[Heart failure in valvular heart disease]

The clinical manifestations of heart failure depend importantly on the rate at which the syndrome develops and specifically on whether sufficient time has elapsed for compensatory mechanisms to become operative and for fluid to accumulate in the interstitial space. In most cases of the valvular heart diseases, patients survive the acute insult, and anatomical and functional abnormalities of the valves develop gradually, so that a host of compensatory mechanisms develop, especially cardiac hypertrophy. These allow the patient to adjust to and tolerate not only the anatomical abnormalities, but also a reduction in cardiac output or changes in loading condition, with less difficulties. The most important goal of treatment for the patients with chronic heart failure is to improve prognosis and the quality of life. Surgical correction is one of the best way to obtain good results in the treatment of the valvular heart diseases. We have been evaluated left ventricular pump function and contractile function before and after surgery for valvular diseases using the method for estimating myocardial contractility, that is, the relationship between ejection fraction and end-systolic volume or a ratio of end-systolic wall stress to end-systolic volume (ESS/ESVI), estimated the reversibility of the left ventricular systolic function after surgery, and determined the timing of operation. To make precise evaluation for the heart failure in patients with chronic valvular heart diseases, particularly during compensatory period, reduced pump function and myocardial contractility rather than clinical symptoms should be assessed and considered as an indicator for severity of the heart failure.