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Bungard TJ, Sonnenberg B. Valvular heart disease: a primer for the clinical pharmacist. Pharmacotherapy 2010; 31:76-91. [PMID: 21182361 DOI: 10.1592/phco.31.1.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Valvular heart disease is a commonly encountered clinical condition that is not taught in most undergraduate and graduate pharmacy programs, leaving the practicing pharmacist without basic knowledge to expand on and subsequently apply to direct patient care. Unlike other areas of cardiology in which thousands of patients are recruited in many well-designed randomized clinical trials, data assessing treatments for valvular heart disease are limited and often consist of retrospective case series or observations. Our goal is to provide a basic overview of chronic valvular heart disease, with emphasis on describing the common conditions requiring surgery and the available options, as well as common pharmacologic therapies used in this patient population. Anomalies in valves can be broadly classified as stenosis and regurgitation. Depending on the valve and the type of anomaly, the impact on the cardiovascular system will vary. Understanding the hemodynamic consequences of aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation is imperative to effectively counsel patients surrounding disease progression and self-monitoring, use of vasodilators, and prophylaxis for endocarditis and rheumatic fever. Further, patient characteristics factored into the choice of implanting either a bioprosthetic (tissue) or prosthetic (metal) valve encompass patient choice, life expectancy, and willingness or ability to accept lifelong anticoagulation therapy. The evolution of metal valves has resulted in newer generations under clinical study that have more laminar flow (minimizing interaction with blood products) and improved pyrolytic carbon (minimizing infection and interaction with blood products). Although antithrombotic therapy with warfarin is now mandatory in North America for all patients receiving metal valves, research is ongoing to assess the need with the most recent generation of valves.
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Affiliation(s)
- Tammy J Bungard
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Park JH, Youn HJ, Yoon JS, Park CS, Oh SS, Chung WB, Chung JW, Choi YS, Lee DH, Oh YS, Chung WS, Hong SJ, Lee YS, Sim SB, Lee SH. The Expression of Transforming Growth Factor-β1 and α-Smooth Muscle Actin is Increased in the Human Myxomatous Valve. KOREAN JOURNAL OF PATHOLOGY 2009. [DOI: 10.4132/koreanjpathol.2009.43.2.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeong-Hwan Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Sook Yoon
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Sung Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Won Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon-Jo Hong
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Soo Lee
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, Korea
| | - Sung-Bo Sim
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hee Lee
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, Korea
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Masci PG, Dymarkowski S, Bogaert J. Valvular heart disease: what does cardiovascular MRI add? Eur Radiol 2007; 18:197-208. [PMID: 17762934 PMCID: PMC3252017 DOI: 10.1007/s00330-007-0731-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 06/26/2007] [Accepted: 07/12/2007] [Indexed: 01/23/2023]
Abstract
Although ischemic heart disease remains the leading cause of cardiac-related morbidity and mortality in the industrialized countries, a growing number of mainly elderly patients will experience a problem of valvular heart disease (VHD), often requiring surgical intervention at some stage. Doppler-echocardiography is the most popular imaging modality used in the evaluation of this disease entity. It encompasses, however, some non-negligible constraints which may hamper the quality and thus the interpretation of the exam. Cardiac catheterization has been considered for a long time the reference technique in this field, however, this technique is invasive and considered far from optimal. Cardiovascular magnetic resonance imaging (MRI) is already considered an established diagnostic method for studying ventricular dimensions, function and mass. With improvement of MRI soft- and hardware, the assessment of cardiac valve function has also turned out to be fast, accurate and reproducible. This review focuses on the usefulness of MRI in the diagnosis and management of VHD, pointing out its added value in comparison with more conventional diagnostic means.
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Affiliation(s)
- Pier Giorgio Masci
- Department of Radiology, Gasthuisberg University Hospital, 49 Herestraat, Leuven, 3000 Belgium
| | - Steven Dymarkowski
- Department of Radiology, Gasthuisberg University Hospital, 49 Herestraat, Leuven, 3000 Belgium
| | - Jan Bogaert
- Department of Radiology, Gasthuisberg University Hospital, 49 Herestraat, Leuven, 3000 Belgium
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Abstract
This review summarizes the major long-term (> or =10 to 15 years) patient outcomes after insertion of many Food and Drug Administration approved prosthetic heart valves (PHV). Mechanical PHV was associated with a better survival (p < 0.02) at 15 years after aortic valve replacement (AVR) than with a bioprosthesis in the Department of Veterans Affairs (DVA) trial. In both the DVA and the Edinburgh Heart Valve trials, bioprosthesis were associated with structural valve deterioration (SVD) (mitral valve replacement [MVR] > AVR) and, therefore, for replacement of the PHV. Thromboembolism and bleeding rate were higher with mechanical PHV. Mortality after AVR and MVR is high at 10 to 15 years because of the associated comorbid conditions and older age of patients. Outcomes with "new" good valves are similar to that with "older" good valves. Complication rates of thromboembolism, bleeding, endocarditis, and leak vary widely; the rates of these complications are not different among different mechanical PHV and among different bioprosthetic PHV. Structural valve deterioration is rare with mechanical PHV. Structural valve deterioration of bioprosthesis after MVR is higher than after AVR; after AVR, homografts and bioprosthesis have similar rates of SVD. The exact rate of SVD of the pulmonary autograft is uncertain. Valve prosthesis-patient mismatch is clinically important when it is severe and in selected patients when it is moderate. Bioprosthesis have a low rate of SVD in the older patient and, thus, are the PHV of choice for AVR in patients > or =60 to 65 years of age and for MVR in patients > or =65 to 70 years of age; in younger patients mechanical valves are the PHV of choice. In individual patients there may be exceptions to these general rules.
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Affiliation(s)
- Shahbudin H Rahimtoola
- Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC + USC Medical Center, Keck School of Medicine at the University of Southern California, 2025 Zonal Avenue, Los Angeles, CA 90033, USA
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