Table 3 Native valve follow-up: aortic stenosis and aortic regurgitation*
Aortic stenosis | ||
|---|---|---|
Mild | Moderate | Severe |
• Vmax: 2.6–2.9 m/s: TTE every 3–5 years • Cardiologist review if symptomatic | • Vmax: 3.5–3.9 m/s: TTE every 12–18 months • Vmax: 3.0–3.4 m/s: TTE every 18–24 months • Valve area: 1.0–1.5cm2 • Cardiologist review | • Vmax: > 4 m/s • Aortic valve area: < 1 cm2 • TTE every 6 months • Cardiologist review |
TTE alerts for urgent Cardiologist review: • LVEF < 50% or reduced flow • Cardiology discussion advised if severe AS and reducing LVEF on sequential TTE’s, LVEF in range of 50–60% • Rapid progression of Vmax: > 0.3 m/s per year • Dilated aortic root (≥ 45 mm In Marfan syndrome; ≥ 50 mm in bicuspid aortic valve patients; ≥ 55 mm for all other patients | ||
Other alerts for Cardiologist review advised: • Development of symptoms: breathlessness, chest pain, pre-syncope, syncope TTE follow-up for bicuspid aortic valves: • Bicuspid valve with no stenosis and mild regurgitation: TTE every 3–5 years • Bicuspid valve with thickening and mild stenosis: TTE every 2 years Aortic sclerosis: • Valve thickening and peak velocity ≤ 2.5 m/s: TTE every 5 years (no follow-up usually needed in > 80 years of age unless restricted cusp excursion) | ||
Aortic regurgitation | ||
|---|---|---|
Mild | Moderate | Severe |
• Mild to moderate: TTE every 3–5 years • Cardiologist review if aortic root dilated | • TTE every 1–2 years • Cardiologist review | • TTE every 6–12 months • Cardiologist review |
TTE alerts for urgent Cardiologist review: • LVEF < 50% • Cardiology discussion advised if severe AR and reducing LVEF on sequential scans, LVEF in range of 50–60% • LV systolic dimension approaching 50 mm; LV diastolic diameter approaching 70 mm or severe LV volume dilatation • Dilated aortic root (≥ 45 mm In Marfan syndrome; ≥ 50 mm in bicuspid aortic valve; ≥ 55 mm for all other patients) | ||
Other alerts for Cardiologist review: • Development of symptoms • Trace-mild AR associated with normal aortic valve morphology, normal aortic root and normal ascending aorta does not usually require TTE surveillance | ||