Valvular Heart Disease: A Companion to Braunwald's Heart Disease E-Book

valvular Heart Disease Is Now An Even Better Source For All Your Questions On Dysfunctions Or Abnormalities Of The Heart’s Four Valves. In The Third Edition, Catherine Otto Is Joined By Robert Bonow And A Team Of Expert Contributors To Bring You The Latest Developments In Imaging And Treatment. The Full-color Images And Illustrations Reflect The Cutting-edge Imaging And Diagnostic Modalities—doppler Echo And Mr—that Are So Important For Diagnosing Aortic Valve Defects. Superb Diagrams, An Increased Focus On Imaging And Case-based Presentation, And New Chapters—on Cardiac Mr And Ct Imaging For Valvular Heart Disease; Genetic, Molecular And Cellular Mechanisms Of Valvular Disease; Bicuspid Aortic Valve Disease; And Ischemic Mitral Regurgitation—further Enhance This Valuable Reference. And, The Full Text Is Available Online At Expertconsult.com Where You Can Search The Entire Contents. • Presents Comprehensive Coverage Of Valvular Heart Disease To Provide You With A Complete Reference And One-stop Shop For This Specialty In Cardiac Medicine. • Provides Complete Guidance On How And Why To Surgically Treat Valve Patients For A Reliable Manual On Managing Difficult Cases. • Features Chapters On Pediatric And Pregnant Patients So You Know What Considerations To Take Into Account When Treating These Special Populations. • Provides Access To The Fully Searchable Text Online At Expertconsult.com. • Introduces Robert Bonow As An Editor, Who Joins Catherine Otto And The Team Of Expert Authors To Provide You With Guidance From Leaders In The Field. • Features New Chapters—genetic, Molecular And Cellular Mechanisms Of Valvular Disease; Bicuspid Aortic Valve Disease; And Ischemic Mitral Regurgitation—for The Latest In Cutting-edge Research And Clinical Data. • Reflects The Latest In Imaging Modalities In The New Section On Cardiac Mr And Ct Imaging For Valvular Heart Disease To Provide You With A Full Understand Of The Tools For The Most Accurate Diagnosis. • Presents Detailed Illustrations And Images In Full Color To Better Showcase Valve Anatomy And Dysfunction, As Well As Important Techniques And Surgical Procedures. • Includes A Summary Of The New Acc/aha Valvular Heart Disease Guidelines In Each Chapter To Keep You Up To Date On The Latest Best Practices Throughout The Field. your Purchase Entitles You To Access The Web Site Until The Next Edition Is Published, Or Until The Current Edition Is No Longer Offered For Sale By Elsevier, Whichever Occurs First. Elsevier Reserves The Right To Offer A Suitable Replacement Product (such As A Downloadable Or Cd-rom-based Electronic Version) Should Access To The Web Site Be Discontinued. Front Cover Copyright Page Contributors Preface Foreword Acknowledgments 1 The Burden of Valvular Heart Disease Key Points A Changing Etiology Nonrheumatic Valvular Heart Disease Aortic Stenosis Aortic Sclerosis Aortic Regurgitation Aortic Root Dilation Mitral Stenosis Mitral Regurgitation Mitral Annular Calcification Tricuspid and Pulmonary Valve Disease Multivalvular and Mixed Valvular Heart Disease Endocarditis Valvular Heart Disease in Women of Reproductive Age Heart Valve Procedures Valve Replacement and Prosthetic Valve Dysfunction Disparities in Access to Care and Quality of Health Care Summary and Conclusions Acknowledgment References 2 Clinical Pathology of Valvular Heart Disease Sources for Morphologic Studies Frequency of Various Valvular Disorders in Necropsy Studies Changing Frequency of Various Valvular Disorders in Recent Decades Specific Valvular Disorders Aortic Stenosis (with or without Regurgitation) Frequency and Causes Valve Structure Necropsy Studies of Patients with Isolated Aortic Stenosis (with or without Aortic Regurgitation) and Never a Cardiac Operation Weights of Operatively Excised Stenotic Aortic Valves Relation of Aortic Valve Weight to Transvalvular Peak Systolic Pressure Gradient Associated Coronary Arterial Narrowing Relation to Left Bundle Branch Block and/or Complete Heart Block Pure Aortic Regurgitation Mitral Stenosis Pure Mitral Regurgitation Left-Sided Atrioventricular Valve Regurgitation Associated with