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Medical Sciences (Basel, Switzerland) Jun 2022Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of... (Review)
Review
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
Topics: Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Rheumatic Heart Disease; Tricuspid Valve Insufficiency; Young Adult
PubMed: 35736352
DOI: 10.3390/medsci10020032 -
Development (Cambridge, England) Jul 2020The valves of the heart are crucial for ensuring that blood flows in one direction from the heart, through the lungs and back to the rest of the body. Heart valve... (Review)
Review
The valves of the heart are crucial for ensuring that blood flows in one direction from the heart, through the lungs and back to the rest of the body. Heart valve development is regulated by complex interactions between different cardiac cell types and is subject to blood flow-driven forces. Recent work has begun to elucidate the important roles of developmental pathways, valve cell heterogeneity and hemodynamics in determining the structure and function of developing valves. Furthermore, this work has revealed that many key genetic pathways involved in cardiac valve development are also implicated in diseased valves. Here, we review recent discoveries that have furthered our understanding of the molecular, cellular and mechanosensitive mechanisms of valve development, and highlight new insights into congenital and acquired valve disease.
Topics: Animals; Gene Expression Regulation, Developmental; Heart Valve Diseases; Heart Valves; Hemodynamics; Humans
PubMed: 32620577
DOI: 10.1242/dev.183020 -
Cardiology Clinics Feb 2021Valvular heart disease (VHD) is generally well tolerated during pregnancy; however, the dramatic changes in hemodynamics that occur during pregnancy can lead to clinical... (Review)
Review
Valvular heart disease (VHD) is generally well tolerated during pregnancy; however, the dramatic changes in hemodynamics that occur during pregnancy can lead to clinical decompensation in high-risk women. Women with VHD considering pregnancy should undergo preconception counseling with a high-risk obstetrician and cardiologist to review the maternal, fetal, and obstetric risks of pregnancy and delivery. Vaginal delivery is recommended for most women with VHD. Given the complexity of managing VHD during pregnancy, women should be managed by a multidisciplinary Pregnancy Heart Team during pregnancy, consisting of a high-risk obstetrician, cardiologist, and cardiac anesthesiologist.
Topics: Female; Heart Failure; Heart Valve Diseases; Hemodynamics; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Risk Adjustment; Risk Assessment
PubMed: 33222810
DOI: 10.1016/j.ccl.2020.09.010 -
Progress in Cardiovascular Diseases 2020Bicuspid aortic valve (BAV) is the most common congenital heart defect, found in up to 2% of the population and associated with a 30% lifetime risk of complications. BAV... (Review)
Review
Bicuspid aortic valve (BAV) is the most common congenital heart defect, found in up to 2% of the population and associated with a 30% lifetime risk of complications. BAV is inherited as an autosomal dominant trait with incomplete penetrance and variable expressivity due to a complex genetic architecture that involves many interacting genes. In this review, we highlight the current state of knowledge about BAV genetics, principles and methods for BAV gene discovery, clinical applications of BAV genetics, and important future directions.
Topics: Aortic Valve; Bicuspid Aortic Valve Disease; Heart Valve Diseases; Humans
PubMed: 32599026
DOI: 10.1016/j.pcad.2020.06.005 -
European Heart Journal Oct 2020Aortic valve stenosis is commonly considered a degenerative disorder with no recommended preventive intervention, with only valve replacement surgery or catheter...
AIMS
Aortic valve stenosis is commonly considered a degenerative disorder with no recommended preventive intervention, with only valve replacement surgery or catheter intervention as treatment options. We sought to assess the causal association between exposure to lipid levels and risk of aortic stenosis.
METHODS AND RESULTS
Causality of association was assessed using two-sample Mendelian randomization framework through different statistical methods. We retrieved summary estimations of 157 genetic variants that have been shown to be associated with plasma lipid levels in the Global Lipids Genetics Consortium that included 188 577 participants, mostly European ancestry, and genetic association with aortic stenosis as the main outcome from a total of 432 173 participants in the UK Biobank. Secondary negative control outcomes included aortic regurgitation and mitral regurgitation. The odds ratio for developing aortic stenosis per unit increase in lipid parameter was 1.52 [95% confidence interval (CI) 1.22-1.90; per 0.98 mmol/L] for low density lipoprotein (LDL)-cholesterol, 1.03 (95% CI 0.80-1.31; per 0.41 mmol/L) for high density lipoprotein (HDL)-cholesterol, and 1.38 (95% CI 0.92-2.07; per 1 mmol/L) for triglycerides. There was no evidence of a causal association between any of the lipid parameters and aortic or mitral regurgitation.
