Valvular heart disease is becoming more
common in our aging population.1
An estimate of the
prevalence of moderate to severe disease in patients >
75 years old is 13.3%.2
Maintenance of hemodynamic
stability in these patients can be quite challenging.
This review will focus on anesthetic management
of the classic lesions: aortic stenosis (AS), aortic
regurgitation (AR), mitral stenosis (MS), and mitral
regurgitation (MR).3
General guidelines for hemodynamic management
(heart rhythm, heart rate, preload, afterload,
and contractility) will be presented for each valvular
lesion. However, the anesthesiologist should bear in
mind that “mixed” valvular lesions are more common
than “pure” valvular lesions. Thus, the clinician
will need to determine which is the most severe
(hemodynamically significant) lesion and/or will
need to “split the difference” between management
goals for multiple valve lesions.
Valvular heart disease is becoming morecommon in our aging population.1 An estimate of theprevalence of moderate to severe disease in patients >75 years old is 13.3%.2 Maintenance of hemodynamicstability in these patients can be quite challenging.This review will focus on anesthetic managementof the classic lesions: aortic stenosis (AS), aorticregurgitation (AR), mitral stenosis (MS), and mitralregurgitation (MR).3General guidelines for hemodynamic management(heart rhythm, heart rate, preload, afterload,and contractility) will be presented for each valvularlesion. However, the anesthesiologist should bear inmind that “mixed” valvular lesions are more commonthan “pure” valvular lesions. Thus, the clinicianwill need to determine which is the most severe(hemodynamically significant) lesion and/or willneed to “split the difference” between managementgoals for multiple valve lesions.
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