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Valvular Heart Disease: Introduction, Clinical Pathogenesis, and Management

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Pathophysiology and Pharmacotherapy of Cardiovascular Disease

Abstract

Valvular heart disease (VHD) is a common cardiac condition with a big impact on healthcare economics. The incidence of VHD had been increasing over the past few decades, likely due to aging population [1]; improved mortality outcomes with increased survival in patients with conditions such as ischemic heart disease, chronic kidney disease, inflammatory disease states, and oncologic patients; earlier diagnoses due to technologic advances in imaging tools; and iatrogenic valve disease such as prosthetic valve dysfunction [2]. It is important to have an in-depth understanding of the different types of VHD; the natural history; interplay between anatomic, genetic, and molecular mechanisms of specific VHD; impact of VHD on other organ systems; and advances in diagnostic and therapeutic options that will translate to improved patient outcomes [3].

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References

  1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on practice guidelines. JACC. 2014;63(22):e57–185.

    PubMed  Google Scholar 

  2. Boudoulas KD, Borer JS, Boudoulas H. Etiology of valvular heart disease in the 21st century. Cardiology. 2013;126:139–52.

    Google Scholar 

  3. Maganti K, Rigolin VR, Sarano ME, et al. Valvular heart disease: diagnosis and management. Mayo Clin Proc. 2010;85(5):483–500.

    PubMed Central  PubMed  Google Scholar 

  4. Knomo VT, Gardin J, Skelton TN, et al. Burden of valvular heart disease: a population-based study. Lancet. 2006;368:1005–11.

    Google Scholar 

  5. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease: cardiovascular health study. J Am Coll Cardiol. 1997;29:630–4.

    CAS  PubMed  Google Scholar 

  6. Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis: the Tromsø study. Heart. 2013;99:396–400.

    PubMed  Google Scholar 

  7. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005;111(7):920–5.

    PubMed  Google Scholar 

  8. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789–800.

    PubMed  Google Scholar 

  9. Garg V, Muth AN, Ransom JF, et al. Mutations in NOTCH1 cause aortic valve disease. Nature. 2005;437:270–4.

    CAS  PubMed  Google Scholar 

  10. Aicher D, Urbich C, Zeiher A, et al. Endothelial nitric oxide synthase in bicuspid aortic valve disease. Annals of Thoracic Surgery. 1997;83(4):1290–4.

    Google Scholar 

  11. Katz R, Wong ND, Kronmal R, et al. Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the multi-ethnic study of atherosclerosis. Circulation. 2006;113:2113–9.

    PubMed  Google Scholar 

  12. Owens DS, Katz R, Takasu J, Kronmal R, Budoff MJ, O’Brien KD. Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA). Am J Cardiol. 2010;105:701–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  13. Kurtz CE, Otto CM. Aortic stenosis: clinical aspects of diagnosis and management, with 10 illustrative case reports from a 25-year experience. Medicine (Baltimore). 2010;89:349–79.

    Google Scholar 

  14. Dweck MR, Boon NA, Newby DE. Calcific aortic stenosis: a disease of the valve and the myocardium. J Am Coll Cardiol. 2012;60:1854–63.

    PubMed  Google Scholar 

  15. Towler DA. Molecular and cellular aspects of calcific aortic valve disease. Circ Res. 2013;113:198–208.

    PubMed Central  CAS  PubMed  Google Scholar 

  16. Faggiano P, Antonini-Canterin F, Erlicher A. Progression of aortic valve sclerosis to aortic stenosis. Am J Cardiol. 2003;91(1):99–101.

    PubMed  Google Scholar 

  17. Lilly LS. Braunwald’s heart disease: a textbook of cardiovascular medicine. Saunders: Elsevier Health Sciences; 2012.

    Google Scholar 

  18. Fernandes SM, Sanders SP, Khairy P, et al. Morphology of bicuspid aortic valve in children and adolescents. J Am Coll Cardiol. 2004;44(8):1648–51.

    PubMed  Google Scholar 

  19. Roberts WC. The congenitally bicuspid aortic valve: a study of 85 autopsy cases. Am J Cardiol. 1970;26(1):72–83.

    CAS  PubMed  Google Scholar 

  20. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292.

