Valvular Heart Disease: A Companion to Braunwald's Heart Disease: Expert Consult - Online and Print, Third Edition

Cover......Page 1
Copyright......Page 2
Contributors......Page 6
Preface......Page 10
Foreword......Page 12
Acknowledgments......Page 14
A Changing Etiology......Page 15
Nonrheumatic Valvular Heart Disease......Page 17
Aortic Stenosis......Page 18
Aortic Regurgitation......Page 20
Mitral Regurgitation......Page 23
Tricuspid and Pulmonary \nValve Disease......Page 24
Endocarditis......Page 25
Heart Valve Procedures......Page 26
Valve Replacement and Prosthetic Valve Dysfunction......Page 27
Disparities in Access to Care and Quality of Health Care......Page 28
References......Page 29
Sources for Morphologic Studies......Page 33
Frequency and Causes......Page 34
Valve Structure......Page 35
Weights of Operatively Excised Stenotic Aortic Valves......Page 36
Relation of Aortic Valve Weight to Transvalvular Peak Systolic Pressure Gradient......Page 38
Pure Aortic Regurgitation......Page 41
Mitral Stenosis......Page 43
Pure Mitral Regurgitation......Page 46
Left-Sided Atrioventricular Valve Regurgitation Associated with Corrected Transposition of the Great Arteries......Page 48
Cardiomyopathy......Page 50
References......Page 51
Histologic Findings......Page 53
Rheumatic Valve Disease......Page 54
Genetics of Aortic Valve Disease......Page 55
Cardiovascular Risk Factors......Page 56
Renin-Angiotensin Signaling Pathway......Page 57
Calcification......Page 58
Cell Signaling Pathways......Page 60
Wnt/Lrp5 Signaling Pathway......Page 61
In Vivo Mouse Models......Page 62
Summary......Page 65
References......Page 67
Hypertrophy versus Remodeling......Page 69
Aortic Stenosis......Page 70
Concentric Hypertrophy and Left \nVentricular Function......Page 71
Mechanisms of Hypertrophy in Aortic Stenosis Versus Mitral Regurgitation......Page 72
Aortic Regurgitation, A Hybrid Disease......Page 73
References......Page 74
Echocardiographic Valve Anatomy......Page 76
Three-Dimensional Echocardiography......Page 79
Qualitative Evaluation......Page 80
Quantitative Evaluation......Page 81
Doppler Cardiac Output......Page 82
Velocity Data and Pressure Gradients......Page 83
Two-Dimensional Imaging......Page 84
Continuity Equation......Page 85
Pressure Half-Time......Page 86
Evaluation of Valvular Regurgitation......Page 87
Color Flow Mapping......Page 88
Continuous Wave Doppler Data......Page 89
Regurgitant Volume and Orifice Area......Page 91
Left Ventricular Diastolic Function......Page 93
Determination of Pulmonary Pressures......Page 94
References......Page 95
Evaluation of Valvular Heart Disease by Cardiac Catheterization and Angiocardiography......Page 99
Angiocardiography......Page 100
Fick Technique......Page 101
Technical Factors......Page 102
Physiologic Factors......Page 103
Pressure Gradients......Page 104
Measurement of Aortic Valve Area......Page 105
Aortic Valve Resistance......Page 106
Pressure Waveform Analysis......Page 107
Pressure Gradients......Page 108
Angiocardiography......Page 109
Angiocardiography......Page 110
Angiocardiography......Page 111
Left Ventricular Diastolic Function......Page 112
References......Page 113
Cardiac Magnetic Resonance......Page 115
Evaluation of Left Ventricular Volumes, Mass, and Function......Page 116
Aortic Stenosis......Page 117
Mitral Stenosis......Page 119
Aortic Regurgitation......Page 120
Mitral Regurgitation......Page 122
Pulmonary and Tricuspid Valve Regurgitation......Page 123
Evaluation of the Coronary Arteries......Page 124
References......Page 125
Diagnosis of Valve Disease......Page 127
Diagnosis and Prevention of Rheumatic Fever......Page 129
Anticoagulation Clinics......Page 130
Anticoagulation in Patients with Native Valve Disease......Page 132
Monitoring Disease Progression......Page 133
Prevention of Left Ventricular Contractile Dysfunction......Page 134
Hypertension......Page 135
Arrhythmias......Page 136
Patient Education......Page 137
References......Page 138
Pressure Gradients......Page 141
Valve Area......Page 143
Left Ventricular Pressure Overload......Page 144
Coronary Blood Flow......Page 145
Clinical History......Page 146
Chest Radiography and Electrocardiography......Page 147
Echocardiography......Page 148
Stress Testing......Page 149
Risk Stratification in Asymptomatic Patients......Page 150
Symptomatic Patients......Page 153
Hemodynamic Progression......Page 154
Symptom Onset......Page 156
Surgical Intervention in Elderly Patients......Page 157
Aortic Valve Replacement at the Time of Coronary Artery \nBypass Surgery......Page 159
