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Valvular Heart Disease

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MGH Cardiology Board Review

Abstract

Valvular heart disease is a growing public health concern – as our population ages, the prevalence of valvular heart disease will only rise. The expansive topic encompasses numerous disease entities, complex hemodynamics, invasive and noninvasive testing, and involved management decisions. In addition, perhaps more so than any other topic in cardiology, the diagnosis and management of valvular heart disease is dependent on the history and physical examination. Such complexity makes valvular heart disease a prime topic for cardiology board examinations.

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Abbreviations

AR:

Aortic regurgitation

AS:

Aortic stenosis

AV:

Aortic valve

BAV:

Percutaneous balloon aortic valvuloplasty

CSA:

Cross sectional area

DFP:

Diastolic filling period

DT:

Deceleration time

HR:

Heart rate

LV:

Left ventricular

LVOT:

Left ventricular outflow tract

MR:

Mitral regurgitation

MS:

Mitral stenosis

MVA:

Mitral valve area

MVG:

Mitral valve gradient

MVR:

Mitral valve replacement

NYHA:

New York Heart Association

PHT:

Pressure half-time

PMV:

Percutaneous mitral valvuloplasty

PR:

Pulmonic regurgitation

PS:

Pulmonic stenosis

RA:

Right atrial

RV:

Right ventricular

TR:

Tricuspid regurgitation

TS:

Tricuspid stenosis

VTI:

Velocity time integral

References

  1. Selzer A. Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med. 1987;317:91–8.

    Article  PubMed  CAS  Google Scholar 

  2. Mohler 3rd ER, Gannon F, Reynolds C, et al. Bone formation and inflammation in cardiac valves. Circulation. 2001;103:1522–8.

    Article  PubMed  Google Scholar 

  3. O’Brien KD, Shavelle DM, Caulfield MT, et al. Association of angiotensin-converting enzyme with low-density lipoprotein in aortic valvular lesions and in human plasma. Circulation. 2002;106:2224–30.

    Article  PubMed  Google Scholar 

  4. Otto CM, Kuusisto J, Reichenbach DD, et al. Characterization of the early lesion of ‘degenerative’ valvular aortic stenosis. Histo­logical and immunohistochemical studies. Circulation. 1994;90:844–53.

    Article  PubMed  CAS  Google Scholar 

  5. Rajamannan NM, Subramaniam M, Rickard D, et al. Human aortic valve calcification is associated with an osteoblast phenotype. Circulation. 2003;107:2181–4.

    Article  PubMed  Google Scholar 

  6. Goldbarg SH, Elmariah S, Miller MA, et al. Insights into degenerative aortic valve disease. J Am Coll Cardiol. 2007;50:1205–13.

    Article  PubMed  Google Scholar 

  7. Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation. 2008;117:2776–84.

    Article  PubMed  Google Scholar 

  8. Roberts WC, Janning KG, Ko JM, et al. Frequency of congenitally bicuspid aortic valves in patients >/=80 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation. Am J Cardiol. 2012;109:1632–6.

    Article  PubMed  Google Scholar 

  9. Blais C, Burwash IG, Mundigler G, et al. Projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis: the multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study. Circulation. 2006;113:711–21.

    Article  PubMed  Google Scholar 

  10. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e1–142.

    Article  PubMed  Google Scholar 

  11. Gorlin R, Gorlin SG. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J. 1951;41:1–29.

    Article  PubMed  CAS  Google Scholar 

  12. Hakki AH, Iskandrian AS, Bemis CE, et al. A simplified valve formula for the calculation of stenotic cardiac valve areas. Circulation. 1981;63:1050–5.

    Article  PubMed  CAS  Google Scholar 

  13. Otto CM, Pearlman AS, Gardner CL. Hemodynamic progression of aortic stenosis in adults assessed by Doppler echocardiography. J Am Coll Cardiol. 1989;13:545–50.

    Article  PubMed  CAS  Google Scholar 

  14. Cheitlin MD, Gertz EW, Brundage BH, et al. Rate of progression of severity of valvular aortic stenosis in the adult. Am Heart J. 1979;98:689–700.

    Article  PubMed  CAS  Google Scholar 

  15. Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343:611–7.

    Article  PubMed  CAS  Google Scholar 

  16. Novaro GM, Katz R, Aviles RJ, et al. Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease: the Cardiovascular Health Study. J Am Coll Cardiol. 2007;50:1992–8.

    Article  PubMed  CAS  Google Scholar 

  17. Ross Jr J, Braunwald E. Aortic stenosis. Circulation. 1968;38:61–7.

    Article  PubMed  Google Scholar 

  18. Cowell SJ, Newby DE, Prescott RJ, et al. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005;352:2389–97.

    Article  PubMed  CAS  Google Scholar 

  19. Rossebo AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–56.

    Article  PubMed  Google Scholar 

  20. Chan KL, Teo K, Dumesnil JG, et al. Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation. 2010;121:306–14.

    Article  PubMed  CAS  Google Scholar 

  21. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    Article  PubMed  CAS  Google Scholar 

  22. Cribier A, Savin T, Saoudi N, et al. Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement? Lancet. 1986;1:63–7.

    Article  PubMed  CAS  Google Scholar 

  23. Freeman RV, Otto CM. Aortic valve disease. In: Fuster V, Walsh R, Harrington R, editors. Hurst’s the heart. 13th ed. New York, NY: McGraw-Hill; 2010.

