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(Circulation. 2009;119:3232-3241.)
© 2009 American Heart Association, Inc.

Valvular Heart Disease: Changing Concepts in Disease Management

Acute Valvular Regurgitation

Karen K. Stout, MD; Edward D. Verrier, MD

From the University of Washington, Seattle.

Correspondence to Karen K. Stout, MD, University of Washington, Box 356422, 1959 Pacific NE, Seattle, WA 98195. E-mail stoutk@u.washington.edu

Key Words: aortic valveaortic valve insufficiency • mitral valve • mitral valve insufficiency • valvular heart diseases • valves

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

	Introduction

 
Acute severe valvular regurgitation is a surgical emergency, but accurate and timely diagnosis can be difficult. Although cardiovascular collapse is a common presentation, examination findings to suggest acute regurgitation may be subtle, and the clinical presentation may be nonspecific. Consequently, the presentation of acute valvular regurgitation may be mistaken for other acute conditions, such as sepsis, pneumonia, or nonvalvular heart failure. Although acute regurgitation may affect any valve, acute regurgitation of the left-sided valves is more common and has greater clinical impact than acute regurgitation of right-sided valves.

Data to guide appropriate management of patients with acute regurgitation are sparse; there are no randomized trials, and much of the literature describes either small series or the experiences of specific centers. Despite these limitations, the available data are sufficient to allow identification of general principles as well as development of applicable guidelines from both the American College of Cardiology/American Heart Association and European Society of Cardiology. The guidelines recommend valve surgery for symptomatic patients with aortic or mitral regurgitation, including those with acute regurgitation.^1–3 The data and guidelines emphasize overarching clinical principles, including the need for a high clinical suspicion of acute regurgitation, timely use of echocardiography, and, in the majority of patients, rapid progression to surgery.

	Causes

 
Causes of acute regurgitation overlap with causes of chronic regurgitation and vary depending on the valve affected (Table 1). Endocarditis may affect either the aortic or mitral valve, whereas other causes are unique to the specific valve involved. The majority of causes . . . [Full Text of this Article]