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In the United States alone there are 15–20 million people suffering from valvular heart disease, yet until recently guidelines used to treat these diseases were quite outdated. Some of the additions to the 2006 guidelines include methods to quantify valve severity, proper timing of valve surgery and indications for mitral valve repair. Additionally, these modernized guidelines urge physicians to look for early indicators of disease, rather than waiting for symptoms to develop.

Aortic Stenosis (AS)

The updated guidelines include grading criteria of AS severity using definitions of jet velocity, mean pressure gradient and valve area. Unfortunately there is no single number or test to define severe AS, but according to the new guidelines severe AS can be diagnosed if any of the following are true:

• Jet velocity >4 m/s

• Mean pressure gradient >40mmHg

• Valvular area <1.0 cm²

For the asymptomatic patient, the following procedures should be performed:

• Echocardiography

• Exercise Testing (although it should be noted that exercise testing should absolutely not be performed in symptomatic patients)

• Careful counseling and patient history

Mitral Regurgitation (MR)

“Early surgical repair has changed the entire paradigm for the treatment of MR,” says Patrick O'Gara, MD, Associate Professor of Medicine at Harvard Medical School. With a suitable anatomical valve and a skilled surgical team, mitral valve repair has become very successful. The new guidelines advocate clinical evaluation and echocardiography, followed by the assessment of left ventricle function and mitral valve repair when success is probable (>90%).

Surgical Considerations

Surgery is now indicated for valve diseases more than ever due to the advent of reliable mechanical and biosynthetic prostheses, reliable valve repair procedures and low operative morbidity and mortality. The new guidelines specify who should be considered for various kinds of valve replacements/repairs. For example, mechanical aortic valve replacement is indicated for patients who already have a mechanical valve in the mitral or tricuspid positions, but a bioprosthesis is suggested for patients who have contraindications for warfarin therapy.

These long overdue guidelines should facilitate the practice of evidence-based medicine, leading to better survival rates and improved qualities of life.

For a downloadable version of the AHA/ACC 2006 Guidelines for the Management of Patients with Valvular Heart Disease, please visit: http://www.americanheart.org/presenter.jhtml?identifier=3040213