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Valvular heart disease challenges in 2017

EuroEcho-Imaging 2017

Lisboa, the largest room of the Congress was full for this session, confirming the increasing importance of valvular heart disease in Cardiology.

Julien Magne (Limoges, FR) presented: Ischaemic mitral regurgitation (MR): when and how to intervene? He reminded the pathophysiology and the dismal prognosis. The cut-off values of severity differ from Europe and US (effective regurgitant orifice area >20 mm² or >40 mm², respectively) The changes in the 2017 ESC/EACTS Guidelines were discussed. In particular, surgery is no longer considered in patients with moderate MR, in line with a recent randomized, although controversial, trial. During the discussion, the adaptive changes of mitral valve apparatus were highlighted with potential medical treatment (such as losartan) in the future.

Philippe Pibarot (Quebec, CA) defined the patient-prosthesis mismatch and its deleterious impact on survival and on rapid deterioration of the prosthesis. He showed that this problem remains an issue in the TAVI era, although its incidence could be lower. When a patient, treated surgically, with a too small prosthesis develops calcification of the prosthesis and requires a redo operation, the Valve in Valve procedure is not always a good option.

In asymptomatic patients with severe aortic stenosis (AS), early intervention or watchful waiting remains controversial. Prof. J Chambers (London, UK) discussed this dilemma. He reminded the particular natural history of the disease. As mortality is strikingly high when symptoms develop, it is essential to ensure that the patient is really asymptomatic: exercise testing is recommended in this setting, as approximately one-third of these patients develop symptoms during the test. The current ESC/EACTS Guidelines were presented. The decision requires a Heart Team discussion. TAVI is not yet an option in asymptomatic patients. In patients with very severe AS, a rapid intervention should be considered, since events rapidly occur. However, cut-off values for very severe As differ in Europe and US: peak velocity >5.5 m/s or >5 m/s, respectively.

The tricuspid valve is no longer the forgotten valve. Prof. R Hahn (New York, US) presented the dismal consequences of untreated tricuspid regurgitation (TR). She described the anatomic differences between primary and secondary TR. Although surgery remains the principal treatment, several percutaneous methods and devices are in development and validation and could facilitate the management of severe TR in the future

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.