Corrected Transposition of the Great Arteries Infective Endocarditis Coronary Heart Disease Cardiomyopathy Tricuspid Valve Disease Tricuspid Regurgitation Tricuspid Valve Stenosis Pulmonic Valve References 3 Cellular, Molecular, and Genetic Mechanisms of Valvular Heart Disease Myxomatous Mitral Valve Disease Histologic Findings Experimental Models of Mitral Valve Disease Rheumatic Valve Disease Calcific Aortic Stenosis Aortic Valve Histology Genetics of Aortic Valve Disease Cardiovascular Risk Factors Molecular and Cellular Events Lipids Renin-Angiotensin Signaling Pathway Calcification Cell Signaling Pathways Wnt/Lrp5 Signaling Pathway Experimental Models of Valvular Heart Disease In Vivo Rabbit Model In Vivo Mouse Models Summary Acknowledgments References 4 Left Ventricular Adaptation to Pressure and/or Volume Overload Background Hypertrophy versus Remodeling Aortic Stenosis Variability in the Response to Pressure Overload Concentric Hypertrophy and Left Ventricular Function Mitral Regurgitation Left Ventricular Function in Mitral Regurgitation Mechanisms of Hypertrophy in Aortic Stenosis Versus Mitral Regurgitation Aortic Regurgitation, A Hybrid Disease Left Ventricular Function in Aortic Regurgitation Mitral Stenosis: The Underloaded Left Ventricle Conclusion References 5 Evaluation of Valvular Heart Disease by Echocardiography Anatomic Imaging Echocardiographic Valve Anatomy Transthoracic versus Transesophageal Imaging Three-Dimensional Echocardiography Evaluation of Left Ventricular Systolic Function Left Ventricular Volumes and Ejection Fraction Qualitative Evaluation Quantitative Evaluation Left Ventricular Wall Stress Doppler Cardiac Output Evaluation of Stenosis Severity Velocity Data and Pressure Gradients Valve Area Two-Dimensional Imaging Continuity Equation Pressure Half-Time Other Measures of Stenosis Severity Stenosis Severity with Changes in Flow Rate Evaluation of Valvular Regurgitation Color Flow Mapping Vena Contracta Proximal Flow Convergence Continuous Wave Doppler Data Distal Flow Reversals Regurgitant Volume and Orifice Area Integration of Regurgitant Parameters Other Echocardiographic Data Left Ventricular Diastolic Function Left Atrial Enlargement and Thrombus Formation Determination of Pulmonary Pressures Right Heart Structure and Function Aortic Anatomy and Dilation References 6 Evaluation of Valvular Heart Disease by Cardiac Catheterization and Angiocardiography Evaluation of Left Ventricular Systolic Function Angiocardiography Cardiac Output Fick Technique Thermodilution Pressure-Volume Loops Evaluation of Stenosis Severity Pressure Gradients Technical Factors Physiologic Factors Aortic Valve Pressure Gradients Pressure Waveform Analysis Valve Area General Concepts Measurement of Aortic Valve Area Angiocardiography Low-Output, Low-Gradient Aortic Stenosis Aortic Valve Resistance Pulmonic Valve Pressure Gradients Pressure Waveform Analysis Valve Area Angiocardiography Mitral Valve Pressure Gradients Pressure Waveform Analysis Valve Area Tricuspid Valve Pressure Gradients Pressure Waveform Analysis Valve Area Angiocardiography Evaluation of Valvular Regurgitation Aortic Regurgitation Pressure Waveform Analysis Angiocardiography Regurgitant Fraction Mitral Regurgitation Pressure Waveform Analysis Angiocardiography Regurgitant Fraction Tricuspid Regurgitation Pressure Waveform Analysis Angiocardiography Regurgitant Fraction Pulmonic Regurgitation Other Cardiac Catheterization Data Pulmonary Artery Pressures and Resistance Systemic Vascular Resistance Left Ventricular Diastolic Function Coronary Angiography References 7 Evaluation of Valvular Heart Disease by Cardiac Magnetic Resonance and Computed Tomography Principles and Instrumentation Cardiac Magnetic Resonance Cardiac Computed Tomography Evaluation of Left Ventricular Volumes, Mass, and Function Evaluation of Right Ventricular Volumes and Function Assessment of Valvular Stenosis Aortic Stenosis Mitral Stenosis Pulmonary and Tricuspid Valve Stenosis Assessment of Valvular Regurgitation Aortic Regurgitation Mitral Regurgitation Pulmonary and Tricuspid Valve Regurgitation Evaluation of Prosthetic Valves Infective Endocarditis Evaluation of the Coronary