Significant VHD affects at least two and half percent of the US population.
The estimated US prevalence of the HD is 15 to 18,000,000 adults.
Prevalence of the HD increases with age.
13% of people greater than 75 years old have at least moderate aortic or mitral valve disease.
Mitral valve disease, dominated by mitral regurgitation, is the most frequent left-sided VHD.
Mitral prolapse estimated prevalence at 2.4% and predominantly occurs in adults and associated with overlapping significant mitral regurgitation in 15%.
Hemodynamically significant right sided VHD mostly tricuspid regurgitation has a prevalence of 0.55% of the adult population and dominates in older subjects.
Bicuspid aortic valve mostly reveals itself during adulthood with the prevalence estimated at 1.3% of live births.
Patients with grade 3 or greater systolic murmurs, any diastolic or radiating murmurs or any nonphysiologic splitting, clicks or evidence of heart failure should have echocardiographic evaluation.
The final pathway of valvular heart disease is heart failure, and sometimes sudden death.
Transthoracic echocardiography is the pref2242ed initial test for the diagnosis of suspected valvular heart disease.
Transesophageal echocardiography may provide better definition of posterior heart structures like the mitral valve and for prosthetic valves where transthoracic echocardiography views may be limited by acoustic shadowing.
Three dimensional echocardiography is valuable for assessing complex valvular disease, such as mitral valve prolapse and for planning valvular surgery.
Cardiovascular magnetic resonance is excellent for evaluating valve structure and function and for measuring cardiac volumes and for adds information in regurgitant disease.
It is recommended that repeated transthoracic echocardiography follow up for aortic stenosis for mild degree is 3 to 5 years, for moderate disease 1 to 2 years, and for severe disease is annually.
It is recommended that repeated transthoracic echocardiography follow up for aortic regurgitation be done at 2 to 3 years for mild disease, 1 to 2 years for moderate disease and 6-12 months for severe disease.
It is recommended that repeated transthoracic echocardiography follow not be done for mitral regurgitation of mild disease, 6-12 months for moderate disease and 6 to 12 months for severe disease.
It is recommended that repeated transthoracic echocardiography follow up be done for mitral stenosis at 3 to 5 years for mild disease, 1 to 2 years for moderate disease and one year for severe disease.
Mortality for isolated aortic valve surgery is 4.4% includes procedures performed on 80 and 90 year olds.
Mechanical valves have longer durability than tissue prostheses but will require lifelong anticoagulation.
Patients with mitral or aortic valve who experience stroke, TIA’s or amaurosis fugax have increased risk of death but not recurrent stroke.
Caused about 20,000 deaths in 2003 and contributes to another 22,500 deaths per year.
Reported to occur with ergot-derived dopamine antagonists pergolide, bromocriptine and cabergoline.
Seen with ergot-derived dopamine agonists similar to lesions seen with antimigraine ergot alkaloid agents ergotamine and methysergide and the anorectic drugs Fenfluramine and dexfenfluramine.
Drug induced heart valve lesions are similar to carcinoid related valvular changes.
Suggested that heart valve disease induced by drugs may be mediated by the serotoninergic system, with high affinity for serotonin receptor subtype 5-HT-2b, which is expressed in heart valves and is able the mediated mitogenesis.
It is theorized that proliferation of fibroblasts occur within heart valves when 5-HT2b receptors are stimulated.
There is an increased risk of heart valve regurgitation with the use of ergo derived dopamine receptors antagonists, pergolide and cabergoline , for the treatment of Parkinson’s disease.
Valvular calcification precedes valvular stenosis.
Mitral annular calcification is associated with cardiovascular risk that is increased by 50%.