TY - CHAP M1 - Book, Section TI - Valvular Heart Disease A1 - Rasmussen, Tyler P. A1 - Enriquez-Sarano, Maurice A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSHeart failure in patients with chronic valvular heart disease is usually precipitated by concurrent illness, progressive deterioration of cardiac function, worsening valvular disease, or occurrence of a complication (eg, atrial fibrillation).Acute onset of severe valvular regurgitation is uncommon. Murmur may be absent and echocardiographic diagnosis is challenging.Acute severe aortic and mitral regurgitation (flail segments secondary to trauma, aortic dissection, ruptured papillary muscle) are surgical emergencies. Acute severe tricuspid regurgitation is usually better tolerated, but on occasion can lead to cardiogenic shock.All decompensated valve diseases are mechanical valvular dysfunctions that require mechanical correction (surgical or interventional). Medical treatment is temporizing or palliative.Transcatheter valvular therapies can be highly effective and should be considered promptly, such as transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and decompensated heart failure.Valvular regurgitation, perivalvular extension of infection, and systemic embolization are important complications of infective endocarditis and should be actively sought on clinical examination, ECG, and echocardiography.Prosthetic valve thrombosis presents with thromboembolic events or heart failure due to valve obstruction. Diagnosis is made by echocardiography or fluoroscopy. Treatment depends on location (left- vs right-sided valves) and thrombus burden.Structural failure of a mechanical prosthesis is rare and requires urgent reoperation. Failure of a bioprosthesis is frequent and progressive due to degeneration. Reoperation after stabilization is recommended. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/03 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201802067 ER -