Arteries Summary References 8 Basic Principles of Medical Therapy in the Patient with Valvular Heart Disease Diagnosis of Valve Disease Preventative Measures Diagnosis and Prevention of Rheumatic Fever Prevention of Infective Endocarditis Prevention of Embolic Events Anticoagulation Clinics Anticoagulation in Patients with Native Valve Disease General Health Maintenance Monitoring Disease Progression Medical Therapy Primary Treatment of Valve Disease Prevention of Left Ventricular Contractile Dysfunction Prevention of Left Atrial Enlargement and Atrial Fibrillation Prevention of Pulmonary Hypertension Symptoms Due to Valve Disease Management of Concurrent Cardiovascular Conditions Hypertension Coronary Artery Disease Aortic Root Disease Arrhythmias Heart Failure Noncardiac Surgery in Patients with Valve Disease Patient Education References 9 Aortic Stenosis Pathophysiology Valvular Hemodynamics Pressure Gradients Valve Area Other Indices of Stenosis Severity Left Ventricular Pressure Overload The Peripheral and Pulmonary Vasculature Coronary Blood Flow Exercise Physiology Clinical Presentation Clinical History Physical Examination Chest Radiography and Electrocardiography Echocardiography Stress Testing Cardiac Catheterization Disease Course Clinical Outcome Asymptomatic Patients Risk Stratification in Asymptomatic Patients Symptomatic Patients Aortic Sclerosis and Mild to Moderate Aortic Stenosis Hemodynamic Progression Associated Clinical Factors Coexisting Coronary Artery Disease Surgical Intervention And Postoperative Outcome Timing of Surgical Intervention Symptom Onset Surgery in Asymptomatic Patients Surgical Intervention in Elderly Patients Aortic Valve Replacement at the Time of Coronary Artery Bypass Surgery Aortic Stenosis with Left Ventricular Systolic Dysfunction Operative Mortality and Long-Term Survival Left Ventricular Changes Postoperative Intracavitary Obstruction Left Ventricular Systolic Function Regression of Left Ventricular Hypertrophy Persistent Diastolic Dysfunction Postoperatively Exercise Capacity and Functional Status Medical Therapy Noninvasive Follow-up Management of Arterial Hypertension Prevention of Endocarditis Management during Periods of Hemodynamic Stress Prevention of Disease Progression References 10 Aortic Regurgitation Etiology Acute Aortic Regurgitation Pathophysiology Diagnosis Management Chronic Aortic Regurgitation Pathophysiology Clinical Presentation Clinical History Physical Examination Electrocardiography and Chest Radiography Echocardiography Other Imaging Modalities Cardiac Magnetic Resonance Cardiac Computed Tomography Radionuclide Angiography Exercise Testing Natural History Patients with Normal Left Ventricular Systolic Function Patients with Left Ventricular Systolic Dysfunction Medical Management Role of Vasodilator Therapy Prevention of Endocarditis Serial Evaluations Indications for Surgery Concomitant Aortic Root Disease References 11 The Bicuspid Aortic Valve History Embryology Bicuspid Aortic Valve: Anatomy, Variants, and Pathologic Features Prevalence Genetics The Bicuspid Aortic Valve and Associated Cardiovascular Lesions Coarctation of the Aorta Turner Syndrome Associated Congenital Heart Malformations Patent Ductus Arteriosus Supravalvular Aortic Stenosis/William Syndrome Ventricular Septal Defect Subvalvular Aortic Stenosis Sinus of Valsalva Aneurysm Shone’s Complex Coronary Artery Anomalies Clinical Presentation Physical Examination Chest Radiography Transthoracic Echocardiography Valvular Complications Associated Lesions Transesophageal Echocardiography Magnetic Resonance Imaging and Computed Tomography Disease Course and Outcomes Aortic Stenosis Aortic Regurgitation Infective Endocarditis Pregnancy and the Bicuspid Aortic Valve Abnormalities of the Aortic Wall Associated with the Bicuspid Aortic Valve Coarctation of the Aorta Aortic Dissection Aortic Medial Disease and Aortic Root Dilatation Cystic Medial Necrosis Aortic Complications after Valve Replacement Familial Bicuspid Aortic Valve and Ascending Aortic Aneurysms Surgical Treatment of the Bicuspid Aortic Valve and Ascending Aorta Recommendations for Management of the Patient with a Bicuspid Aortic Valve References 