CONCLUSION
Lifelong exposure to high LDL-cholesterol increases the risk of symptomatic aortic stenosis, suggesting that LDL-lowering treatment may be effective in its prevention.
Topics: Aortic Valve Stenosis; Cholesterol, HDL; Cholesterol, LDL; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Lipids; Male; Mendelian Randomization Analysis; Plasma; Risk Factors; Triglycerides
PubMed: 32076698
DOI: 10.1093/eurheartj/ehaa070 -
Annual Review of Medicine Jan 2023This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development... (Review)
Review
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
Topics: Humans; Heart Valve Diseases; Mitral Valve Insufficiency; Aortic Valve Stenosis; Atrial Fibrillation; Bicuspid Aortic Valve Disease
PubMed: 36400067
DOI: 10.1146/annurev-med-042921-122533 -
Journal of the American College of... Feb 2021
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Topics: Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 33342586
DOI: 10.1016/j.jacc.2020.11.018 -
Cardiology Clinics Feb 2020There is consensus on important aspects of managing heart valve disease. Despite this, many patients are managed by general physicians or cardiologists without... (Review)
Review
There is consensus on important aspects of managing heart valve disease. Despite this, many patients are managed by general physicians or cardiologists without specialist competencies in valve disease, which leads to suboptimal outcomes. Multidisciplinary heart valve clinics bring together cardiologists, surgeons, nurses, and in some countries scientists to deliver expert guidelines and experience-driven optimal care. Patients are referred at the optimal time for interventions at heart valve centers, defined by strict standards of facilities and processes. Valve networks link valve clinic, heart valve center, and the community to improve the passage of patients at every level of care.
Topics: Cardiac Care Facilities; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans
PubMed: 31753178
DOI: 10.1016/j.ccl.2019.09.006 -
Trends in Cardiovascular Medicine Jul 2020The mitral annulus is a fibrous structure that surrounds the mitral valve leaflets and is prone to calcification. Despite its common occurrence, association with... (Review)
Review
The mitral annulus is a fibrous structure that surrounds the mitral valve leaflets and is prone to calcification. Despite its common occurrence, association with cardiovascular morbidity and mortality and relationship with dysfunction of the mitral valve, the pathobiology of mitral annular calcification is incompletely understood. Mitral annular calcification is no longer regarded as a local, chronic and degenerative process resulting in precipitation of calcium and phosphate, but as an active and regulated molecular process that is related to lipid metabolism, hemodynamic stress, chronic kidney disease, bone and mineral metabolism and inflammation. This review summarizes the current evidence examining the pathophysiologic determinants of mitral annular calcification.
Topics: Age Factors; Animals; Calcinosis; Heart Valve Diseases; Humans; Inflammation Mediators; Lipid Metabolism; Mitral Valve; Osteogenesis; Prevalence; Prognosis; Risk Factors; Signal Transduction
PubMed: 31402089
DOI: 10.1016/j.tcm.2019.07.011 -
Journal of Cardiovascular Translational... Jun 2014Cardiac valve surgery is life saving for many patients. The advent of minimally invasive surgical techniques has historically allowed for improvement in both... (Review)
Review
Cardiac valve surgery is life saving for many patients. The advent of minimally invasive surgical techniques has historically allowed for improvement in both postoperative convalescence and important clinical outcomes. The development of minimally invasive cardiac valve repair and replacement surgery over the past decade is poised to revolutionize the care of cardiac valve patients. Here, we present a review of the history and current trends in minimally invasive aortic and mitral valve repair and replacement, including the development of sutureless bioprosthetic valves.
Topics: Aortic Valve; Cardiac Surgical Procedures; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Minimally Invasive Surgical Procedures; Mitral Valve; Mitral Valve Annuloplasty; Treatment Outcome
PubMed: 24797148
DOI: 10.1007/s12265-014-9569-1