p.3 抽出テキスト

8.6. Follow-up ................................................................................................... 4671 9. Mitral regurgitation ......................................................................................... 4671 9.1. Primary mitral regurgitation .............................................................. 4671 9.1.1. Prevalence and aetiology ............................................................. 4671 9.1.2. Evaluation ........................................................................................... 4671 9.1.2.1. Echocardiography and right heart catheterization .. 4671 9.1.2.2. Biomarkers ................................................................................ 4671 9.1.2.3. Cardiac magnetic resonance and computed tomography .............................................................................................. 4672 9.1.2.4. Genetic evaluation ................................................................. 4674 9.1.3. Medical therapy ............................................................................... 4674 9.1.4. Indications for intervention ........................................................ 4674 9.1.5. Follow-up ........................................................................................... 4675 9.2. Secondary mitral regurgitation ......................................................... 4675 9.2.1. Prevalence and aetiology ............................................................. 4675 9.2.2. Evaluation ........................................................................................... 4675 9.2.3. Definition of atrial secondary mitral regurgitation ........... 4675 9.2.4. Management of ventricular secondary mitral regurgitation .................................................................................................. 4676 9.2.4.1. Medical and device therapy ............................................... 4676 9.2.4.2. Indications for intervention ............................................... 4677 9.2.4.3. Follow-up ................................................................................... 4678 9.2.5. Management of atrial secondary mitral regurgitation ..... 4679 9.2.5.1. Medical therapy and rhythm management ................. 4679 9.2.5.2. Indications for intervention ............................................... 4679 9.2.5.3. Follow-up ................................................................................... 4679 10. Mitral stenosis ................................................................................................. 4679 10.1. Prevalence and aetiology .................................................................. 4679 10.2. Rheumatic mitral stenosis ................................................................ 4679 10.2.1. Evaluation ........................................................................................ 4679 10.2.2. Medical therapy ............................................................................. 4680 10.2.3. Indications for intervention ..................................................... 4680 10.2.4. Follow-up ......................................................................................... 4680 10.3. Degenerative mitral stenosis with mitral annular calcification ......................................................................................................... 4680 10.3.1. Evaluation ........................................................................................ 4681 10.3.2. Indications for intervention ..................................................... 4681 11. Tricuspid regurgitation ................................................................................ 4682 11.1. Prevalence and aetiology .................................................................. 4682 11.2. Evaluation ................................................................................................ 4683 11.3. Medical therapy .................................................................................... 4683 11.4. Indications for intervention ............................................................. 4683 11.4.1. Surgery .............................................................................................. 4683 11.4.1.1. Patients without indication for left-sided valve surgery ........................................................................................................ 4685 11.4.1.2. Patients with indication for left-sided valve surgery 4685 11.4.2. Transcatheter techniques ......................................................... 4686 12. Tricuspid stenosis .......................................................................................... 4687 12.1. Prevalence and aetiology .................................................................. 4687 12.2. Evaluation ................................................................................................ 4687 12.3. Medical therapy .................................................................................... 4688 12.4. Indications for intervention ............................................................. 4688 13. Multiple and mixed valvular heart disease .......................................... 4688 13.1. Prevalence and undertreatment .................................................... 4688 13.2. Evaluation and diagnostic pitfalls ................................................... 4688 13.3. Indications for intervention ............................................................. 4688 13.3.1. Multiple valvular heart disease ................................................ 4688 13.3.2. Mixed aortic valve disease ........................................................ 4690 13.3.3. Mixed mitral valve disease ........................................................ 4690 13.4. Follow-up ................................................................................................ 4690 14. Management of patients with prosthetic valves or valve repair 4690 14.1. Choice of prosthetic valve ............................................................... 4690 14.2. Follow-up of patients with prosthetic valves ........................... 4691 14.3. Antithrombotic therapy in patients with treated valvular heart disease ..................................................................................................... 4691 14.3.1. Mechanical heart valves ............................................................. 4691 14.3.1.1. Post-operative anticoagulation and therapeutic targets ......................................................................................................... 4691 14.3.1.2. Prevention and management of bleeding .................. 4693 14.3.1.3. Management of anticoagulation therapy before and after non-cardiac invasive procedures .......................................... 4693 14.3.2. Biological heart valves ................................................................ 4695 14.3.2.1. Patients with a surgical biological heart valve and no indication for oral anticoagulation .................................................. 4695 14.3.2.2. Patients with a transcatheter heart valve and no indication for oral anticoagulation .................................................. 4695 14.3.2.3. Patients with a surgical biological heart valve and an indication for oral anticoagulation .................................................. 4696 14.3.2.4. Patients with a transcatheter biological heart valve and an indication for oral anticoagulation ................................... 4696 14.4. Management of prosthetic valve dysfunction and complications .................................................................................................... 4697 14.4.1. Structural valve deterioration ................................................. 4697 14.4.2. Non-structural valve dysfunction .......................................... 4698 14.4.2.1. Prosthesis–patient mismatch .......................................... 4698 14.4.2.2. Paravalvular leak and haemolysis .................................. 4698 14.4.3. Endocarditis .................................................................................... 4698 14.4.4. Valve thrombosis .......................................................................... 4698 14.4.4.1. Hypo-attenuated leaflet thickening .............................. 4698 14.4.4.2. Clinically significant valve thrombosis ......................... 4698 15. Management during non-cardiac surgery ............................................ 4700 15.1. Pre-operative evaluation ................................................................... 4700 15.2. Specific valve lesions ........................................................................... 4700 15.2.1. Aortic stenosis ............................................................................... 4700 15.2.2. Mitral stenosis ................................................................................ 4701 15.2.3. Aortic and mitral regurgitation .............................................. 4701 15.3. Peri-operative monitoring ................................................................ 4702 16. Management of valvular heart disease during pregnancy ............. 4702 16.1. Management before pregnancy ..................................................... 4702 16.2. Management during pregnancy ...................................................... 4703 16.2.1. Patients with native valve disease ......................................... 4703 16.2.2. Patients with prosthetic valves ............................................... 4703 17. Sex-specific considerations in patients with valvular heart disease ........................................................................................................................ 4703

17.1. Aortic valve disease ............................................................................ 4703 17.2. Mitral valve disease .............................................................................. 4704 17.3. Tricuspid valve disease ...................................................................... 4704 18. Key messages .................................................................................................. 4704 19. Gaps in evidence ............................................................................................ 4705 20. ‘What to do’ and ‘What not to do’ messages from the Guidelines ................................................................................................................. 4707 21. Evidence tables ............................................................................................... 4710 22. Data availability statement ......................................................................... 4710 23. Author information ...................................................................................... 4710 24. Appendix ........................................................................................................... 4710 25. References ........................................................................................................ 4711

ESC Guidelines                                                                                                                                                                                          4637

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