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Controversies in asymptomatic valvular diseases


Valvular Heart Diseases

Severe organic mitral regurgitation: early surgery is mandatory

PRO: D.Messika-Zeitoun (Paris, France) - Slides, Rebuttal Slides
CONTRA: R.Rosenhek (Vienna, Austria) - Slides, Rebuttal Slides

Arguments in favour and against early surgery were presented on the basis of the available scientific evidence. Surgery (preferably mitral valve repair) is indicated when some LV ventricular dysfunction is documented (LVEF <60% ; LVESD >45 mm). Furthermore, new onset of atrial fibrillation and elevated systolic pulmonary artery pressure (>50 mmHg at rest; > 60 mmHg at exercise) are good arguments in favour of surgery. The size of the LA has been shown to be an important determinant of the outcome of patients with asymptomatic organic mitral regurgitation, and therefore should play a role in the decision–making. When all the above circumstances are absent, a attentive waiting attitude is reasonable. Generally speaking, a more aggressive approach is justified when there is a high likelihood of durable valve repair at a low risk.

Severe aortic stenosis should be operated before symptom onset

PRO: S.Rahimtoola (Los Angeles, US) - Slides, Rebuttal Slides
CONTRA: H.Baumgartner (Muenster, Germany) - Slides, Rebuttal Slides

Surgery is advocated when LV dysfunction (LVEF<50%) is present and when patients develop symptoms or a fall in blood pressure below baseline during exercise test. If the surgical risk is not high, aortic valve replacement can be reasonably carried out even in asymptomatic patients under a number of circumstances associated with a negative influence on prognosis: excessive LV hypertrophy (in patients without hypertension), moderate-severe valve calcification, peak velocity >5.5 m/s, peak velocity progression >0.3m/s/year, ventricular arrhythmias, markedly elevated natriuretic peptide level.




Controversies in asymptomatic valvular diseases

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.