Intervention indication – Part II

Each patient with valvular heart disease is almost an internal medicine book, given the various associated comorbidities that they may have. Therefore, there is no general basic rule to be applied in all cases.

In order to help this rationale, the American Heart Association’s classification by A-D stages brings some interesting points to discuss and help the reader to have a guide in the handling of cases.

The main indications are in stages C and D, because it is an important valve disease and what differentiates both stages is the presence (stage D) or not (stage C) of symptoms.

We will divide into the specific valve diseases and their etiologies to bring a summary of the intervention indication. Each valve disease will be addressed specifically and in greater detail in specific posts.

Aortic valve disease

Aortic valve disease can manifest as stenosis or regurgitation. Here, primary or secondary etiology does not differentiate us in terms of conduct. Stage D patients are initially indicated, but subtypes of aortic stenosis such as D2 and D3 deserve further discussion.

Stage C patients have an indication very similar to that found in primary mitral regurgitation, that is, in cases of significant hemodynamic repercussions such as a drop in the ejection fraction, significant cavity dilations or associated arrhythmias.

The indication of percutaneous treatment for aortic stenosis has more basis in the literature. Current guidelines (2019) recommend TAVR even for patients of intermediate surgical risk, but recent publications in low-risk patients may change this scenario.

But we must keep in mind: TAVR only for elderly patients, aged over 70 years.

Suggested literature:

1 – Braunwald, Eugene. Cardiovascular medicine treaty. 10th ed. São Paulo: roca, 2017. v.1 and v.2.

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