Rapid Review·Cardiovascular
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Valvular Heart Disease
T1Must knowValvular Heart Disease
Focus on
When each valve lesion goes to surgery: any symptomatic lesion, any acute regurgitation, mitral stenosis with pulmonary hypertension, and an asymptomatic lesion once the ejection fraction falls below its threshold (50 percent aortic stenosis, 55 aortic regurgitation, 60 mitral regurgitation).
Key takeaways
When a Valve Goes to Surgery
Rule
symptomatic disease; asymptomatic disease with a falling ejection fraction; mitral stenosis with pulmonary hypertension; and any acute regurgitation.| Lesion | Operate when |
|---|---|
| Any valve lesion | Symptomatic disease |
| Aortic stenosis, asymptomatic | Ejection fraction under 50 percent |
| Aortic regurgitation, asymptomatic | Ejection fraction under 55 percent |
| Mitral regurgitation, asymptomatic | Ejection fraction under 60 percent |
| Mitral stenosis | Pulmonary hypertension |
| Any acute regurgitation | Always |
Pages
Aortic valve
Aortic Stenosis, Bicuspid Aortic Valve, Aortic Regurgitation.Mitral valve
Mitral Stenosis, Mitral Valve Prolapse, Mitral Regurgitation.Right-sided valves
Tricuspid Regurgitation, Pulmonary Stenosis, Pulmonary Regurgitation.Replacement valves
Prosthetic Heart Valves.Before non-cardiac surgery
the valve plan is on Approach to Perioperative Cardiac Management.An asymptomatic patient has severe aortic regurgitation with an ejection fraction of 52 percent; another has severe mitral regurgitation with an ejection fraction of 58 percent. Does either need surgery?
Both do. The asymptomatic threshold is under 55 percent for aortic regurgitation and under 60 percent for mitral regurgitation (50 percent is the aortic stenosis line).
How it's tested
Asymptomatic severe aortic stenosis with an ejection fraction of 45 percent: valve replacement.
Asymptomatic severe aortic regurgitation with an ejection fraction of 52 percent: surgery; the threshold is 55 percent.
Asymptomatic severe primary mitral regurgitation with an ejection fraction of 58 percent: surgery; the threshold is 60 percent.
Acute regurgitation of any valve: emergency surgery.
Go deeper
Related Step 2 pages: Aortic Stenosis, Aortic Regurgitation, Mitral Stenosis, Mitral Regurgitation, Prosthetic Heart Valves, Approach to Perioperative Cardiac Management
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