21. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease Section 16. Cardiovascular Disorders hyperlink to list of chapters in current section.Chapter 207. valvular heart disease. Topics. General. Mitral Valve Disease. http://www.merck.com/pubs/mmanual/section16/chapter207/207a.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 207. Valvular Heart Disease Topics [General] Mitral Valve Disease Aortic Valve Disease Tricuspid Valve Disease [General] (For discussion of pulmonic valve disease and other congenital cardiac abnormalities, see Congenital Heart Disease in Ch. 261.)

22. THE MERCK MANUAL OF GERIATRICS, Sec. 11, Ch. 89, Valvular Heart Disease Looks at stenosis and regurgitation for aortic, mitral and tricuspid valves, their symptoms and signs, Category Health Conditions and Diseases Heart Disease Valvular...... valvular heart disease. These agerelated effects influence the development ofsymptoms and complications in elderly patients with valvular heart disease. http://www.merck.com/pubs/mm_geriatrics/sec11/ch89.htm

Section 11. Cardiovascular Disorders this section includes Chapter 83. Aging and the Cardiovascular System Chapter 84. Diagnostic Evaluation Chapter 85. Hypertension Chapter 86. Hypotension ... Chapter 96. Cardiovascular Surgery and Percutaneous Interventional Techniques Chapter 89. Valvular Heart Disease Contributor: Melvin Cheitlin With age, fibrotic thickening and increased opacity occur in the mitral and aortic valves. The aorta becomes stiffer (increasing systolic blood pressure and stress on the mitral valve), and afterload on the left ventricle increases (increasing myocardial oxygen demand and thus the requirement for myocardial blood flow). These age-related effects influence the development of symptoms and complications in elderly patients with valvular heart disease. In elderly patients, the predominant causes of valvular heart disease are degenerative calcification, myxomatous degeneration, papillary muscle dysfunction, and infective endocarditis; valvular damage from rheumatic and syphilitic diseases is uncommon. Most often, valvular heart disease is suspected when murmurs are detected during the physical examination. Noninvasive imaging techniques help identify the etiology, establish the diagnosis, and assess disease severity. Medical management is appropriate for many elderly patients; surgery (

23. Postgraduate Medicine: Valvular Heart Disease valvular heart disease. Although valvular heart disease has been with us sinceancient times, its management continues to be rife with controversy. http://www.postgradmed.com/issues/2001/08_01/mehra_intro.htm

Valvular heart disease A four-article symposium Symposium coordinator Mandeep R. Mehra, MD Vice Chairman, Ochsner Heart and Vascular Institute Chief, Cardiomyopathy and Heart Transplantation Center Ochsner Clinic New Orleans VOL 110 / NO 2 / AUGUST 2001 / POSTGRADUATE MEDICINE VALVULAR HEART DISEASE : Introduction to a four-article symposium by Mandeep R. Mehra, MD TIMELY INTERVENTION IN ASYMPTOMATIC AORTIC STENOSIS : Emerging clinical parameters may help predict outcomes by Myung H. Park, MD MYSTERIES OF MITRAL VALVE PROLAPSE : Proper treatment requires consideration of all clues by Mahesh S. Mulumudi, MD, Krishnamoorthy Vivekananthan, MD NATIVE MITRAL VALVE REGURGITATION : Proactive management can improve outlook by Robert L. Scott, MD, PhD VALVULAR HEART DISEASE AND PREGNANCY : A high index of suspicion is important to reduce risks by Ananth K. Prasad, MD, Hector O. Ventura, MD Creating a highway system that has no means of controlno stop signs, no cloverleaf interchanges, no on- or off-rampsresults in inefficient traffic flow. When a similar analogy is applied to the heart, it becomes clear that the integrity of the quadrivalvular apparatus is essential for maintaining the vital function of the cardiac pump. Although valvular heart disease has been with us since ancient times, its management continues to be rife with controversy. What is the role of pharmacologic therapy for problems that are truly mechanical? What is the appropriate timing of surgical intervention in valvular heart disease? How do other medical conditions, such as pregnancy, influence management of valvular dysfunction? Does valvular disease tend to be overdiagnosed? These are some of the many clinically relevant questions that this symposium seeks to answer.

