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Valvular Heart Disease in Adults: Management of Native Valve Disease

Xin Zhang1, Steven M Hollenberg1

  • 1Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ 08103.

FP Essentials
|July 4, 2017
PubMed

Insights

Valvular heart disease (VHD) management involves treating comorbidities and considering valve interventions like replacement or percutaneous procedures, especially for severe aortic stenosis and regurgitation. Personalized treatment strategies are crucial for optimal patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Valvular heart disease (VHD) necessitates comprehensive management beyond valve repair or replacement.
  • Comorbidities such as diabetes, hypertension, and hyperlipidemia significantly impact VHD progression and patient outcomes.
  • Left ventricular dysfunction is a critical factor influencing treatment decisions and prognosis in VHD patients.

Purpose of the Study:

  • To outline current management strategies for various types of valvular heart disease (VHD).
  • To detail indications for surgical and transcatheter interventions in VHD.
  • To emphasize the importance of managing associated cardiovascular risk factors and left ventricular function.

Main Methods:

  • Review of established guidelines and evidence for the management of aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), and mitral regurgitation (MR).
  • Discussion of open surgical versus transcatheter valve replacement techniques, including risk stratification.
  • Consideration of specific patient populations, such as pregnant women with VHD.

Main Results:

  • Valve replacement is indicated for symptomatic severe AS, severe AS with left ventricular dysfunction, symptomatic or severe asymptomatic AR with left ventricular dysfunction, and severe chronic mitral regurgitation.
  • Transcatheter procedures are preferred for high-surgical-risk patients undergoing AS or MR interventions.
  • Percutaneous commissurotomy is an option for mitral stenosis, and valve replacement for severe tricuspid regurgitation.

Conclusions:

  • Comprehensive management of VHD includes treating comorbidities, optimizing left ventricular function, and selecting appropriate valve intervention strategies.
  • Transcatheter valve replacement offers a less invasive option for high-risk patients, particularly for AS and MR.
  • Definitive management of severe VHD is recommended before pregnancy.

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