The AHA Guidelines and Scientific Statements Handbook

Valvular Heart Disease

Robert O. Bonow

18

Introduction
Echocardiography
Quantifi cation of severity of valve disease
Endocarditis prophylaxis
Rheumatic fever prophylaxis
Specifi c valve lesions
Aortic stenosis
Echocardiography (imaging, spectral, and color
Doppler) in AS
Exercise testing
Indications for cardiac catheterization
Low-fl ow/low-gradient AS
Indications for aortic valve replacement
Aortic balloon valvotomy
Aortic regurgitation
Diagnosis and initial evaluation
Medical therapy
Indications for cardiac catheterization
Indications for aortic valve replacement or repair
Bicuspid aortic valve with dilated ascending aorta
Management
Mitral stenosis
Indications for echocardiography
Medical therapy: prevention of systemic embolization
Indications for invasive hemodynamic evaluation
Indications for percutaneous mitral balloon valvotomy
Indications for surgery
Mitral valve prolapse
Evaluation of the asymptomatic patient
Evaluation and management of the symptomatic
patient
Mitral regurgitation
Indications for transthoracic echocardiography
Indications for transesophageal echocardiography

Indications for cardiac catheterization

Indications for surgery

Ischemic mitral regurgitation

Tricuspid valve disease

Management

Endocarditis

Indications for transthoracic echocardiography

Indications for transesophageal echocardiography

Surgery for native valve endocarditis

Surgery for prosthetic valve endocarditis

Selection of valve prostheses

Selection of an aortic valve prosthesis

Selection of a mitral valve prosthesis

Future directions

Introduction

During the past two decades, major advances have

occurred in diagnostic techniques, the understand-

ing of natural history, and interventional cardiology

and surgical procedures for patients with valvular

heart disease. These advances have resulted in

enhanced diagnosis, more scientifi c selection of

patients for surgery or catheter-based intervention

versus medical management, and increased survival

of patients with these disorders. The information

base from which to make clinical management deci-

sions has greatly expanded in recent years, yet in

many situations, management issues remain contro-

versial or uncertain. Unlike many other forms of

cardiovascular disease, there is a scarcity of large-

scale multicenter trials addressing the diagnosis and

treatment of patients with valvular disease from

which to derive defi nitive conclusions, and the

information available in the literature represents

primarily the experiences reported by single institu-

tions in relatively small numbers of patients.

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978 -1-405-18463-2