24. Postgraduate Medicine: Valvular Heart Disease And Pregnancy valvular heart disease and pregnancy. A high index of suspicion is importantto reduce risks. Special concerns with valvular heart disease. http://www.postgradmed.com/issues/2001/08_01/prasad.htm

Valvular heart disease and pregnancy A high index of suspicion is important to reduce risks Ananth K. Prasad, MD; Hector O. Ventura, MD VOL 110 / NO 2 / AUGUST 2001 / POSTGRADUATE MEDICINE CME learning objectives To understand the physiologic changes during pregnancy To comprehend the impact of valvular heart disease during pregnancy To be able to diagnose and manage patients with valvular heart disease during pregnancy The authors disclose no financial interest in this article. This is the fourth of four articles on valvular heart disease. This page is best viewed with a browser that supports tables. Preview : Valvular heart disease is often first recognized during pregnancy, when increased demands on the heart trigger symptoms. The profound hemodynamic changes associated with pregnancy have marked effects on patients with this disease and require special attention and care. In this article, Drs Prasad and Ventura discuss possible causes, clinical manifestations, and management of valvular heart disease during pregnancy. Prasad AK, Ventura HO. Valvular heart disease and pregnancy: a high index of suspicion is important to reduce risks. Postgrad Med 2001;110(2):69-88

25. Valvular Heart Disease How do you get valvular heart disease? Heart valves can be defectivefrom birth. How do you know if you have valvular heart disease? http://www.cardioliving.com/consumer/vhd.shtm

Valvular Heart Disease What is it? Blood flow through the heart’s four chambers (two atria and two ventricles) is controlled by four valves. The valves keep blood from flowing backwards. Sometimes the valves don’t function properly. This is called valvular heart disease. The two valves most commonly affected by valvular heart disease are the aortic valve and the mitral valve. The aortic valve controls blood flow from the left ventricle into the aorta, the body’s main artery. The mitral valve controls blood flow from the left atrium into the left ventricle. Who gets a diseased valve? Anyone can develop a diseased heart valve. Valvular heart disease is more common in older people, but babies can be born with valves that do not function properly. How do you get valvular heart disease? Heart valves can be defective from birth. Valvular heart disease can result from aging, heart attacks, infections, or other disease processes that affect the circulatory system.

26. Advanced Search AFP June 1, 2001. valvular heart disease Review and Update. 1. TABLE1 Physical Examination of Patients with valvular heart disease. http://www.aafp.org/afp/20010601/2201.html

Advanced Search Valvular Heart Disease: Review and Update BENJAMIN SHIPTON, D.O., Mercer, Pennsylvania HANEY WAHBA, M.D., Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania A PDF version of this document is available. Download PDF now (8 pages / 126 KB). More information on using PDF files. F amily physicians routinely encounter patients with valvular heart disease. Although major advances in our understanding of this disease have been made in the past two decades, only recently has there been evidence-based literature from which to draw conclusions about its diagnosis and management. The American College of Cardiology and American Heart Association (ACC/AHA) Task Force recently published comprehensive practice guidelines to help clinicians manage this challenging disorder. Improved surgical techniques, noninvasive techniques for surveillance of left ventricular function and guidelines for the timing of surgery have likely combined to contribute to improved survival and decreased morbidity in patients with chronic valvular heart disease. FIGURE 1.