    PubMed  Google Scholar 

  21. Marijon E, Mirabel M, Celermajer DS, et al. Rheumatic heart disease. Lancet. 2012;379:953–64.

    PubMed  Google Scholar 

  22. Olsen MH, Wachtell K, Bella JN, et al. Aortic valve sclerosis relates to cardiovascular events in patients with hypertension (a LIFE substudy). Am J Cardiol. 2005;95(1):132–6.

    PubMed  Google Scholar 

  23. Otto CM, Predergast B. Aortic-valve stenosis-from patients at risk to severe valve obstruction. N Engl J Med. 2014;371:744–56.

    CAS  PubMed  Google Scholar 

  24. Novaro GM, Katz R, Aviles RJ, et al. Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease: the cardiovascular health study. J Am Coll Cardiol. 2007;50:1992–8.

    CAS  PubMed  Google Scholar 

  25. Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–56.

    PubMed  Google Scholar 

  26. Hekimian G, Boutten A, Flamant M, et al. Progression of aortic valve stenosis is associated with bone remodelling and secondary hyperparathyroidism in elderly patients—the COFRASA study. Eur Heart J. 2013;34:1915–22

    CAS  PubMed  Google Scholar 

  27. Rosenhek R, Klaar U, Schemper M, et al. Mild and moderate aortic stenosis: natural history and risk stratification by echocardiography. Eur Heart J. 2004;25:199–205.

    PubMed  Google Scholar 

  28. Stewart RA, Kerr AJ, Whalley GA, et al. Left ventricular systolic and diastolic function assessed by tissue Doppler imaging and outcome in asymptomatic aortic stenosis. Eur Heart J. 2010;31:2216–22.

    PubMed  Google Scholar 

  29. Iung B, Vahanian A. Degenerative calcific aortic stenosis: a natural history. Heart. 2012;98 Suppl 4:iv7–13.

    PubMed  Google Scholar 

  30. Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis: clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997;95:2262–70.

    CAS  PubMed  Google Scholar 

  31. Rajamannan NM, Evans FJ, Aikawa E, et al. Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: calcific aortic valve disease – 2011 update. Circulation. 2011;124:1783–91.

    PubMed Central  PubMed  Google Scholar 

  32. Lindman BR, Bonow RO, Otto CM. Current management of calcific aortic stenosis. Circ Res. 2013;113:223–37.

    PubMed Central  CAS  PubMed  Google Scholar 

  33. Detaint D, Michelena HI, Nkomo VT, et al. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart. 2014;100:126–34.

    PubMed  Google Scholar 

  34. Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart. 2008;94:1634–8.

    CAS  PubMed  Google Scholar 

  35. Eleid MF, Forde I, Edwards WD, et al. Type A aortic dissection in patients with bicuspid aortic valves: clinical and pathological comparison with tricuspid aortic valves. Heart. 2013;99:1668–74.

    PubMed  Google Scholar 

  36. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373(9667):956–66.

    PubMed  Google Scholar 

  37. Bach DS, Siao D, Girard SE, et al. Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement the potential role of subjectively overestimated operative risk. Circ: Cardiovasc Qual Outcomes. 2009;2(6):533–9.

    Google Scholar 

  38. Ross J, Braunwald E. Aortic stenosis. Circulation. 1968;38(1S5):V-61–7.

    Google Scholar 

  39. Bouma BJ, van Den Brink RB, van Der Meulen JH. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart. 1999;82(2):143–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  40. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95.

    CAS  PubMed  Google Scholar 

  41. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366:1696–704 [Erratum, N Engl J Med 2012;367:881.].

    CAS  PubMed  Google Scholar 

  42. Loscalzo J. From clinical observation to mechanism – Heyde’s syndrome. N Engl J Med. 2012;367:1954–6.

    CAS  PubMed  Google Scholar 

  43. Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005;111(24):3290–5.

    PubMed  Google Scholar 

  44. Carabello BA, Crawford MH. Aortic stenosis. In: Crawford MH, editor. Current diagnosis and treatment in cardiology. 2nd ed. New York: McGraw-Hill Professional; 2003. p. 108–20.

    Google Scholar 

  45. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1–23.

    PubMed  Google Scholar 

  46. Rajani R, Rimington H, Chambers JB. Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms. Heart. 2010;96:689–95.

    PubMed  Google Scholar 

  47. Maréchaux S, Hachicha Z, Bellouin A, et al. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis. Eur Heart J. 2010;31:1390–7.

    PubMed Central  PubMed  Google Scholar 

  48. Fougères E, Tribouilloy C, Monchi M, et al. Outcomes of pseudo-severe aortic stenosis under conservative treatment. Eur Heart J. 2012;33:2426–33.

