Valvular Heart Disease: A Companion to Braunwald's Heart Disease: Expert Consult - Online and Print, Third Edition

466 Pages·2009·202.15 MB·English

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VALVULAR HEART DISEASE: 978-1-4160-5892-2
A COMPANION TO BRAUNWALD’S HEART DISEASE
Copyright © 2009, 2004, 1999 by Saunders, an imprint of Elsevier Inc.
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Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment and drug therapy may become
necessary or appropriate. Readers are advised to check the most current information provided
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verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of the practitioner, relying on their own experience and
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each individual patient, and to take all appropriate safety precautions. To the fullest extent of the
law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to
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The Publisher
Library of Congress Cataloging-in-Publication Data
Valvular heart disease : a companion to Braunwald’s heart disease / [edited by] Catherine M. Otto,
Robert O. Bonow. – 3rd ed.
p. ; cm.
Rev. ed. of: Valvular heart disease / Catherine M. Otto. c2004.
Includes bibliographical references and index.
ISBN 978-1-4160-5892-2
1. Heart valves–Diseases. I. Otto, Catherine M. II. Bonow, Robert O. III. Otto, Catherine M.
Valvular heart disease. IV. Braunwald’s heart disease.
[DNLM: 1. Heart Valve Diseases–therapy. 2. Heart Valve Diseases–diagnosis. 3. Heart Valve
Diseases–pathology. WG 260 V2152 2009]
RC685.V2O78 2009
616.1’25–dc22
2008044872
Executive Publisher: Natasha Andjelkovic
Project Manager: Bryan Hayward
Design Direction: Steve Stave
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1

v
Contributors
David H. Adams, MD Charles J. Bruce, MD
Professor and Chairman Associate Professor of Medicine
Department of Cardiothoracic Surgery Mayo Clinic College of Medicine
Mount Sinai Medical Center Consultant, Division of Cardiovascular Diseases
New York, New York Department of Internal Medicine, Mayo Clinic
Rochester, Minnesota
Thomas M. Bashore, MD
Professor of Medicine Blase A. Carabello, MD
Vice Chief, Division of Cardiology Professor and Vice-Chair
Duke University Medical Center Department of Medicine
Durham, North Carolina The W.A. “Tex” and Deborah Moncrief, Jr. Baylor College
of Medicine
Helmut Baumgartner, MD Medical Care Line Executive
Professor of Adult Congenital Heart Disease Department of Medicine, Veterans Affairs Medical Center
Adult Congenital and Valvular Heart Disease Center Houston, Texas
University Hospital Muenster
University of Muenster Heidi M. Connolly, MD
Muenster, Germany Professor of Medicine
Mayo Clinic College of Medicine
Michael A. Beardslee, MD Division of Cardiovascular Diseases
Associate Professor of Medicine Mayo Clinic
Cardiovascular Division Rochester, Minnesota
Department of Medicine
Washington University School of Medicine Mario J. Garcia, MD
St. Louis, Missouri Professor of Medicine and Radiology
Director Cardiovascular Imaging
Ronen Beeri, MD Mount Sinai Medical Center
Cardiovascular Research Center, New York, New York
Heart Institute
Hadassah-Hebrew University Medical Center Brian P. Griffin, MD
Jerusalem, Israel John and Rosemary Brown Endowed Chair in
Cardiovascular Medicine
Peter C. Block, MD Department of Cardiovascular Medicine
Director, Clinical Trials Office Cleveland Clinic
Department of Cardiology Cleveland, Ohio
Emory University Hospital
Atlanta, Georgia Bernard Iung, MD
Department of Cardiology
Robert O. Bonow, MD Bichat Hospital
Goldberg Distinguished Professor of Cardiology Paris, France
Northwestern University Feinberg School of Medicine
Chief, Division of Cardiology Jong Mi Ko, BA
Co-Director, Bluhm Cardiovascular Institute Research Assistant
Northwestern Memorial Hospital Baylor Heart and Vascular Institute
Chicago, Illinois Baylor University Medical Center
Dallas, Texas
Alan C. Braverman, MD
Professor of Medicine Robert A. Levine, MD
Cardiovascular Division Professor of Medicine
Department of Medicine Harvard Medical School
Washington University School of Medicine Cardiac Ultrasound Laboratory
St. Louis, Missouri Massachussets General Hospital
Boston, Massachussets
v
vi S. Chris Malaisrie, MD Michael D. Puchalski, MD
Assistant Professor of Surgery Assistant Professor
s
or Northwestern University Feinberg School of Medicine Department of Pediatrics
t
u Director of Thoracic Aortic Surgery University of Utah School of Medicine
b
ri Bluhm Cardiovascular Institute Primary Children’s Medical Center
t
n
o Northwestern Memorial Hospital Salt Lake City, Utah
C
Chicago, Illinois
Nalini Marie Rajamannan, MD
Patrick M. McCarthy, MD Associate Professor of Medicine
Heller-Sacks Professor of Surgery Division of Cardiology
Northwestern University Feinberg School of Medicine, Department of Medicine
Chief, Division of Cardiothoracic Surgery Feinberg Cardiovascular Research Institute
Co-Director, Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine
Northwestern Memorial Hospital Chicago, Illinois
Chicago, Illinois
William C. Roberts, MD
George A. Mensah, MD Executive Director
Chief Medical Officer Baylor Heart and Vascular Institute
Associate Director for Medical Affairs Baylor University Medical Center
National Center for Chronic Disease Prevention and Dallas, Texas
Health Promotion
Centers for Disease Control and Prevention Raphael Rosenhek, MD
Atlanta, Georgia Associate Professor
Department of Cardiology
L. LuAnn Minich, MD Medical University Vienna
Professor, Department of Pediatrics Vienna, Austria
University of Utah School of Medicine
Primary Children’s Medical Center Hartzell V. Schaff, MD
Salt Lake City, Utah Stuart W. Harrington Professor of Surgery
Mayo Clinic College of Medicine
Brad Munt, MD Division of Cardiovascular Surgery
Echocardiography Laboratory Mayo Clinic
St. Paul’s Hospital and Providence Health Rochester, Minnesota
Vancouver, British Columbia, Canada
Ehud Schwammenthal, MD
Rick A. Nishimura, MD Department of Cardiac Rehabilitation
Judd and Mary Morris Leighton Professor of Heart Institute
Cardiovascular Diseases Sheba Medical Center
Professor of Medicine Tel Hashomer, Israel
Mayo Clinic College of Medicine
Division of Cardiovascular Diseases Pravin M. Shah, MD
Mayo Clinic Chair and Medical Director
Rochester, Minnesota Hoag Heart Valve Center
Medical Director
Patrick T. O’Gara, MD Non-Invasive Cardiac Imaging
Associate Professor of Medicine Hoag Heart and Vascular Institute
Harvard Medical School Newport Beach, California
Director of Clinical Cardiology
Brigham & Women’s Hospital David M. Shavelle, MD
Boston, Massachusetts Associate Professor of Medicine
Division of Cardiology
Yutaka Otsuji, MD David Geffen School of Medicine at UCLA
Second Department of Internal Medicine Director, Interventional Cardiology Fellowship
University of Occupational and Environmental Health Los Angeles County/Harbor-UCLA Medical Center
Sangyo University of Occupational and Environmental Torrance, California
Health
Kitakyushu, Japan Paul Stelzer, MD
Professor, Department of Cardiothoracic Surgery
Catherine M. Otto, MD Mount Sinai Medical Center
J. Ward Kennedy-Hamilton Endowed Professor of Cardiology New York, New York
Director, Cardiology Fellowship Programs
University of Washington School of Medicine
Seattle, Washington
Karen Stout, MD Alec Vahanian, MD vii
Director, Adult Congenital Heart Disease Program Department of Cardiology
C
Assistant Professor of Medicine Bichat Hospital o
n
Adjunct Assistant Professor of Pediatrics Paris, France t
r
University of Washington School of Medicine ib
u
Seattle, Washington Richard V. Williams, MD to
r
Associate Clinical Professor s
Lloyd Y. Tani, MD Department of Pediatrics
Professor, Department of Pediatrics University of Utah School of Medicine
University of Utah School of Medicine Primary Children’s Medical Center
Primary Children’s Medical Center Salt Lake City, Utah
Salt Lake City, Utah
Pilar Tornos, MD
Servei de Cardiologia
Hospital Universitari Vall d’Hebron
Barcelona, Spain

Preface
Worldwide, valvular heart disease remains a major cause This book integrates the diverse knowledge required for
of morbidity and mortality. In the United States, there are optimal care of the patient with valvular heart disease by each
approximately 100,000 open-heart operations each year for of these health professionals. Since the publication of the sec-
valve replacement or repair, which accounts for about 20% ond edition of Otto’s Valvular Heart Disease, there have been
of all cardiac surgical cases. A far greater number of patients substantial advances in our understanding of the disease pro-
have valve disease that is managed medically. Because the cesses and optimal treatments for valvular heart disease, with
prevalence of valve disease increases as a function of age, we an upsurge of interest in understanding the causes of valve
anticipate that even greater numbers of patients will come disease and improved diagnostic techniques. With publication
to medical attention with the aging of the population in this of updated guidelines by the American College of Cardiology/
country and abroad. American Heart Association (ACC/AHA) and the European
Recognition of a heart murmur remains central to the prac- Society of Cardiology, evidence-based approaches to the treat-
tice of medicine because primary care physicians usually ment of valvular heart disease are becoming accepted. We
make the initial diagnosis of valvular heart disease followed anticipate more clinical outcome studies in patients with val-
by referral to a specialist. Noninvasive methods for diagno- vular heart disease in the future. This field has now matured to
sis and evaluation of disease severity have greatly increased the point where a multi-author book, building on the material
our knowledge of valvular heart disease: the ability to moni- in the second edition, and inclusion as part of the Braunwald
tor stenosis severity with varying flow rates has broadened Companion Series is appropriate.