27. Phen/Fen & Valvular Heart Disease PHEN/FEN AND valvular heart disease July 8, 1997 QUESTIONS AND ANSWERS.1. WHAT IS PHEN/FEN ? 2. WHAT IS valvular heart disease? http://www.fda.gov/cder/news/phen/phenfenqa.htm

"PHEN/FEN" AND VALVULAR HEART DISEASE July 8, 1997 QUESTIONS AND ANSWERS 1. WHAT IS "PHEN/FEN" ? Phentermine ("phen") and fenfluramine ("fen") are prescription medications approved by the FDA as single medicines for short-term (a few weeks) use as appetite suppressants in the management of obesity. Some physicians have prescribed them recently to be used in combination with each other and to be used for extended periods of time in weight loss programs. Such use of the products is called "off label" because there have been no studies presented to the FDA to demonstrate either the effectiveness or safety of the two drugs taken together or for longer periods of time (greater than a few weeks). "Phen" is short for phentermine , an amphetamine-like drug marketed under various trade names such as Ionamin ® and Fastin® , as well as several generic forms of phentermine. It is approved for short-term use as an appetite suppressant. "Fen" is short for

28. Valvular Heart Disease valvular heart disease WG 14. Number of members 177 Meetings organised with thecollaboration of the ESC Working Group on valvular heart disease. ETP course. http://www.escardio.org/society/wg/wg14.htm

Working Groups List of Working Groups in alphabetical order Acute Cardiac Care - WG 27 Arrhythmias - WG 8 Cardiac Cellular Electrophysiology - WG 11 Cardiac Pacing - WG 9 Cardiac Rehabilitation and Exercise Physiology - WG 1 Cardiovascular Magnetic Resonance - WG 26 Cardiovascular Nursing - WG 24 Cardiovascular Pharmacology and Drug Therapy - WG 3 Cardiovascular Surgery - WG 25 Cellular Biology of the Heart - WG 2 Computers in Cardiology - WG 15 Developmental Anatomy and Pathology - WG 17 Echocardiography - WG 7 Epidemiology and Prevention - WG 13 Grown-up Congenital Heart Disease - WG 22 Heart Failure - WG 19 Hypertension and the Heart - WG 20 Microcirculation - WG 6 Myocardial and Pericardial Diseases - WG 21 Myocardial Function - WG 4 Nuclear Cardiology - WG 5 Pathogenesis of Atherosclerosis - WG 23 Peripheral Circulation - WG 16 Pulmonary Circulation and Right Ventricular Function - WG 12 Thrombosis - WG 18 Valvular Heart Disease - WG 14 Valvular Heart Disease - WG 14 Number of members: 17 Nucleus Chairperson: Dr. C. Gohlke-Bärwolf F.E.S.C.; Herzzentrum, Südring 15, 79189 Bad Krozingen, Germany, Tel: +49.7633.402.0, Fax: +49.7633.402.212

29. Valvular Heart Disease valvular heart disease Chairman Alec Vahanian, Paris, France. Issues. In the EuroHeart Survey for valvular heart disease the following issues are addressed http://www.escardio.org/survey/survey/Valvular.htm

Euro Heart Survey Valvular Heart Disease Chairman: Alec Vahanian, Paris, France The purpose of this survey is to collect data from a selected sample of cardiology departments throughout Europe, to evaluate the current practice in evaluation and treatment of valvular heart disease, and the accordance between existing guidelines and current practice. Issues In the Euro Heart Survey for Valvular Heart Disease the following issues are addressed: Use of diagnostic procedures Catheterisation in pre-operative evaluation Echocardiography (Mode: transthoracic or transoesophageal approach, Frequency, Indications) Exercise testing Intervention during active endocarditis Indications for surgery (heart failure, infection, or other) Duration of antibiotic treatment before surgery Type of surgery Management of patients after prosthetic valve replacement Who follows the patients (cardiologist, surgeon, GP or other)? How (clinical, echocardiographic follow-up) and how often are they followed? Current anticoagulation practice in valvular heart disease In native valve disease After valve replacement: how to follow, patient education, use of self-management, what is the target INR, combinations with antiplatelet therapy?