    PubMed  Google Scholar 

  49. Gotzmann M, Lindstaedt M, Bojara W, et al. Clinical outcome of transcatheter aortic valve implantation in patients with low-flow, low gradient aortic stenosis. Catheter Cardiovasc Interv. 2012;79:693–701.

    PubMed  Google Scholar 

  50. Lancellotti P, Magne J, Donal E, et al. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol. 2012;59:235–43 [Erratum, J Am Coll Cardiol 2013;62:260.].

    CAS  PubMed  Google Scholar 

  51. Cowell SJ, et al. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005;352(23):2389–97.

    CAS  PubMed  Google Scholar 

  52. Moura LM, et al. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis. J Am Coll Cardiol. 2007;49(5):554–61.

    PubMed Central  CAS  PubMed  Google Scholar 

  53. Vasques F, Messori A, Lucenteforte E, et al. Immediate and late outcome of patients aged 80 years and older undergoing isolated aortic valve replacement: a systematic review and meta-analysis of 48 studies. Am Heart J. 2012;163:477–85.

    PubMed  Google Scholar 

  54. Reynolds MR, Magnuson EA, Lei Y, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in high risk patients with severe aortic stenosis: results of the PARTNER (placement of aortic transcatheter valves) trial (cohort A). J Am Coll Cardiol. 2012;60:2683–92.

    PubMed  Google Scholar 

  55. Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343:611–7.

    CAS  PubMed  Google Scholar 

  56. Rigolin V; Bonow R. Aortic Regurgitation. Valvular Heart Disease. 2009. A. Wang and T. M. Bashore, Humana Press: 187-205

    Google Scholar 

  57. Enriquez-Sarano M, Tajik AJ. Aortic regurgitation. N Engl J Med. 2004;351(15):1539–46.

    CAS  PubMed  Google Scholar 

  58. Singh JP, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham heart study). Am J Cardiol. 1999;83(6):897–902.

    CAS  PubMed  Google Scholar 

  59. Lebowitz NE, et al. Prevalence and correlates of aortic regurgitation in American Indians: the strong heart study. J Am Coll Cardiol. 2000;36(2):461–7.

    CAS  PubMed  Google Scholar 

  60. Dujardin KS, et al. Mortality and morbidity of aortic regurgitation in clinical practice a long-term follow-up study. Circulation. 1999;14:1851–7.

    Google Scholar 

  61. Roberts WC, et al. Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005). Circulation. 2006;114(5):422–9.

    PubMed  Google Scholar 

  62. Sutton M, Plappert T, Spiegel A, et al. Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study. Circulation. 1987;76:77–89.

    CAS  PubMed  Google Scholar 

  63. Feiring AJ, Rumberger JA. Ultrafast computed tomography analysis of regional radius-to-wall thickness ratios in normal and volume-overloaded human left ventricle. Circulation. 1992;85:1423–32.

    CAS  PubMed  Google Scholar 

  64. Rigolin V, Bonow RO. Hemodynamic characteristics and progression to heart failure in regurgitant lesions. Heart Fail Clin. 2006;2(4):453–46.

    PubMed  Google Scholar 

  65. Detaint D, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. J Am Coll Cardiol Img. 2008;1(1):1–11.

    Google Scholar 

  66. Mann T, McLaurin L, Grossman W, et al. Assessing the hemodynamic severity of acute aortic regurgitation and normal left ventricular function. N Engl J Med. 1975;293:108–13.

    CAS  PubMed  Google Scholar 

  67. Roes SD, et al. Flow assessment through four heart valves simultaneously using 3-dimensional 3-directional velocity-encoded magnetic resonance imaging with retrospective valve tracking in healthy volunteers and patients with valvular regurgitation. Investig Radiol. 2009;44(10):669–75.

    Google Scholar 

  68. Myerson SG, d’Arcy J, Mohiaddin R, et al. Clinical outcome in aortic regurgitation with cardiovascular magnetic resonance. Circulation. 2012;126(12):1452–60.

    PubMed  Google Scholar 

  69. Mahajerin A, et al. Vasodilator therapy in patients with aortic insufficiency: a systematic review. Am Heart J. 2007;153(4):454–61.

    CAS  PubMed  Google Scholar 

  70. Rowe JC, Bland EF, Sprague HB. The course of mitral stenosis without surgery: ten- and twenty-year perspectives. Ann Intern Med. 1960;52:741–9.

