The guidelines consider successively general comments on the evaluation of the patients with the management of native valve disease and that of the important group of patients who have undergone previous cardiac intervention.
Nowadays, we are more and more often faced with patients with severe valve disease but with no symptoms. In such cases the performance of a stress test should be encouraged, particularly in aortic stenosis, if it can be carried out in an appropriate setting.
Echocardiography is today the key examination to assessing valve disease. Echocardiographic examination should always integrate quantitative parameters, with the assessment of the mechanism of valve lesions and its consequences, as well as clinical findings.
Catheterisation to evaluate valve function should be indicated only in the rare cases of discordance between clinical and echocardiographic findings. On the other hand, the indication for pre-operative coronary angiography should be wide. Finally, the decision for early intervention should take into account the surgical risk related to the type of surgery, and the general condition and life expectancy of the patient.
At the other end of the spectrum, in patients with very advanced valve disease surgery should still be considered after careful evaluation of the risk-to-benefit ratio. In this high-risk population, the decision will depend on three major parameters: Spontaneous prognosis; surgical risk, which should be evaluated using quantative scores such as the EuroScore and, finally, the evaluation of life expectancy. This evaluation should be multi-disciplinary, including cardiologists, surgeons, and anaesthesiologists, and should take into account the wishes of the well-informed patient.
Intervention in valve disease should be performed promptly, trying wherever possible to use the less invasive techniques. In mitral regurgitation, surgical repair is the treatment of choice and should be discussed in all patients. The decision to perform conservative surgery or valve replacement will take into account valve anatomy and also the experience of the surgical team. The good results of mitral valve repair apply also to tricuspid regurgitation, which should be looked for and repaired during surgery on the left heart valve disease to avoid re-intervention at higher risk. For mitral stenosis, the efficacy of percutaneous mitral commissurotomy has been well established. Today, this technique represents a complement of mitral valve replacement.
The choice of the most appropriate valve prosthesis is a matter of debate. It should be based on the integration of several factors. First and foremost, are the wishes of the well-informed patient. Second, it should take into account the feasibility and the risk of anticoagulation in mechanical prosthesis, and the risk of re-intervention for bioprostheses. It is arbitrary to base the decision on age alone, which should be integrated with other factors.
The publication of these new recommendations, together with those from the United States hopefully represents an important aid for decision-making in of the management of patients with valve disease. However, it should be emphasised that they rely only on a relatively low level of evidence. This should be an incitation to perform more well-controlled studies on this topic to, thus, improve the level of our knowledge.
ESC Press Office | alfa
Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University
The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy