Valvular Heart Disease: From Bedside to Bench and Back Again
The discipline of valvular heart disease owes much to Rene Laennec since the stethoscope he invented remains the primary tool with which valve disease is clinically recognized. The ability to diagnose stenotic and regurgitant lesions on the basis of their characteristic murmurs is a core element of the bedside examination. For many years, valvular heart disease remained an understudied family of conditions. However, in recent years we have gained a better understanding of the pathophysiology of valve disease through research that has included sophisticated analyses of the beating human heart, studies of animal and in vitro models of valve dysfunction as well as biochemical and microscopic examination of diseased valves. There has also been preliminary study of the feasibility of growing valves in vitro. Indeed, the study of valve disease has transitioned from the bedside to the bench. Investigation of two of the most common and clinically important conditions, aortic stenosis and functional mitral regurgitation, has led the way aided by advances in imaging methods for quantitating the progression of disease. For example we now appreciate the similarities and differences between calcific aortic valvular disease and atherosclerosis and know that functional mitral regurgitation, long defined by the absence of structural leaflet changes is, in fact associated with leaflet enlargement. With this new understanding that these studies have provided, has come the potential for new forms of treatment such as pharmacologic and non-surgical mechanical intervention for valve disorders, the treatment of which has heretofore been limited to surgical intervention for end-stage disease. Using the information we have gained at the bench to inform new bedside treatments will define future management of valve disease.
- © 2011 by American Heart Association, Inc.