    CAS  PubMed  Google Scholar 

  71. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. 2003;24:1231–43.

    PubMed  Google Scholar 

  72. Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med. 2007;357:470–6.

    CAS  PubMed  Google Scholar 

  73. Padmavati S. Rheumatic heart disease: prevalence and preventive measures in the Indian subcontinent. Heart. 2001;86:127.

    PubMed Central  CAS  PubMed  Google Scholar 

  74. Paar JA, Berrios NM, Rose JD, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol. 2010;105:1809–14.

    PubMed Central  PubMed  Google Scholar 

  75. Galve E, Candell-Riera J, Pigrau C, et al. Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N Engl J Med. 1988;319:817–23.

    CAS  PubMed  Google Scholar 

  76. Wood P. An appreciation of mitral stenosis. I. Clinical features. Br Med J. 1954;4870:1051–63.

    Google Scholar 

  77. Gordon SP, Douglas PS, Come PC, Manning WJ. Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis implications for follow-up. J Am Coll Cardiol. 1992;19:968–73.

    CAS  PubMed  Google Scholar 

  78. Holen J, Aaslid R, Landmark K, et al. Determination of pressure gradient in mitral stenosis with a noninvasive ultrasound Doppler technique. Acta Med Scand. 1976;199:455–60.

    CAS  PubMed  Google Scholar 

  79. Hatle L, Brubakk A, Tromsdal A, et al. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J. 1978;40:131–40.

    PubMed Central  CAS  PubMed  Google Scholar 

  80. Nishimura RA, Rihal CS, Tajik AJ, et al. Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol. 1994;24:152–8.

    CAS  PubMed  Google Scholar 

  81. Kawahara T, Yamagishi M, Seo H, et al. Application of Doppler color flow imaging to determine valve area in mitral stenosis. J Am Coll Cardiol. 1991;18:85–92.

    CAS  PubMed  Google Scholar 

  82. Faletra F, Pezzano Jr A, Fusco R, et al. Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices. J Am Coll Cardiol. 1996;28:1190.

    CAS  PubMed  Google Scholar 

  83. Abascal VM, Wilkins GT, Choong CY, et al. Echocardiographic evaluation of mitral valve structure and function in patients followed for at least 6 months after percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1988;12:606–15.

    CAS  PubMed  Google Scholar 

  84. Cohen DJ, Kuntz RE, Gordon SP, et al. Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty. N Engl J Med. 1992;327:1329–35.

    CAS  PubMed  Google Scholar 

  85. Nobuyoshi M, Arita T, Shirai S, et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009;119:e211–9.

    PubMed  Google Scholar 

  86. WHO. Rheumatic fever and rheumatic heart disease. Report of a WHO expert consultation. Geneva, 29 Oct – 1 Nov 2001. WHO Technical Report Series 923. [online], (2004).

  87. Nakhjavan FK, Katz MR, Maranhao V, Goldberg H. Analysis of influence of catecholamine and tachycardia during supine exercise in patients with mitral stenosis and sinus rhythm. Br Heart J. 1969;31:753–61.

    PubMed Central  CAS  PubMed  Google Scholar 

  88. Iung B, Nicoud-Houel A, Fondard O, et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period. Eur Heart J. 2004;25:701–7.

    PubMed  Google Scholar 

  89. Iung B, Cormier B, Ducimetiere P, et al. Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation. 1996;94:2124–30.

    CAS  PubMed  Google Scholar 

  90. Abdel-Hady ES, El-Shamy M, El-Rifai AA, et al. Maternal and perinatal outcome of pregnancies complicated by cardiac disease. Int J Gynaecol Obstet. 2005;90:21–5.

    PubMed  Google Scholar 

  91. Cole TO, Adeleye JA. Rheumatic heart disease and pregnancy in Nigerian women. Clin Cardiol. 1982;5:280–5.

    CAS  PubMed  Google Scholar 

  92. Nkomo VT. Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa. Heart. 2007;93:1510–9.

    PubMed Central  PubMed  Google Scholar 

  93. Otto CM. Clinical practice. Evaluation and management of chronic mitral regurgitation. N Engl J Med. 2001;345:740–6.

    CAS  PubMed  Google Scholar 

  94. Dal-Bianco JP, Levine RA. Anatomy of the mitral valve apparatus: role of 2D and 3D echocardiography. Cardiol Clin. 2013;31:151–64.

