RT Book, Section
A1 Rasmussen, Tyler P.
A1 Enriquez-Sarano, Maurice
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201802067
T1 Valvular Heart Disease 
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201802067
RD 2024/10/05
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.