our understanding of the complex hemodynamics of valvu- The authors for each chapter were chosen for their clin-
lar stenosis and regurgitation; serial noninvasive studies in ical and research expertise, although we acknowledge that
patients with mild or moderate degrees of valve dysfunction there now are many other experts in valvular heart disease
have improved our understanding of the natural history of worldwide who could not be included in this volume due to
valvular disease; and these noninvasive methods now allow space limitations. Each chapter provides a summary of the
precise assessment of the changes in valvular and ventricular pathophysiology, clinical presentation, and natural history of
function after medical or surgical interventions. In addition, the disease process along with a discussion of medical ther-
better options for correction of valve dysfunction, including apy and timing of surgical intervention, including postopera-
percutaneous interventions, improved valve substitutes, and tive outcome. Each chapter is extensively illustrated and the
the increasing use of valve repair procedures now are avail- major clinical trials are summarized in tables whenever pos-
able. Earlier intervention is increasingly being considered sible. Current guidelines are provided and discussed in each
as the risk-benefit ratio improves and as the potential long- chapter, with an appendix providing the exact definitions of
term adverse consequences of valve disease are more clearly the recommendation grades and levels of evidence used in
defined. the ACC/AHA guideline documents. The reference list for
Optimal care of the patient with valvular heart disease each chapter emphasizes more recent studies, with only the
requires knowledgeable collaboration among several different most important earlier studies cited.
types of health professionals. The diagnosis often is suspected The book begins with a section on basic principles in diag-
by the primary care physician or nurse practitioner based on nosis and management of valvular heart disease. Chapters
auscultation of a cardiac murmur or recognition of symp- discuss disease prevalence and anatomic pathology followed
toms that might be due to valvular disease. Further evalu- by an in-depth chapter on our rapidly expanding knowl-
ation by a cardiologist typically involves subspecialists in edge of the cellular and molecular mechanisms of disease
echocardiography and interventional cardiology, as well as initiation and progression. A chapter on the left ventricular
the skilled assistance of cardiac sonographers, radiology tech- response to pressure and/or volume overload is included as
nicians, and cardiac catheterization laboratory technologists. this is a key factor in the decision-making process regarding
Cardiac surgeons expert in valve repair or replacement have the optimal timing of surgical intervention. Next are several
made enormous advances in the past two decades that have chapters on diagnostic evaluation of valvular heart disease
transformed the outlook of patients with valve disease. In by echocardiography, cardiac catheterization, and advanced
patients undergoing surgical or percutaneous intervention, cardiac imaging techniques. The chapter on basic principles
cardiovascular anesthesiologists, cardiac perfusionists, and of medical management in patients with valvular heart
coronary care unit nurses are all key members of the team. disease serves as a quick clinical reference source with tables
Increasingly, cardiac surgeons and interventional cardiologist summarizing indications for echocardiography and timing
are working together to decide on the optimal treatment plan of follow-up studies, diagnosis and prevention of rheumatic
in each patient, with the increasing use of “hybrid” approach fever, updated endocarditis guidelines, recommendations for
where a combination of surgical and nonsurgical techniques physical activity in patients with valve disorders, an over-
are used in an procedure suite designed for both open surgi- view of anticoagulation recommendations, and indications
cal or robotic and percutaneous procedures. In addition, opti- for coronary angiography.
mal management of patients with valvular heart disease often The next section of the book addresses aortic valve disease
depends on close collaboration with other medical special- and includes chapters on aortic stenosis, aortic regurgitation,
ties, for example, high-risk obstetrics in the pregnant patient the bicuspid aortic valve, and both surgical and percutane-
with valvular heart disease, medical genetics in patients with ous approaches to treatment of aortic valve disease. The sec-
inherited conditions, electrophysiologists when arrhythmias tion on mitral valve disease includes separate chapters on
complicate the clinical presentation, and the heart transplant rheumatic valve disease, myxomatous mitral valve disease,
team in patients with irreversible ventricular dysfunction. functional mitral regurgitation, timing of surgery for mitral
ix