Valvular Heart Disease in the Elderly
Degenerative aetiology predominates in valvular heart disease. This review summarises the main group of valvular diseases with the main focus on their management. Aortic stenosis increases in frequency with age, and the important causes are the degenerative calcifying valves, congenital abnormalities and rheumatic in origin. About half the patients with AS die suddenly. The key symptoms indicating intervention are angina, exertional syncope and heart failure, but the ideal management of severe aortic stenosis with left ventricular dysfunction is controversial. Transcatheter aortic valve replacement (TAVR) is an option for patients with high or very high risk for surgical aortic valve replacement. Aortic valve replacement is indicated in severe AR who are symptomatic and in patients with severe AR who are asymptomatic but with left ventricular systolic dysfunction. Surgery is indicated in patients with severe MR with symptoms, and the factors influencing the timing of intervention are the symptoms, left ventricular ejection fraction, atrial fibrillation and pulmonary hypertension. Surgery in mitral stenosis depends on the symptoms right ventricular function, and pulmonary artery pressure.
KeywordsAortic stenosis Aortic regurgitation Mitral regurgitation Mitral stenosis Transcatheter aortic valve replacement Percutaneous mitral balloon valvuloplasty
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