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[Guidelines of the Spanish Society of Cardiology on valve heart disease]
J Azpitarte1, A M Alonso, F García Gallego
1Servicio de Cardiología. Complejo Hospitaliario Virgen de las Nieves. Granada.
Insights
Valvular heart disease management has evolved significantly due to scientific advancements and improved living standards. Innovations in diagnosis, cardiac surgery, and percutaneous interventions offer better patient outcomes for valve conditions.
Area of Science:
- Cardiology and Cardiovascular Surgery
- Medical Diagnostics
- Public Health
Context:
- Valvular heart diseases remain a significant global health burden, impacting morbidity and mortality.
- Changes in living standards and medical treatments have altered the prevalence of conditions like rheumatic fever.
- Emergence of new etiologies for valve impairment, including age-related calcific aortic stenosis and myxomatous mitral valve disease.
Purpose:
- To review the advancements in the diagnosis and management of valvular heart disease.
- To highlight the impact of scientific progress and improved living conditions on valve disease epidemiology.
- To discuss the evolving landscape of treatment options for various valve pathologies.
Summary:
- Echocardiography has revolutionized diagnosis, enabling precise visualization of valve anatomy and hemodynamic assessment.
- Cardiac surgery has seen major improvements in extracorporeal circulation, myocardial preservation, and valve prostheses.
- Minimally invasive techniques like percutaneous catheter balloon valvuloplasty offer alternatives for specific conditions such as mitral stenosis.
Impact:
- Improved understanding of natural disease history allows for optimized surgical timing, reducing reliance on advanced symptoms.
- Advancements in surgical repair and prosthetic valves enhance treatment efficacy and patient recovery.
- New interventional procedures provide less invasive options, expanding the therapeutic armamentarium for valvular heart disease.
Abstract:
Valvular heart diseases, which continue to be a major cause of morbidity and mortality world wide, have undergone radical changes since the first valve prostheses were implanted 40 years ago. These changes have been the result of both scientific progress and improved standard of living in developed countries. The availability of penicillin to treat streptococcal pharyngitis and less crowded living conditions have now made rheumatic fever uncommon in these countries. However, other forms of valve impairment have appeared over the past several years. The etiology of some of these valvular diseases remains obscure (e. g. myxomatous mitral valve); others, such as the senile type of calcific aortic valve stenosis, seem to be the price to be paid for the extension of life expectancy. With regard to diagnosis, echocardiography has constituted a formidable tool for visualizing anatomic valve changes, interpreting complex hemodynamic derangements, and evaluating repercussion on the left ventricle. In addition, the iteration of this non-invasive examination has allowed a much better understanding of the natural history of non-severe valvular disease and therefore of the precise timing for surgical intervention, without awaiting, in most cases, the appearance of advanced symptomatology. This has also been possible because of the great advances in cardiac surgery which can be summarised as: a) the improvement in extracorporeal circulation and myocardial preservation techniques; b) the greatly improved biologic and mechanic valve substitutes; c) the introduction of imaginative mitral valve repair procedures, and d) the use of intraoperative transesophageal echocardiography to assess the adequacy of valve repair. At the same time, percutaneous catheter balloon valvuloplasty has emerged as a valid alternative to mitral surgical commissurotomy for mitral stenosis. All these changes, and many more that can not be described in this brief summary, make a review of the management of patients with valve heart disease appropriate.