Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Valvular Heart Disease Aortic Stenosis (AS) Valvular Injury 1513

complications and prognosis

Complications

■Medical therapy – improves symptoms while LV dysfunction pro-

gresses(medical therapy can mask severe symptomatic AS)

■Aortic valve replacement

➣Acute

Complications of cardiopulmonary bypass surgery

Morbidity higher with poor LV function

➣Long-term

Warfarin therapy for mechanical AVR

Endocarditis

Thromboembolism

Deterioration of bioprosthetic AVR or mechanical valve mal-

function (bioprosthetic valve deterioration is more common

than mechanical valve malfunction)

Prognosis

■Asymptomatic – excellent prognosis (risk of sudden death < 1%/year)

■Symptomatic – survival rate decreases significantly unless aortic

valve replaced

➣Natural history related to symptoms of AS without AVR

Angina – 50% survival at 5 years from symptom onset

Syncope – 50% survival at 3 years from symptom onset

Congestive heart failure – 50% survival at 2 years from symp-

tom onset

■Post-AVR

➣Normal LV function – good prognosis

VALVULAR INJURY

JUDITH A. WISNESKI, MD

history & physical

Trauma may cause:

■Rupture of papillary muscle with acute mitral regurgitation (MR)

(see Valvular heart disease)

■Rupture of chordae tendineae with acute MR (see Valvular heart

disease)

■Rupture of mitral valve with acute MR (see Valvular heart disease)

■Rupture of tricuspid valve with acute tricuspid regurgitation (see

Valvular heart disease)