{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;5\\\/1\\\/10\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;5\\\/1\\\/10\u0022}],\u0022ac\u0022:{\u0022spmdc;5\\\/1\\\/10\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;5\\\/1\\\/10\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAortic regurgitation (AR) suffers from sparse data, according to Jeffrey S. Boyer, MD, of the Weill Medical College of Cornell University in New York, NY. \u201cAR has been studied less than any other form of valvular heart disease,\u201d he said.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Evalvular\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cblockquote id=\u0022disp-quote-1\u0022 class=\u0022disp-quote\u0022\u003E\n            \u003Cp id=\u0022p-2\u0022\u003E\n               \u003Cstrong\u003ENine presenters across two sessions discussed various aspects of valvular heart disease, from key studies, optimum medications, and medical management vs. surgical repair. Emerging concepts in aortic stenosis received special attention, included in both the Special Session \u201cState-of-the-Art Management of Valvular Heart Disease\u201d and serving as the topic of a Cardiovascular Seminar two days later. Here are highlights from those presentations.\u003C\/strong\u003E\n            \u003C\/p\u003E\n         \u003C\/blockquote\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1661500229\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16069\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003E\n               \u003Cem\u003ECredit: AJ Photo\/Photo Researchers, Inc.\u003C\/em\u003E\n            \u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\n            \u003Cstrong\u003EAortic regurgitation\u003C\/strong\u003E (AR) suffers from sparse data, according to Jeffrey S. Boyer, MD, of the Weill Medical College of Cornell University in New York, NY. \u201cAR has been studied less than any other form of valvular heart disease,\u201d he said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ECalcium channel antagonists have received attention as vasodilators of choice in AR. Studies, however, have been contradictory.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Boyer reported a recent study (Evangelista et al, \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E 2005) which randomized 95 individuals with AR between nifedipine, enalapril, and no treatment. Endpoints were LV functional status and need for valve replacement surgery. After a 7-year follow-up, aortic valve replacement was roughly similar between all three study arms, although fewer (39%) in the control (no medication) group went on to replacement. Replacement surgery was somewhat higher in the enalapril arm (50%) and somewhat less (41%) in the nifedipine arm.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAn earlier study, however (Sondergaard et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2000: 139), used MRI to demonstrate that felodipine brought favorable short- and long-term improvements in AR, and actually reduced the regurgitant volume.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EIn calling for more AR studies, Dr. Borer offered the following guidance: Pay close attention to all clinical variables that contribute to long term outcomes and consider long-acting nifedipine the best and most current approach to long-term pharmacotherapy for AR.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003E\n            \u003Cstrong\u003EMitral stenosis\u003C\/strong\u003E (MS) is less commonly seen in the United States thanks to prophylaxis of rheumatic fever. But in the developing world, notably Africa and India, MS is still common. Stenotic lesions typically emerge 10\u201320 years post-infection. Overt symptoms generally fail to emerge until the stenotic valve leads to functional impairment.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E\u201cPercutaneous mitral valve balloon valvuloplasty (PMV) is the procedure of choice for selected patients with mitral stenosis,\u201d said Igor F. Palacios, MD, Associate Professor of Medicine at Harvard Medical School.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EPMV is \u201cwidely accepted as an excellent alternative to commissurotomy for managing patients whose stenosis has become symptomatic,\u201d he said. \u201cStudies show that PMV offers dependable immediate and long-term follow-up results. And that\u0027s what we\u0027re seeing in our patients as well.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDr. Palacios and his colleagues have developed a scoring system based on echocardiography that helps to select patients more likely to see positive outcomes with PMV. Dr. Palacios has published several reports on his \u201cecho score\u201d over the last decade, and \u201cthis system has proven fundamental to predicting both immediate and long-term outcomes.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cPMV achieves excellent hemodynamic and clinical improvement,\u201d Dr. Palacios said. \u201cImprovements continue at long-term follow-up as well.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Transesophageal echography of a mitral valve leak\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1661500229\u0022 data-figure-caption=\u0022Transesophageal echography of a mitral valve leak\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/10\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16070\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ETransesophageal echography of a mitral valve leak\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003E\n               \u003Cem\u003ECredit: James Cavallini\/Photo Researchers, Inc\u003C\/em\u003E\n            \u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003E\n            \u003Cstrong\u003EMitral regurgitation\u003C\/strong\u003E \u201cbegets more mitral regurgitation,\u201d said Patrick O\u0027Gara, MD, Director, Cardiovascular Division, Brigham \u0026amp; Women\u0027s Hospital, Boston, MA. \u201cChronic volume overload leads on to LV dysfunction. And things tend to degrade from there.