Valvular Heart Disease

  • Divya GollapudiEmail author


Severe valvular disease is identified as a potential “active cardiac condition” in the American College of Cardiology/American Heart Association (ACC/AHA) perioperative guidelines, requiring evaluation and management prior to noncardiac surgery. Attention to the type and severity of valvular heart disease during the preoperative visit can help guide perioperative risk assessment and management. Severe aortic stenosis and mitral stenosis are considered to pose the greatest perioperative risk. Distinguishing pathologic from functional murmurs and assessing a patient’s functional status by careful history and exam are the first essential steps. An echocardiogram should be obtained preoperatively if symptoms or exam are concerning for severe valvular disease.

Perioperative considerations in patients with other structural heart conditions, such as congenital cyanotic heart disease, are beyond the scope of this book—the patient’s cardiologist should generally be involved in the care of these patients.


Aortic Stenosis Mitral Regurgitation Aortic Regurgitation Mitral Stenosis Mitral Valve Prolapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. J Am Coll Cardiol 2014. doi: 10.1016/j.jacc.2014.07.944.Google Scholar
  2. 2.
    Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Wright D. Aortic stenosis and surgery. J Hosp Med. 2012;7(8):655–6.CrossRefPubMedGoogle Scholar
  5. 5.
    McGee S. Evidence-based physical diagnosis. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012. 736 p.Google Scholar
  6. 6.
    Bonow RO, Carabellow 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 Develop Guidelines for the Management of Patients with Valvular Heart Disease). Circulation. 2008;118:e523–661.CrossRefPubMedGoogle Scholar
  7. 7.
    Frogel J, Galusca D. Anesthetic considerations for patients with advanced valvular heart disease undergoing noncardiac surgery. Anesthesiol Clin. 2010;28(1):67–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Lai HC, Lai HC, Lee WL, et al. Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgery. Acta Anaesthesiol Scand. 2010;54(5):580–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Choudhry NK, Etchells EE. The rational clinical examination. Does this patient have aortic regurgitation? JAMA. 1999;281(23):2231–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Bajaj NS, Agarwal S, Rajamanickam A, et al. Impact of severe mitral regurgitation on postoperative outcomes after noncardiac surgery. Am J Med. 2013;126(6):529–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Lai HC, Lai HC, Lee WL, et al. Mitral regurgitation complicates postoperative outcome of noncardiac surgery. Am Heart J. 2007;153(4):712–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis. Circulation. 2008;118:887–96.CrossRefPubMedGoogle Scholar
  13. 13.
    Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 2007;115:1736–54.CrossRefGoogle Scholar
  14. 14.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of WashingtonSeattleUSA

Personalised recommendations