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2017 Update Incorporated - Valvular Heart Disease

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2 Key Points Î Patients with valvular heart disease (VHD) may present with a heart murmur, symptoms, or incidental findings of valvular abnormalities on noninvasive testing. Î The initial evaluation should include a detailed history and physical exam, electrocardiogram (ECG), chest x-ray, and transthoracic echocardiogram (TTE). Î Decisions about treatment are based primarily on the presence or absence of symptoms, severity of VHD, and response of the ventricle to pressure or volume overload imposed by VHD. Î VHD requires a multidisciplinary team and approach for its diagnosis and management. Î Reasons for valve intervention are to improve symptoms, prolong survival, and reduce the risk of complications. Î An evaluation of the surgical or interventional risk for each individual patient should be performed if intervention is indicated which includes a standard surgical risk score, along with consideration of comorbidites, frailty, and procedure specfic impediments. Î Follow-up of patients with VHD is important to assess symptom status, provide patient education, and monitor disease severity, typically with periodic echocardiography. Table 1. The Heart Valve Team Recommendations COR LOE Patients with severe VHD should be evaluated by a multidisciplinary Heart Valve Team when intervention is considered. I C Consultation with or referral to a Heart Valve Center of Excellence is reasonable when discussing treatment options for • asymptomatic patients with severe VHD, • patients who may benefit from valve repair versus valve replacement, or • patients with multiple comorbidities for whom valve intervention is considered. IIa C The Heart Valve Team

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