12 Surgical Approach to Aortic Valve Disease Fundamental Principles Aortic Valve Leaflet Repair Techniques Aortic Valve Replacement Mechanical Valves Stented Tissue Valves Stentless Tissue Valves Aortic Homograft Ross Procedure Aortic Root Replacement Valve-Sparing Root Reconstruction Root Enlargement/Prevention of Mismatch Special challenges in aortic root surgery Aortic Dissection Aortic Valve Replacement after Previous Coronary Artery Bypass Grafting Aortic Root Aneurysm after Previous Heart Surgery The Porcelain Aorta New developments Minimally Invasive Approaches Percutaneous/Transapical Approaches Risk of Surgery Conclusion References 13 Percutaneous Aortic Valve Implantation Patient Selection for Percutaneous Aortic Valve Implantation Percutaneous Aortic Valve Designs Balloon-Expandable Percutaneous Aortic Valves Implantation Percutaneous Transvenous and Transarterial Techniques. Transapical Transcatheter Balloon-Expandable Valve Implantation. Procedural Success and Complications Immediate Hemodynamic Results Long-Term Outcome Self-Expanding Valves Implantation Procedural Success and Complications Immediate Hemodynamic Results Long-Term Outcome Alternatives To Percutaneous Aortic Valve Implantation Surgical Aortic Valve Replacement Aortic Balloon Valvuloplasty Aortic Balloon Valvuloplasty Followed by External Beam Radiation Apical to Aortic Conduit Ongoing Trials Acknowledgment and Disclosure References 14 Rheumatic Mitral Valve Disease Pathophysiology Mechanisms of Valve Obstruction Hemodynamic Consequences of Mitral Stenosis Mitral Gradient Left Atrium Pulmonary Circulation Right Heart Left Ventricle Exercise Physiology Clinical Presentation History Physical Examination Chest Radiography and Electrocardiography Echocardiography Assessment of Severity Assessment of Valve Morphology Consequences of Mitral Stenosis Mitral Regurgitation Associated Lesions Thromboembolic Risk Stress Testing Other Noninvasive Investigations Cardiac Catheterization Natural History Onset and Progression of Valvular Lesions Clinical Outcome without Intervention Complications Medical Therapy Prevention of Rheumatic Fever Treatment of Symptoms Prevention of Thromboembolism Modalities of Follow-up Surgical Therapy Closed Surgical Commissurotomy Open Surgical Commissurotomy Mitral Valve Replacement Balloon Mitral Commissurotomy Patient Selection Experience of the Medical and Surgical Teams Technique Monitoring of the Procedure and Assessment of Immediate Results Immediate Results Efficacy Failures Risks Predictors of Immediate Results Long-Term Results Predictors of Long-Term Results Applications of Balloon Mitral Commissurotomy in Special Patient Groups After Surgical Commissurotomy Patients at High Risk for Surgery Treatment Strategy References 15 Myxomatous Mitral Valve Disease Definition Anatomy of the Normal and Myxomatous Mitral Valve Etiology and Pathology of Mitral Valve Prolapse Genetic Factors Epidemiology and Natural History Diagnosis and Clinical Features Symptoms Cardiac Physical Findings Noncardiac Physical Findings Echocardiographic Diagnosis Classification of Prolapse on Echocardiography Localization of Prolapse and Flail by Echocardiography Assessment of Mitral Regurgitation Echocardiography in Defining Likelihood of Repair Three-Dimensional Echocardiography Other Diagnostic Techniques Electrocardiography Angiography Other Imaging Techniques Mitral Valve Prolapse Syndrome Management of the Asymptomatic Patient Complications of Mitral Valve Prolapse Infective Endocarditis Cerebrovascular Ischemic Events Sudden Cardiac Death and Ventricular Arrhythmia Mitral Regurgitation Follow-up after Mitral Valve Repair Conclusions and Future Perspectives References 16 Ischemic Mitral Regurgitation Mechanisms Dynamic Changes Ischemic Mitral Regurgitation and Remodeling Therapy Medical Therapy Nonpharmacologic Therapy Cardiac Resynchronization Therapy Percutaneous and Surgical Coronary Revascularization Surgery of the Valve and Its Apparatus Mitral Annuloplasty Tethering Reduction Procedures: Left Ventricular Plasty Direct Procedures for Papillary Muscle Displace­ment Procedures to Leaflets Procedures to Chordae Remaining Questions Diagnosis Summary