    Google Scholar 

  24. Stout KK, Verrier ED. Acute valvular regurgitation. Circulation. 2009;119:3232–41.

    Article  PubMed  Google Scholar 

  25. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.

    Article  PubMed  Google Scholar 

  26. Maroo A, Deedy M, Griffin BP. Aortic valve disease. In: Griffen BP, Topol EJ, editors. Manual of cardiovascular medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  27. Sellers RD, Levy MJ, Amplatz K, et al. Left retrograde cardioangiography in acquired cardiac disease: technic, indications and interpretations in 700 cases. Am J Cardiol. 1964;14:437–47.

    Article  PubMed  CAS  Google Scholar 

  28. Bolen JL, Alderman EL. Hemodynamic consequences of afterload reduction in patients with chronic aortic regurgitation. Circulation. 1976;53:879–83.

    Article  PubMed  CAS  Google Scholar 

  29. Greenberg BH, DeMots H, Murphy E, et al. Beneficial effects of hydralazine on rest and exercise hemodynamics in patients with chronic severe aortic insufficiency. Circulation. 1980;62:49–55.

    Article  PubMed  CAS  Google Scholar 

  30. Lin M, Chiang HT, Lin SL, et al. Vasodilator therapy in chronic asymptomatic aortic regurgitation: enalapril versus hydralazine therapy. J Am Coll Cardiol. 1994;24:1046–53.

    Article  PubMed  CAS  Google Scholar 

  31. Bonow RO, Nikas D, Elefteriades JA. Valve replacement for regurgitant lesions of the aortic or mitral valve in advanced left ventricular dysfunction. Cardiol Clin. 1995;13:73–83, 5.

    PubMed  CAS  Google Scholar 

  32. Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes EP, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine. 8th ed. St. Louis, MO: W.B. Saunders; 2007.

    Google Scholar 

  33. Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of e­chocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60:299–308.

    Article  PubMed  CAS  Google Scholar 

  34. Abascal VM, Wilkins GT, O’Shea JP, et al. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation. 1990;82:448–56.

    Article  PubMed  CAS  Google Scholar 

  35. Palacios IF. Farewell to surgical mitral commissurotomy for many patients. Circulation. 1998;97:223–6.

    Article  PubMed  CAS  Google Scholar 

  36. Reyes VP, Raju BS, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994;331:961–7.

    Article  PubMed  CAS  Google Scholar 

  37. Palacios IF, Sanchez PL, Harrell LC, et al. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. 2002;105:1465–71.

    Article  PubMed  Google Scholar 

  38. Ben Farhat M, Ayari M, Maatouk F, et al. Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation. 1998;97:245–50.

    Article  PubMed  CAS  Google Scholar 

  39. Enriquez-Sarano M, Schaff HV, Orszulak TA, et al. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91:1022–8.

    Article  PubMed  CAS  Google Scholar 

  40. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg. 1998;116:734–43.

    Article  PubMed  CAS  Google Scholar 

  41. Hauck AJ, Freeman DP, Ackermann DM, et al. Surgical pathology of the tricuspid valve: a study of 363 cases spanning 25 years. Mayo Clin Proc. 1988;63:851–63.

    Article  PubMed  CAS  Google Scholar 

  42. Moller JE, Connolly HM, Rubin J, et al. Factors associated with progression of carcinoid heart disease. N Engl J Med. 2003;348:1005–15.

    Article  PubMed  Google Scholar 

  43. Simula DV, Edwards WD, Tazelaar HD, et al. Surgical pathology of carcinoid heart disease: a study of 139 valves from 75 patients spanning 20 years. Mayo Clin Proc. 2002;77:139–47.

    PubMed  Google Scholar 

  44. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1–23.

    Article  PubMed  Google Scholar 

  45. Al Zaibag M, Ribeiro P, Al Kasab S. Percutaneous balloon valvotomy in tricuspid stenosis. Br Heart J. 1987;57:51–3.

    Article  PubMed  CAS  Google Scholar 

  46. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83:897–902.

    Article  PubMed  CAS  Google Scholar 

  47. Taramasso M, Vanermen H, Maisano F, et al. The growing clinical importance of secondary tricuspid regurgitation. J Am Coll Cardiol. 2012;59:703–10.

    Article  PubMed  Google Scholar 

  48. Topilsky Y, Tribouilloy C, Michelena HI, et al. Pathophysiology of tricuspid regurgitation: quantitative Doppler echocardiographic assessment of respiratory dependence. Circulation. 2010;122:1505–13.

    Article  PubMed  Google Scholar 

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Elmariah, S. et al. (2014). Valvular Heart Disease. In: Gaggin, H., Januzzi, Jr., J. (eds) MGH Cardiology Board Review. Springer, London. https://doi.org/10.1007/978-1-4471-4483-0_16

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  • DOI: https://doi.org/10.1007/978-1-4471-4483-0_16

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