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Valvular Heart Disease: Difference between revisions
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In the US population, the national prevalence of moderate and severe valve disease was estimated at 2,5%, determined by echocardiography. In another cohort, prevalence based on clinical signs and symptoms, confirmed by echocardiographic imaging, the estimated prevalence of at least moderate valvular diseas was estimated at 1,8%. This difference indicates the under diagnosing of valvular heart disease, and illustrates the fact that diagnosis on the basis of clinical information alone is not reliable. <cite>Nkomo</cite>. Prevalence did not change according to gender, but increased substantially with advancing age, with 13,2 % after the age of 75 years, versus <2% prior to 65 years old. The predominance of degenerative etiologies accounts for the higher prevalence in the elderly. Moreover, the prevalence of degenerative valve disease is expected to rise with the aging population of Western countries. | In the US population, the national prevalence of moderate and severe valve disease was estimated at 2,5%, determined by echocardiography. In another cohort, prevalence based on clinical signs and symptoms, confirmed by echocardiographic imaging, the estimated prevalence of at least moderate valvular diseas was estimated at 1,8%. This difference indicates the under diagnosing of valvular heart disease, and illustrates the fact that diagnosis on the basis of clinical information alone is not reliable. <cite>Nkomo</cite>. Prevalence did not change according to gender, but increased substantially with advancing age, with 13,2 % after the age of 75 years, versus <2% prior to 65 years old. The predominance of degenerative etiologies accounts for the higher prevalence in the elderly. Moreover, the prevalence of degenerative valve disease is expected to rise with the aging population of Western countries. | ||
Mitral regurgitation was found to be the most frequent valvular disease, with a prevalence of 1,7 %, followed by aortic regurgitation (0,5%), aortic stenosis (0,4%) and mitral stenosis (0,1%). | Mitral regurgitation was found to be the most frequent valvular disease, with a prevalence of 1,7 %, followed by aortic regurgitation (0,5%), aortic stenosis (0,4%) and mitral stenosis (0,1%). | ||
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==== Echocardiography ==== | ==== Echocardiography ==== | ||
The tricuspid valve structure and function can be assessed echocardiographically, as well as the annular size. This imaging modality is used to evaluate the degree of regurgitation, pressures and ventricular function. | The tricuspid valve structure and function can be assessed echocardiographically, as well as the annular size. This imaging modality is used to evaluate the degree of regurgitation, pressures and ventricular function. | ||
==== Cardiac catheterization ==== | |||
Increased right atrial and right ventricular end-diastolic pressures and the degree of pulmonary artery hypertension is documented. Pulmonary artery pressures of over 60 mm Hg usually are due to left-sided lesions leading to secondary TR. | |||
=== Treatment === | |||
Treatment strategy for tricuspid regurgitation is dictated by the etiology and the underlying cause of the valve disease and the overall condition of the patient. | |||
==== Medical ==== | |||
When pulmonary hypertension is the underlying cause of tricuspid annular dilation, medical management alone may minimize the need for surgical intervention. | |||
==== Surgical ==== | |||
Surgical options for tricuspid regurgitation include annuloplasty or valve replacement with a mechanical valve or bioprosthesis. | |||
==== Prognosis ==== | |||
Heart enlargement, increased pulmonary vascular mark-ings and dilated central pulmonary arteries. | |||
== Pulmonary valve stenosis == | |||
=== Etiology and pathology === | |||
The typical domeshaped pulmonary valve stenosis is the most common form of right ventricular outflow tract obstruction. Stenosis is caused by fusion of the pulmonary valve leafl ets and a narrowed central orifi ce. The valve is usually mobile and associated with medial abnormalities and dilation of the pulmonary trunk. PVS may be associated with Noonan, Williams, Alagille, Keutel or rubella syndromes. (Evidence-based cardiology CHAPTER 63 Adult congenital heart disease) | |||
=== Clinical presentation === | |||
Most patients with mild to moderate pulmonary valve stenosis are asymptomatic. Severe pulmonary valve stenosis may cause exertional dyspnea and fatigue, chest pain, palpitations and syncope. | |||
On physical examination, thrill along the left sternal edge, and a long systolic ejection murmur with late peak may be appreciated. S2 may be widely split with reduced or absent P2. | |||