While most cases of valvular disease in the United States were at one time due to rheumatic heart disease (still true in developing countries), other causes are now more common. The typical findings of each lesion are described in Table 10-1.
Echocardiography yields information about valve morphology, left ventricular mass and function, and atrial and ventricular chamber size. Doppler ultrasound provides quantitative measurements of transvalvular gradients and pulmonary artery pressure and gives more qualitative estimates of valvular regurgitation. The prevalence of mild or even moderate valvular regurgitation is not small, and care must be taken not to overestimate the importance of these findings. Transesophageal echo (TEE) often provides improved image quality. Valve morphology (particularly with prosthetic valves), vegetations, thrombi, and eccentric regurgitant jets are more easily identified with TEE.
The now withdrawn diet medications fenfluramine and dexfenfluramine may be associated with valvular heart disease, but whether these agents cause clinically significant valvular abnormalities remains controversial. Recent data suggest that this is, if anything, a rare occurrence.
Bonow RO et al: Guidelines for the management of patients with valvular heart disease. Circulation 1998;98:1949.
Boon NA: The medical management of valvar heart disease. Heart 2002;87:395.
Pretre R et al: Cardiac valve surgery in the octogenarian. Heart 2000;83:116.
Sachdev M et al: Effect of fenfluramine-derivative diet pills on cardiac valves: a meta-analysis of observational studies. Am Heart J 2002;44:1065.
Shipton B et al: Valvular heart disease: review and update. Am Fam Physician 2001;63:2201.
Revision date: June 11, 2011
Last revised: by Dave R. Roger, M.D.