    PubMed  Google Scholar 

  95. Essop MR, Nkomo VT. Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa. Circulation. 2005;112:3584–91.

    PubMed  Google Scholar 

  96. Marcus RH, Sareli P, Pocock WA, et al. Functional anatomy of severe mitral regurgitation in active rheumatic carditis. Am J Cardiol. 1989;63:577–84.

    CAS  PubMed  Google Scholar 

  97. Marcus RH, Sareli P, Pocock WA, Barlow JB. The spectrum of severe rheumatic mitral valve disease in a developing country. Correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann Intern Med. 1994;120:177–00.

    CAS  PubMed  Google Scholar 

  98. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341:1–7.

    CAS  PubMed  Google Scholar 

  99. Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE. Reconsideration of echocardiographic standards for mitral valve prolapse lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol. 1988;11:1010–9.

    CAS  PubMed  Google Scholar 

  100. Enriquez-Sarano M, Basmadjian AJ, Rossi A, et al. Progression of mitral regurgitation: a prospective Doppler echocardiographic study. J Am Coll Cardiol. 1999;34:1137–44.

    CAS  PubMed  Google Scholar 

  101. Perloff JK, Roberts WC. The mitral apparatus. Functional anatomy of mitral regurgitation. Circulation. 1972;46:227–39.

    CAS  PubMed  Google Scholar 

  102. Silverman ME, Hurst JW. The mitral complex. Interaction of the anatomy, physiology, and pathology of the mitral annulus, mitral valve leaflets, chordae tendineae, and papillary muscles. Am Heart J. 1968;76:399–418.

    CAS  PubMed  Google Scholar 

  103. Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335:1417–23.

    CAS  PubMed  Google Scholar 

  104. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382–94.

    PubMed  Google Scholar 

  105. Bonow RO. Chronic mitral regurgitation and aortic regurgitation: have indications for surgery changed? J Am Coll Cardiol. 2013;61:693–701.

    PubMed  Google Scholar 

  106. Cioffi G, Tarantini L, De Feo S, Pulignano G, Del Sindaco D, Stefenelli C, et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. Eur J Heart Fail. 2005;7(7):1112–7.

    PubMed  Google Scholar 

  107. Kanzaki H, Bazaz R, Schwartzman D, et al. A mechanism for immediate reduction in mitral regurgitation after CRT. J Am Coll Cardiol. 2004;44:1619–25.

    PubMed  Google Scholar 

  108. Feldman T, Leon MB. Prospects for percutaneous valve therapies. Circulation. 2007;116:2866–77.

    PubMed  Google Scholar 

  109. Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart. 2007;93:271–6.

    PubMed Central  PubMed  Google Scholar 

  110. Badano LP, Muraru D, Enriquez-Sarano M. Assessment of functional tricuspid regurgitation. Eur Heart J. 2013;34(25):1875–85.

    PubMed  Google Scholar 

  111. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–9.

    PubMed  Google Scholar 

  112. Lee JW, Song JM, Park JP, Kang DH, Song JK. Long-term prognosis of isolated significant tricuspid regurgitation. Circ J. 2010;74:375–80.

    PubMed  Google Scholar 

  113. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg. 2012;143:632–8.

    PubMed  Google Scholar 

  114. Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg. 2011;141:1431–14.

    PubMed  Google Scholar 

  115. Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg. 2010;22:79–83.

    PubMed  Google Scholar 

  116. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease: incidence, prognostic implications, mechanism and management. J Am Coll Cardiol. 2009;53:401–8.

    PubMed  Google Scholar 

  117. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718–25.

    PubMed  Google Scholar 

  118. Kim HK, Kim YJ, Park EA, et al. Assessment of hemodynamic effects of surgical correction of severe functional tricuspid regurgitation: cardiac magnetic resonance imaging study. Eur Heart J. 2010;31:1520–8.

    PubMed  Google Scholar 

  119. Taramasso M, Vanermen H, Maisano F, Guidotti A, La Canna G, Alfieri O. The growing clinical importance of secondary tricuspid regurgitation. J Am Coll Cardiol. 2012;59:703–10.

    PubMed  Google Scholar 

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Kunchakarra, S., Puthumana, J., Maganti, K. (2015). Valvular Heart Disease: Introduction, Clinical Pathogenesis, and Management. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_54

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