Aim:
To give you a grasp of the important valve lesions, identify severity and how to manage a safe anaesthetic.
What is common?
Aortic stenosis (AS) and mitral regurgitation (MR)
What is deadly?
AS, mitral stenosis (MS), hypertrophic obstructive cardiomyopathy (HOCM)
What preparation?
The usual setup for anaesthesia and
Arterial monitoring
Metaraminol, ephedrine (and adrenaline)
Echo to assess cardiac output and valve function in real time
Defibrillation pads depending on severity
Severity memory aid (from the ACC AHA guidelines)
| AS | Valve area = 2.5 – 3.5cm2 | Pressure gradient mmHg |
| Mild | > 1.5 | < 25 |
| Mod | 1 – 1.5 | 25 – 40 |
| Severe | < 1 | > 40 |
| MS | 4 – 6cm2 | |
| Mild | > 1.5 | < 5 |
| Mod | 1 – 1.5 | 5 – 10 |
| Severe | < 1 | > 10 |
| AR | ||
| Mild | < 30% | < 0.1 |
| Mod | ||
| Severe | > 50% | > 0.3 |
| MR | ||
| Mild | < 30% | Small central jet 4cm2 |
| Mod | ||
| Severe | > 50% | Large central jet 8cm2 Any wall impinging jet |
