Emergencies in valve disease

This review will deal with strategies for emergency management of patients with valve disease, a situation that is now rare but remains a very challenging problem: valvular patients are often elderly with a high frequency of comorbidity; furthermore, there is a growing proportion of previously operated patients who present with further problems.

The main treatment is valve replacement, however, the conservative surgical approach is developing, and, more recently, percutaneous interventional techniques have been introduced. Percutaneous mitral commissurotomy is an established treatment for mitral stenosis whereas transcatheter aortic valve implantation, which is presently at the evaluation phase, shows promise.

The keys to success are establishing a rapid diagnosis based mainly on echocardiography followed by early intervention. Every effort should be made to avoid performing intervention in an emergency setting, as it is always of high risk. Strategies include better patient and physician education in order to decrease the incidence of endocarditis and prosthetic-related complications such as thromboembolism and considering earlier intervention when symptoms or objective signs of ventricular dysfunction are observed in patients with known valve disease.