CHRONIC VALVULAR HEART-DISEASE - NATURAL-HISTORY AND INDICATION TO SURGERY

In industrialized countries, chronic valvular heart disease is nowaday s mainly of congenital or degenerative origin, while rheumatic valve d isease is more and more decreasing, The most frequent valvular lesion is today aortic stenosis, which usually shows a more rapid progression than aortic insufficiency or mitral valve lesions. The progression of chronic valve disease is, however, variable and often not predictable in individual cases, Thus, regular examinations are indicated dependi ng on the etiology, symptoms, left ventricular function and concomitan t lesions, An accelerated course is possible in patients with degenera tive aortic stenosis or concomitant coronary artery disease. In chroni c mitral insufficiency due to valve prolaps or coronary artery disease sudden decompensation or worsening of the clinical course can occur i n the case of chordal rupture or ischemic papillary muscle dysfunction . Most pure valvular lesions of other etiology than mitral valve prola ps progress slowly, The indication for valve surgery or valvuloplasty is usually given, when symptoms occur in the presence of severe valve dysfunction or even when moderate symptoms are present, when reconstru ctive surgery is possible (mitral valve prolaps). Aortic stenosis is t ypically operated in all except very young or very old patients, where as mitral stenosis is usually treated by balloon valvuloplasty in pati ents with mobile and minimally calcified lesions. In severe volume ove rload operation is indicated not only by symptoms, but also in the eve nt of severe left ventricular dilatation or decrease of left ventricul ar ejection fraction in order to prevent irreversible myocardial damag e with consecutive poor systolic function after valve operation. In mi tral regurgitation due to mitral valve prolaps operation is usually pe rformed even in asymptomatic patients with moderate insufficiency beca use of the favourable results after reconstructive surgery. Primary he art transplantation should be considered in the case of valvular lesio ns with severely compromised left ventricular function.