Pathophysiology Heart Murmurs David Leder Outline I. Basic Pathophysiology II. Describing murmurs III. Systolic murmurs IV. Diastolic murmurs V. Continuous murmurs VI. Summary Basic Pathophysiology Murmurs = Math Q =

More information

Atrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation

Atrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation Quick reference guide Issue date: June 2006 Atrial fibrillation The management of atrial fibrillation Developed by the National Collaborating Centre for Chronic Conditions Contents Contents Patient-centred

More information

Ischemic Heart Disease: Angina Pectoris

Ischemic Heart Disease: Angina Pectoris Ischemic Heart Disease: Angina Pectoris Robert J. Straka, Pharm.D. FCCP Associate Professor University of Minnesota College of Pharmacy Minneapolis, Minnesota, USA strak001@umn.edu Learning Objectives

More information

CARDIAC RISKS OF NON CARDIAC SURGERY

CARDIAC RISKS OF NON CARDIAC SURGERY CARDIAC RISKS OF NON CARDIAC SURGERY N E W S T U D I E S & N E W G U I D E L I N E S W. B. C A L H O U N, M D, F A C C 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management

More information

Presenter Disclosure Information

Presenter Disclosure Information 2:15 3 pm Managing Arrhythmias in Primary Care Presenter Disclosure Information The following relationships exist related to this presentation: Raul Mitrani, MD, FACC, FHRS: Speakers Bureau for Medtronic.

More information

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 42/Oct. 19, 2015 Page 7214

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 42/Oct. 19, 2015 Page 7214 ORGANIC TRICUSPID VALVE REPAIR WITH AUTOLOGOUS GLUTARALDEHYDE FIXED PERICARDIAL PATCH: A SINGLE CENTER RESULTS Murtaza A Chishti 1, Ajay Meena 2, Gaurav Goyal 3, Premraj Nagarwal 4, Varun Chhabra 5, Aashish

More information

Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE

Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with

More information

EAE TEACHING COURSE Aorta and aortic valve 2012

EAE TEACHING COURSE Aorta and aortic valve 2012 EAE TEACHING COURSE Aorta and aortic valve 2012 31th March 2012 Szczecin, Poland EP EAE TEACHING COURSE: aorta and aortic valve Szczecin, 31st March 2012 Prof. Luigi Badano, Italy Prof. Patrizio Lancellotti,

More information

Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis. Michael A. Blazing

Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis. Michael A. Blazing Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis Michael A. Blazing Outline The coming crush A practical approach to clinical risk assessment Classic approach to

More information

Cardioband: A New Era of Mitral Valve Repair. Valtech Cardio, Ltd. PCR London Valves. September 22, 2015. Transcript

Cardioband: A New Era of Mitral Valve Repair. Valtech Cardio, Ltd. PCR London Valves. September 22, 2015. Transcript Cardioband: A New Era of Mitral Valve Repair Valtech Cardio, Ltd. PCR London Valves September 22, 2015 Transcript C O R P O R A T E P A R T I C I P A N T S Prof. Eberhard Grube, M.D., Ph.D., University

More information

Percutaneous closure of paravalvular leaks EULOGIO GARCIA MD MADRID ~ SPAIN

Percutaneous closure of paravalvular leaks EULOGIO GARCIA MD MADRID ~ SPAIN Percutaneous closure of paravalvular leaks EULOGIO GARCIA MD MADRID ~ SPAIN BACKGROUND The incidente of paravalvular leaks is variable ( from 2% up to 17% ). More frequent in mechanical valves. Surgical

More information

Managing the Patient with Atrial Fibrillation

Managing the Patient with Atrial Fibrillation Pocket Guide Managing the Patient with Atrial Fibrillation Updated April 2012 Editor Stephen R. Shorofsky, MD, Ph.D. Assistant Editors Anastasios Saliaris, MD Shawn Robinson, MD www.hrsonline.org DEFINITION

More information

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:

More information

Current Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose

Current Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.

More information

The P Wave: Indicator of Atrial Enlargement

The P Wave: Indicator of Atrial Enlargement Marquette University e-publications@marquette Physician Assistant Studies Faculty Research and Publications Health Sciences, College of 8-12-2010 The P Wave: Indicator of Atrial Enlargement Patrick Loftis

More information

Clinical Practice Guideline for Anticoagulation Management

Clinical Practice Guideline for Anticoagulation Management Clinical Practice Guideline for Anticoagulation Management This guideline is to inform practitioners of the Standard of Care for providing safe and effective anticoagulation management for ambulatory patients.

More information

Aortic Valve Stenosis and CAD

Aortic Valve Stenosis and CAD EUROECHO 14, Copenhagen 2010 Aortic Valve Stenosis and CAD Aleksandar N. Neskovic Clinical Hospital Center Zemun Belgrade University School of Medicine Aortic Stenosis and CAD Important facts Links AS/CAD

More information

A 35 yo female presents increasing fatigue and shortness of breath for several days. She is found to be in atrial fibrillation.

A 35 yo female presents increasing fatigue and shortness of breath for several days. She is found to be in atrial fibrillation. Ryan G. Aleong Cardiology Department University of Colorado A 35 yo female presents increasing fatigue and shortness of breath for several days. She is found to be in atrial fibrillation. 1. Initiation

More information

HEART HEALTH WEEK 3 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease HEART FAILURE. Relatively mild, symptoms with intense exercise

HEART HEALTH WEEK 3 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease HEART FAILURE. Relatively mild, symptoms with intense exercise WEEK 3 SUPPLEMENT HEART HEALTH A Beginner s Guide to Cardiovascular Disease HEART FAILURE Heart failure can be defined as the failing (insufficiency) of the heart as a mechanical pump due to either acute

More information

National Medicines Information Centre

National Medicines Information Centre National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie THE CONTEMPORARY MANAGEMENT OF ATRIAL FIBRILLATION VOLUME 12 NUMBER 3 2006

More information

AHA/ACC Guideline. e521

AHA/ACC Guideline. e521 AHA/ACC Guideline 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

More information

Dental Work and the Risk of Bacterial Endocarditis

Dental Work and the Risk of Bacterial Endocarditis Variety Children s Heart Centre Dental Work and the Risk of Bacterial Endocarditis Certain heart conditions and structural defects increase the risk of developing endocarditis (a heart valve infection)

More information