Operative Mortality and Long-Term Survival......Page 160
Persistent Diastolic Dysfunction Postoperatively......Page 161
Management of Arterial Hypertension......Page 162
Prevention of Disease Progression......Page 163
References......Page 164
Pathophysiology......Page 169
Diagnosis......Page 170
Clinical History......Page 171
Electrocardiography and Chest Radiography......Page 173
Cardiac Magnetic Resonance......Page 174
Cardiac Computed Tomography......Page 175
Role of Vasodilator Therapy......Page 176
Prevention of Endocarditis......Page 177
Concomitant Aortic Root Disease......Page 178
References......Page 180
History......Page 183
Bicuspid Aortic Valve: Anatomy, Variants, and Pathologic Features......Page 184
Prevalence......Page 186
Coarctation of the Aorta......Page 187
Coronary Artery Anomalies......Page 188
Chest Radiography......Page 189
Valvular Complications......Page 190
Disease Course and Outcomes......Page 191
Infective Endocarditis......Page 192
Aortic Dissection......Page 193
Aortic Medial Disease and Aortic Root Dilatation......Page 194
Cystic Medial Necrosis......Page 195
Familial Bicuspid Aortic Valve and Ascending Aortic Aneurysms......Page 196
Recommendations for Management of the Patient with a Bicuspid \nAortic Valve......Page 197
References......Page 198
Fundamental Principles......Page 201
Aortic Valve Leaflet Repair Techniques......Page 202
Mechanical Valves......Page 203
Stentless Tissue Valves......Page 206
Aortic Homograft......Page 208
Ross Procedure......Page 209
Valve-Sparing Root Reconstruction......Page 212
Root Enlargement/Prevention of Mismatch......Page 214
Aortic Dissection......Page 216
Aortic Valve Replacement after Previous Coronary Artery Bypass Grafting......Page 217
The Porcelain Aorta......Page 218
Percutaneous/Transapical Approaches......Page 220
References......Page 221
Patient Selection for Percutaneous Aortic Valve Implantation......Page 223
Percutaneous Transvenous and Transarterial Techniques.......Page 224
Transapical Transcatheter Balloon-Expandable Valve Implantation.......Page 226
Procedural Success and Complications......Page 227
Long-Term Outcome......Page 228
Implantation......Page 230
Immediate Hemodynamic Results......Page 231
Acknowledgment and Disclosure......Page 232
References......Page 234
Mitral Gradient......Page 235
Left Ventricle......Page 236
Physical Examination......Page 237
Assessment of Severity......Page 238
Assessment of Valve Morphology......Page 239
Stress Testing......Page 240
Clinical Outcome without Intervention......Page 241
Modalities of Follow-up......Page 242
Patient Selection......Page 243
Technique......Page 244
Monitoring of the Procedure and Assessment of Immediate Results......Page 245
Risks......Page 246
Long-Term Results......Page 247
Predictors of Long-Term Results......Page 248
Treatment Strategy......Page 249
References\r......Page 253
Anatomy of the Normal and Myxomatous Mitral Valve......Page 257
Etiology and Pathology of Mitral Valve Prolapse......Page 258
Epidemiology and Natural History......Page 260
Symptoms......Page 261
Echocardiographic Diagnosis......Page 262
Assessment of Mitral Regurgitation......Page 264
Echocardiography in Defining Likelihood of Repair......Page 265
Mitral Valve Prolapse Syndrome......Page 266
Infective Endocarditis......Page 267
Cerebrovascular Ischemic Events......Page 268
Follow-up after Mitral Valve Repair......Page 269
References......Page 270
Mechanisms......Page 274
Dynamic Changes......Page 276
Ischemic Mitral Regurgitation and Remodeling......Page 277
Medical Therapy......Page 278
Mitral Annuloplasty......Page 279
Procedures to Chordae......Page 281
References......Page 283
Mitral Regurgitation: Timing of Surgery......Page 288
Decompensated Stage with Irreversible Left Ventricular Dysfunction......Page 289
Natural History of Mitral Regurgitation......Page 290
Advances in Surgical Intervention......Page 291
Late Outcome......Page 292
Predictors of Postoperative Left Ventricular Dysfunction......Page 293
Effect of Surgical Correction on Outcome......Page 294
Etiology of Mitral Regurgitation......Page 295
Clinical Evaluation......Page 297
Primary Valvular Mitral Regurgitation: Indications for Surgery......Page 298
Symptomatic Patients: Severe Left Ventricular Dysfunction......Page 299
Atrial Fibrillation......Page 300
Ischemic Mitral Regurgitation: Indications for Surgery......Page 301
References......Page 302
Mitral Valve Repair and Replacement, Including Associated Atrial Fibrillation and Tricuspid Regurgitation......Page 305