and Perspectives Acknowledgments References 17 Mitral Regurgitation: Timing of Surgery Recent Advances Pathophysiology Acute Volume Overload Stage Chronic Compensated Stage Decompensated Stage with Irreversible Left Ventricular Dysfunction Natural History of Mitral Regurgitation Advances in Surgical Intervention Predictors of Surgical Outcome Early Mortality Late Outcome Predictors of Postoperative Left Ventricular Dysfunction Unexpected Left Ventricular Dysfunction Effect of Surgical Correction on Outcome Acute Mitral Regurgitation Etiology and Presentation Clinical Evaluation Treatment Chronic Mitral Regurgitation Etiology of Mitral Regurgitation Clinical Evaluation Primary Valvular Mitral Regurgitation: Indications for Surgery Symptomatic Patients: Normal Left Ventricular Function Symptomatic and Asymptomatic Patients: Left Ventricular Dysfunction Symptomatic Patients: Severe Left Ventricular Dysfunction Asymptomatic Patients: Normal Left Ventricular Function Atrial Fibrillation Ischemic Mitral Regurgitation: Indications for Surgery Functional Mitral Regurgitation: Indications for Surgery References 18 Mitral Valve Repair and Replacement, Including Associated Atrial Fibrillation and Tricuspid Regurgitation Mitral Valve Anatomy and Function Functional Anatomy and Classification of Mitral Regurgitation The Mitral Valve Complex and Annulus Mitral Valve Repair Surgical Preparation and Perioperative Care Surgical Approaches Repair Techniques: Myxomatous (Degenerative) Mitral Prolapse Ischemic or Functional Mitral Regurgitation: Indications and Repair Techniques Mitral Valve Re-Repair Mitral Valve Replacement Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery Tricuspid Valve Surgery Surgical Outcomes Conclusions References 19 Percutaneous Transcatheter Treatment for Mitral Regurgitation Direct Edge-to-Edge Mitral Leaflet Repair The EVEREST Trials Percutaneous Repair beyond Direct Valvular Intervention Coronary Sinus Devices The Viacor PTMA Device The Carillon Mitral Contour Device The Monarc Device Comparison of Devices Anatomic Limitations Retrograde Transventricular Mitral Annuloplasty Left Atrial Devices Myocardial/Annular Support Devices The Coapsys Device Percutaneous Approaches Percutaneous Mitral Valve Replacement References 20 Intraoperative Echocardiography for Mitral Valve Disease Objectives of Intraoperative Transesophageal Echocardiography Surgical Roadmap of the Diseased Mitral Valve Definition of Mitral Valve Prolapse Terminology for Leaflet Anatomy Carpentier Classification Duran Classification Modified Carpentier Classification Determination of Pathophysiology of Mitral Regurgitation Assessment of Mitral Regurgitation Evaluation of Valve Functional Pathology Evaluation of Structural Changes in the Valve Mitral Annulus Mitral Leaflets Chordae Tendineae Papillary Muscles Left Ventricle Left Atrium Etiology of Mitral Regurgitation Rheumatic Disease Myxomatous Degenerative Mitral Valve Disease Infective Endocarditis Dilated Cardiomyopathy Ischemic Heart Disease Congenital Cleft Mitral Valve Leaflet Perforation Chronic Inflammatory Processes Fibroelastic Degeneration Echocardiography-Guided Surgical Approach Dilated Annulus with Normal Leaflet Tissue, Incomplete Tip Coaptation, and Central Regurgitation Dilated Annulus with Excess Leaflet Tissue and Central Regurgitation Flail Posterior Leaflet Scallop (Type 2) with Chordal Rupture or Elongation and Excess Leaflet Height Associated with Eccentric Flail Anterior Leaflet (Commonly at A2) with Chordal Rupture and Eccentric Regurgitation Jet Combination of Restricted Posterior Leaflet (Type 3b) and Flail Anterior Leaflet (Type 2) Leaflet Perforation Cleft Mitral Valve Mixed Rheumatic Mitral Stenosis and Regurgitation Infective Endocarditis Commissural Prolapse Decisions for Mitral Valve Replacement Intraoperative Echocardiographic Assessment of Surgery Mitral Valve Repair Mitral Valve Replacement Impact of Intraoperative Echocardiography on Surgical Outcome Emerging Role of Intraoperative Three-Dimensional Transesophageal Echocardiography Three-Dimensional Transesophageal Echocardiography Based on Reconstruction Real-Time Three-Dimensional Transesophageal Echocardiography