TY - CHAP M1 - Book, Section TI - Valvular Heart Disease A1 - Pislaru, Sorin V. A1 - Enriquez-Sarano, Maurice A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Heart failure in patients with chronic valvular heart disease is usually precipitated by concurrent illness, progressive deterioration of cardiac function, or worsening valvular disease.Acute onset of severe valvular regurgitation is uncommon. Clinical 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.Severe symptomatic aortic stenosis is a surgical disease. Medical treatment is temporizing or palliative.Transcatheter aortic valve replacement (TAVR) or aortic balloon valvuloplasty should be considered in patients with severe AS and decompensated heart failure.Hemodynamically significant mitral stenosis should be treated by mechanical intervention on the valve (percutaneous mitral balloon valvuloplasty or surgery). Medical treatment is temporizing or palliative.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 Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1107717764 ER -