The Mitral Valve Complex and Annulus......Page 306
Repair Techniques: Myxomatous (Degenerative) Mitral Prolapse......Page 307
Ischemic or Functional Mitral Regurgitation: Indications and Repair Techniques......Page 310
Mitral Valve Replacement......Page 312
Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery......Page 313
Tricuspid Valve Surgery......Page 315
Surgical Outcomes......Page 316
References......Page 317
Percutaneous Transcatheter Treatment for Mitral Regurgitation......Page 321
Direct Edge-to-Edge Mitral \nLeaflet Repair......Page 322
The EVEREST Trials......Page 323
Coronary Sinus Devices......Page 324
The Viacor PTMA Device......Page 325
The Carillon Mitral Contour Device......Page 326
The Monarc Device......Page 327
Anatomic Limitations......Page 328
Left Atrial Devices......Page 329
Percutaneous Approaches......Page 332
References......Page 334
Objectives of Intraoperative Transesophageal Echocardiography......Page 336
Definition of Mitral Valve Prolapse......Page 337
Modified Carpentier Classification......Page 338
Mitral Leaflets......Page 339
Papillary Muscles......Page 340
Ischemic Heart Disease......Page 342
Fibroelastic Degeneration......Page 343
Decisions for Mitral Valve Replacement......Page 344
Impact of Intraoperative Echocardiography on Surgical Outcome......Page 345
Real-Time Three-Dimensional Transesophageal Echocardiography......Page 346
References......Page 347
Response of the Right Heart to Pressure and/or Volume Overload......Page 348
Valve Stenosis and Regurgitation......Page 349
Right Ventricular Size and Function......Page 351
Etiology......Page 352
Natural History......Page 354
General......Page 355
Specific Considerations Based on Etiology......Page 356
Dilemmas in Management......Page 357
Etiology......Page 358
Diagnosis......Page 359
Medical and Surgical Treatment......Page 361
Etiology......Page 363
Diagnosis......Page 364
Medical and Surgical Treatment......Page 365
References......Page 366
Infective Endocarditis......Page 370
Cardiac Risk Factors......Page 371
Noncardiac Risk Factors......Page 372
Pathophysiology and Pathogenesis of Infective Endocarditis......Page 373
Clinical Manifestations......Page 375
Evolution of the Duke Criteria......Page 376
Vegetations......Page 377
Use and Overuse of Echocardiography......Page 378
Cardiac Complications......Page 380
Common Features......Page 381
The Injection Drug User......Page 382
When to Operate in Infective Endocarditis......Page 383
Gram-Negative Bacilli......Page 385
Other Microorganisms......Page 386
Viridans Group Streptococci with Penicillin Resistance, Nutritionally Variant Streptococci, and Gemella Species......Page 387
Enterococcal Endocarditis......Page 388
Staphylococcus aureus......Page 390
Fungal Endocarditis......Page 391
References......Page 392
Prosthetic Heart Valves......Page 397
Mechanical Valves......Page 398
Durability and Long-Term Outcomes......Page 399
Stented Heterograft Valves......Page 400
Stentless Heterograft Valves......Page 401
Autografts......Page 402
Comparison of Mechanical versus \rTissue Valves......Page 403
Interruption of Anticoagulation......Page 404
Infective Endocarditis Prophylaxis......Page 405
Echocardiography......Page 406
Infective Endocarditis......Page 408
Prosthetic Valve Thrombosis......Page 409
References......Page 410
Mitral Stenosis......Page 413
Clinical Presentation......Page 415
Treatment......Page 416
Diagnostic Tests......Page 417
Treatment......Page 418
Aortic Valvular Stenosis......Page 419
Diagnostic Tests......Page 420
Treatment......Page 421
Clinical Presentation......Page 422
Supravalvular Aortic Stenosis......Page 423
Diagnostic Tests......Page 424
Diagnostic Tests......Page 425
Tricuspid Regurgitation......Page 426
Clinical Presentation......Page 427
Disease Progression......Page 428
Disease Progression......Page 429
Diagnostic Tests......Page 430
Pulmonary Regurgitation......Page 431
References......Page 433
Pregnancy......Page 438
Peripartum and Postpartum Changes......Page 439
Epidemiology......Page 440
Risk Factors for Adverse \nOutcomes......Page 441
Clinical Monitoring......Page 443
Type of Delivery......Page 444
Aortic Stenosis......Page 445
Aortic Regurgitation......Page 446
Prosthetic Valves......Page 447
Anticoagulation......Page 448
References......Page 449
Appendix 1: Acc/aha guidelines classification and levels of evidence......Page 451
Appendix 2: Esc guidelines classification and levels of evidence......Page 452
A......Page 453
C......Page 456
E......Page 458
I......Page 459
M......Page 460
P......Page 463
T......Page 465
Y......Page 466