Summary References 21 Right-Sided Valve Disease Pathophysiology of Right-Sided Valve Disease Primary Versus Secondary Right-Sided Valve Disease Response of the Right Heart to Pressure and/or Volume Overload Principles of Diagnosis Valve Stenosis and Regurgitation Right Ventricular Size and Function Pulmonary Artery Pressures Tricuspid Valve Anatomy Tricuspid Regurgitation Etiology Diagnosis Natural History Medical and Surgical Treatment General Timing of Surgery Specific Considerations Based on Etiology Endocarditis Prophylaxis Dilemmas in Management Tricuspid Stenosis Etiology Diagnosis Natural History Medical and Surgical Treatment Pulmonic Stenosis Etiology Diagnosis Natural History Pregnancy Exercise and Athletes Medical and Surgical Treatment Pulmonic Regurgitation Etiology Diagnosis Natural History Medical and Surgical Treatment References 22 Infective Endocarditis Epidemiology Cardiac Risk Factors Noncardiac Risk Factors Pathophysiology and Pathogenesis of Infective Endocarditis Diagnosis Clinical Manifestations Evolution of the Duke Criteria Transthoracic and Transesophageal Echocardiography Echocardiographic Features Vegetations Para-Valvular Extension of Infection (Myocardial Abscess Formation) Fistula Formation Perforation and Valvular regurgitation Dehiscence of Prosthetic Valve Use and Overuse of Echocardiography Other Imaging Modalities in Infective Endocarditis Complications Cardiac Complications Embolization Mycotic Aneurysms Renal Dysfunction Valvular and Paravalvular Abscess Formation Less Common Complications Clinical Approach Common Features Determining Prognosis The Injection Drug User Prosthetic Valve Endocarditis Infected Intracardiac Devices When to Operate in Infective Endocarditis Microbiology Gram-Positive Cocci Streptococci Staphylococci Gram-Negative Bacilli HACEK and Other Unusual Gram-Negative Bacteria Gram-Positive Bacilli Anaerobic Bacteria Fungi Other Microorganisms “Culture-Negative” Endocarditis Polymicrobial Endocarditis Antimicrobial Treatment Viridans Group Streptococci Highly Penicillin-Susceptible Viridans Group Streptococci and Streptococcus bovis Viridans Group Streptococci and Streptococcus bovis with Penicillin Tolerance Viridans Group Streptococci with Penicillin Resistance, Nutritionally Variant Streptococci, and Gemella Species Streptococcus pneumoniae Enterococcal Endocarditis Staphylococcal Endocarditis Coagulase-Negative Staphylococci Staphylococcus aureus Endocarditis Due to Enterobacteriaceae or Pseudomonas Species Fungal Endocarditis Q Fever Endocarditis Infective Endocarditis Due to Chlamydiae Culture-Negative Endocarditis References 23 Prosthetic Heart Valves Mechanical Valves Durability and Long-Term Outcomes Tissue Valves Stented Heterograft Valves Stentless Heterograft Valves Homografts Autografts Comparison of Mechanical versus Tissue Valves Choice of Prosthetic Heart Valve Medical Management and Surveillance after Valve Replacement Anticoagulation Interruption of Anticoagulation Excessive Anticoagulation Anticoagulation in Pregnant Women Antiplatelet Therapy Infective Endocarditis Prophylaxis Clinical Assessment Echocardiography Evaluation and Treatment of Prosthetic Valve Dysfunction Structural Valve Deterioration Paravalvular Regurgitation Infective Endocarditis Thromboembolism Prosthetic Valve Thrombosis Hemolytic Anemia Prosthesis-Patient Mismatch References 24 Valve Disease in Children Key Points Mitral Valve Mitral Stenosis Clinical Presentation Diagnostic Tests Treatment Mitral Regurgitation Clinical Presentation Diagnostic Tests Disease Progression Treatment Aortic Valve Aortic Valvular Stenosis Diagnostic Tests Disease Progression Treatment Subaortic Stenosis Clinical Presentation Diagnostic Tests Disease Progression Treatment Supravalvular Aortic Stenosis Clinical Presentation Diagnostic Tests Disease Progression Treatment Aortic Regurgitation Clinical Presentation Diagnostic Tests Disease Progression Treatment Tricuspid Valve Tricuspid Regurgitation Clinical Presentation Diagnostic Tests Disease Progression Treatment Tricuspid Stenosis Clinical Presentation Diagnostic Tests Disease Progression Treatment Pulmonary Valve Pulmonary Stenosis Clinical Presentation