CC: chest pain, new murmur
ID: 60 yo male with no medical history was referred to the ED by his PMD for new murmur and bilateral leg swelling. He reports chronic chest pain and dyspnea on exertion for the past year and an episode of syncope about 8 months ago. Exam was notable for a III/VI systolic murmur heard throughout. Patient underwent a TTE that demonstrated severe aortic stenosis. He subsequently underwent surgical aortic valve replacement.
adapted from MKSAP 17
Pearls from morning report:
- Open surgical management of the aortic valve has traditionally been the preferred method of aortic valve replacement with TAVR reserved for those who were poor surgical candidates; however, in a recent study in NEJM, TAVR has been shown to be non-inferior to surgery.
- Indications to obtain a TTE include a murmur > grade III/VI, continuous murmur, symptoms and/or the presence of a murmur, and a diastolic murmur.
The first successful replacement of the aortic valve was performed and reported in 1960 by Dr. Harken. Earlier surgical approaches to aortic valve disease were limited by the heart beating during the operation as cardiopulmonary bypass had not yet been developed.
Want to read more?
Aortic Stenosis (New England Journal of Medicine)
Aortic-Valve Stenosis – From Patients at Risk to Severe Valve Obstruction (New England Journal of Medicine)
2013 ACC/AHA Guideline for the Management of Heart Failure (Journal of the American College of Cardiology)
Reardon, MJ et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321-1331.
MKSAP 17: Medical Knowledge Self-assessment Program. Philadelphia : American College Of Physicians, 2016. Print.