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(Circulation. 2008;118:1779.)
© 2008 American Heart Association, Inc.

Editor's Note

Editor’s Note

Catherine M. Otto, MD

Series Editor, Valvular Heart Disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In clinical practice, diagnosis and treatment of valvular heart disease are challenging for several reasons. Individual practitioners have less experience with valve disease compared with more prevalent conditions such as coronary disease, heart failure, hypertension, and atrial fibrillation. Few controlled clinical trials in patients with valvular heart disease have been published, so guidelines are largely based on clinical experience and expert opinion. In addition, our understanding of the pathophysiological responses to valve dysfunction is incomplete, and our knowledge of the basic mechanisms of disease in the valve leaflets is rudimentary.

The prevalence of different types of valvular heart disease continues to change worldwide as prevention of rheumatic fever results in fewer cases of rheumatic heart disease while, at the same time, increased longevity results in more cases of age-related calcific valve disease. Valve disease now is classified more accurately as primary or secondary. Primary valve dysfunction is due to a congenital anatomic abnormality such as a bicuspid aortic valve or to a disease process that affects the valve leaflets such as calcific aortic stenosis or myxomatous mitral valve disease. In contrast, secondary valve dysfunction is characterized by relatively normal valve leaflets with dysfunction due to alterations in valve geometry, as in, for example, mitral regurgitation in patients with ischemic disease or a cardiomyopathy. Treatment of secondary valve dysfunction is directed at treatment of the underlying disease process, whereas treatment of primary valve dysfunction is largely limited to watchful waiting with optimization of the timing of surgical or percutaneous intervention.

Noninvasive . . . [Full Text of this Article]