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EWhat do we know about chronic mitral regurgitation in 2005? \u201cMyxomatous degeneration dominates as the causative pathology in the United States,\u201d Dr. O\u0027Gara said, accounting for 45% of all cases. \u201cIt\u0027s the most common cause of mitral regurgitation among adults.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EWith regard to surgery, \u201crepair beats replacement every time,\u201d Dr. O\u0027Gara said. \u201cRepair should be the choice in 90% of patients.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EThere are special challenges in MR, Dr. O\u0027Gara noted, including \u201cpatients who present initiallly with ischemic changes, very severe LV dysfunction, and infective endocarditis.\u201d But \u201cwhatever the clinical scenario, there are three objectives to keep in mind: establish the specific etiology of the chronic regurgitation, quantitate the severity, and stratify risk. And remember the importance of antibiotic prophylaxis.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EDr. O\u0027Gara urged collaborative approaches to care in MR. \u201cInstitute a coordinated team approach. Work with the surgeon and other caregivers. Everybody should be in the loop.\u201d And when it comes to initiating this approach Dr. O\u0027Gara said, \u201cthe earlier the better. I firmly recommend consulting earlier rather than later\u2014the outcomes definitely improve.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003E\n            \u003Cstrong\u003EAortic stenosis\u003C\/strong\u003E (AS) is another valvular abnormality where \u201cthe jury is still out on pharmacotherapeutic approaches,\u201d Dr. O\u0027Gara said. \u201cStatins appear to retard the rate of progression in AS, with ACEIs doing the opposite. But a recent study (Cowell SJ et al, \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E 2005) did not bear out statin superiority. \u201cStay tuned on this issue,\u201d Dr. O\u0027Gara said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EIn a companion presentation, \u201cAortic Stenosis in Clinical Practice\u2014Statins and Beyond,\u201d Nalini Rajamannan, MD, Northwestern University Medical Center, Chicago, IL, presented intriguing new evidence supporting the role of valve calcification in the development of AS. \u201cEpidemiological studies support an \u2018atherosclerotic hypothesis\u2019 for the cellular mechanisms behind AS,\u201d Dr. Rajamannan said. \u201cWe\u0027re seeing that the same risk factors for atherosclerotic disease are risk factors for AS. And hsCRP levels are elevated as well in AS. This appears to be an inflammatory process associated with calcification.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EEmerging experimental evidence has demonstrated calcification and \u201cbone-like features\u201d including osteoclast deposition in stenotic aortic valves. \u201cHypercholesterolemia plays a role in this calcification,\u201d Dr. Rajamannan said. She referred to a study by Shavelle and colleagues (\u003Cem\u003ELancet\u003C\/em\u003E 2002) which found that statin therapy reduced aortic valve calcification by more than 60%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EThis mirrored Dr. O\u0027Gara\u0027s earlier report that statins, at least in some studies, retard AS progression. With new evidence pointing to inflammatory and calcific features in AS, statins appear to be promising medical alternatives for treatment of AS.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003E\n            \u003Cstrong\u003ETricuspid regurgitation\u003C\/strong\u003E \u201cinvolves the nearly forgotten valve,\u201d said Heidi Connolly, MD, Mayo Clinic, Rochester, MN.\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe causes of tricuspid regurgitation \u201care many, but it is not the most common valvular abnormality. Tricuspid regurgitation is often associated with right-sided heart overload, so we tend to see hypoxia, cyanosis, and polycythemia. But not all tricuspid regurgitation is \u2018pure\u2019 (only one etiology) and when there are other valves involved there will certainly be signs and symptoms related to LV dysfunction as well.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003ECauses of tricuspid regurgitation can range from rheumatic heart disease (the most common \u2018pure\u2019 etiology) to endocarditis, prolapse, and papillary muscle dysfunction. Other causes include carcinoid, Marfan Syndrome, as well as the congenital Ebstein anomaly.\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003E\u201cMedical care is limited,\u201d Dr. Connolly said. \u201cDiuretics are the only drugs demonstrated to help.\u201d Nor are there adequate percutaneous techniques. \u201cWhen medical therapy fails, you have to get in there and fix the problem.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-27\u0022\u003EDr. Connolly reviewed annuloplasty techniques, noting that replacement with a porcine valve is indicated in cases resulting from either rheumatic disease or carcinoid, or when there is recurrent regurgitation despite earlier repair. \u201cThere are mechanical valves available as well, but we see no difference in outcomes between bioprostheses versus mechanical valves.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2005 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/5\/1\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}