Diagnostic Tests Pulmonary Regurgitation References 25 Valvular Heart Disease in Pregnancy Physiologic Changes of Pregnancy Normal Hemodynamic Changes Pregnancy Positional Changes Peripartum and Postpartum Changes Evaluation by Echocardiography Cardiac Output Normal Anatomic Changes Doppler Changes Epidemiology Risk Factors for Adverse Outcomes Basic Clinical Approach Evaluation of Disease Severity Management during Pregnancy Clinical Monitoring Medical Therapy Effects of Intercurrent Illness Inheritability Management in the Peripartum Period Peripartum Hemodynamic Monitoring Type of Delivery Timing of Surgical Intervention Specific Valvular Lesions and Outcomes Aortic Stenosis Mitral Stenosis Aortic Regurgitation Mitral Regurgitation Right-Sided Valve Disease Prosthetic Valves Outcomes Medical Therapy Anticoagulation References Appendix 1: Acc/aha guidelines classification and levels of evidence Appendix 2: Esc guidelines classification and levels of evidence Index A B C D E F G H I J K L M N O P R S T U V W X Y The burden of valvular heart disease / George A. Mensah Clinical pathology of valvular heart disease / William Clifford Roberts and Jong Mi Ko Cellular, molecular and genetic mechanisms of valvular heart disease / Nalini Marie Rajamannan Left ventricular adaptation to pressure and/or volume overload / Blase A. Carabello Evaluation of valvular heart disease by echocardiography / Catherine M. Otto Evaluation of valvular heart disease by cardiac catheterization and angiocardiography / David M. Shavelle Evaluation of valvular heart disease by cardiac magnetic resonance and computed tomography / Mario J. Garcia Basic principles of medical therapy in the patient with valvular heart disease / Catherine M. Otto Aortic stenosis / Raphael Rosenhek and Helmut Baumgartner Aortic regurgitation / Pilar Tornos and Robert O. Bonow The bicuspid aortic valve / Alan C. Braverman and Michael A. Beardslee Surgical approach to aortic valve disease / Paul Stelzer and David H. Adams Percutaneous aortic valve implantation / Brad Munt Rheumatic mitral valve disease / Bernard Iung and Alec Vahanian Myxomatous mitral valve disease / Brian Griffin Ischemic mitral regurgitation / Robert A. Levine ... [et al.] Mitral regurgitation : timing of surgery / Rick A. Nishimura and Hartzell V. Schaff Mitral valve repair and replacement, including associated atrial fibrillation and tricuspid regurgitation / Patrick M. McCarthy and S. Chris Malaisrie Percutaneous transcatheter intervention for mitral regurgitation / Peter C. Block Intraoperative echocardiography for mitral valve disease / Pravin M. Shah Right-sided valve disease / Charles J. Bruce and Heidi M. Connolly Infective endocarditis / Thomas M. Bashore Prosthetic heart valves / Patrick T. O'Gara Valve disease in children / L. LuAnn Minich ... [et al.] Valvular heart disease in pregnancy / Karen Stout. Valvular Heart Disease is now an even better source for all your questions on dysfunctions or abnormalities of the heart2s four valves. In the third edition, Catherine Otto is joined by Robert Bonow and a team of expert contributors to bring you the latest developments in imaging and treatment. The full-color images and illustrations reflect the cutting-edge imaging and diagnostic modalities--Doppler echo and MR--that are so important for diagnosing aortic valve defects. Superb diagrams, an increased focus on imaging and case-based presentation, and new chapters--on Cardiac MR and CT imaging for valvular heart disease; Genetic, molecular and cellular mechanisms of valvular disease; Bicuspid aortic valve disease; and Ischemic mitral regurgitation--further enhance this valuable reference. And, the full text is available online at expertconsult.com where you can search the entire contents. Presents comprehensive coverage of valvular heart disease to provide you with a complete reference and one-stop shop for this specialty in cardiac medicine. Provides complete guidance on how and why to surgically treat valve patients for a reliable manual on managing difficult cases. Features chapters on pediatric and pregnant patients so you know what considerations to take into account when treating these special populations