Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

First European Guidelines on the Management of Valvular Heart Disease

04.09.2007
Today valve disease still represents an important health problem; valve patients are getting older and older with more and more comorbities, which contribute to increased operative risk and render the decision-making process more difficult. The recent ESC Guidelines on the management of valvular heart disease are the first European guidelines on this topic.

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
Further information:
http://www.escardio.org

More articles from Health and Medicine:

nachricht Study tracks inner workings of the brain with new biosensor
16.08.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht Foods of the future
15.08.2018 | Georg-August-Universität Göttingen

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: It’s All in the Mix: Jülich Researchers are Developing Fast-Charging Solid-State Batteries

There are currently great hopes for solid-state batteries. They contain no liquid parts that could leak or catch fire. For this reason, they do not require cooling and are considered to be much safer, more reliable, and longer lasting than traditional lithium-ion batteries. Jülich scientists have now introduced a new concept that allows currents up to ten times greater during charging and discharging than previously described in the literature. The improvement was achieved by a “clever” choice of materials with a focus on consistently good compatibility. All components were made from phosphate compounds, which are well matched both chemically and mechanically.

The low current is considered one of the biggest hurdles in the development of solid-state batteries. It is the reason why the batteries take a relatively long...

Im Focus: Color effects from transparent 3D-printed nanostructures

New design tool automatically creates nanostructure 3D-print templates for user-given colors
Scientists present work at prestigious SIGGRAPH conference

Most of the objects we see are colored by pigments, but using pigments has disadvantages: such colors can fade, industrial pigments are often toxic, and...

Im Focus: Unraveling the nature of 'whistlers' from space in the lab

A new study sheds light on how ultralow frequency radio waves and plasmas interact

Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...

Im Focus: New interactive machine learning tool makes car designs more aerodynamic

Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.

When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...

Im Focus: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

LaserForum 2018 deals with 3D production of components

17.08.2018 | Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

 
Latest News

Quantum bugs, meet your new swatter

20.08.2018 | Information Technology

A novel synthetic antibody enables conditional “protein knockdown” in vertebrates

20.08.2018 | Life Sciences

Metamolds: Molding a mold

20.08.2018 | Information Technology

VideoLinks
Science & Research
Overview of more VideoLinks >>>