30. International Congress On Valvular Heart Disease valvular heart disease IN 21 st CENTURY TRENDS IN EPIDEMIOLOGY STATEOF-ART IMAGING3D echo, intracardiac echo, contrast echo multislice computed tomography http://www.szpitaljp2.krakow.pl/vhd2003/

8-10 May 2003, Kraków, Poland Organizing Committee Christa Gohlke-Bärwolf (D) Chairperson of the Working Group on Valvular Heart Disease, European Society of Cardiology Eric G. Butchart (UK) Co-Chairman of the Working Group on Valvular Heart Disease, European Society of Cardiology Wies³awa Tracz (PL) Director of the Institute of Cardiology, Jagiellonian University, Kraków Piotr Podolec (PL) Chairman of the Polish Cardiac Society - Kraków Chamber International Board R.J.C. Hall (UK), A. Vahanian (FR), M.J. Antunes (P), J.C. Schoevaerdts (B), B. Iung (FR), A.Y. Nisanci (TR), M.P. Tornos Mas (ES), H. Siniawski (D), J. R.T.C. Roelandt (NL), H. Kesteloot (B) Honorary Patronage Micha³ Tendera President-Elect of the European Society of Cardiology Andrzej Cie¶liñski (PL) President of the Polish Cardiac Society Scientific and Advisory Committee Chairpersons: Irena Rawczyñska-Englert Chairperson of Polish Working Group on Valvular Heart Disease Wies³awa Tracz Director of the Institute of Cardiology, Jagiellonian University, Kraków Piotr Podolec Chairman of the Polish Cardiac Society - Kraków Chamber J. Adamus, J. Andres, W. Banasiak , A. Bochenek, A. Biederman

31. Study Enrollment Completed Clinical Trials valvular heart disease. Massachusetts. Boston; Brigham andWomens Hospital AVERT Artificial Valve Endocarditis Reduction Trial. http://www.centerwatch.com/patient/studies/cat155.html

Return to Trial Listings Page Study Enrollment Completed Sorry, the clinical trial that was previously described on this page is no longer actively seeking patients. Patient Resources: [ Trial Listing Notification Services Drug Directories About Clinical Research ... Patient Bookstore Professional Resources: [ Research Center Profiles Industry Provider Profiles Industry News Professional Resources ... Professional Bookstore General: [ Search Site Map Your Privacy CW World ... Home This site was developed in association with Illumina Interactive of Boston, MA

32. Current Medical Management Of Valvular Heart Disease Online Continuing Medical Education, Current medical management ofvalvular heart disease Emil Hayek, MD, and Brian P. Griffin, MD. http://www.clevelandclinicmeded.com/ccjmcme/valvulardisease/default.asp

Online Continuing Medical Education Current medical management of valvular heart disease Emil Hayek, MD, and Brian P. Griffin, MD Release Date: 7/29/02 Expiration Date: 7/29/04 Please read this case and answer the questions that follow: A 65-year-old man presents to your outpatient clinic with progressive dyspnea on exertion, generalized fatigue, and occasional palpitations. The patient reports the onset of shortness of breath several years ago which he noticed during exercise and which has gradually progressed to severe dyspnea with minimal exertion. The patient reports no chest pain, cough, or history of lung disease. Physical exam: Afebrile. Blood pressure 150/90 mm Hg, pulse 18 per minute, respirations 16 per minute, pulse oximetry 99% on room air. Lungs: clear to auscultation. Heart: regular rhythm with III/VI holosystolic blowing murmur heard best at the apex with radiation to the axilla and accentuation with standing and Valsalva maneuver. Chest x-ray: consistent with cardiomegaly.

33. Valvular Heart Disease valvular heart disease The Aortic Valve. The usual AV Area (AVA)is 2.53.5 Cm2. The aortic valve is a trileaflet structure that http://www.cts.usc.edu/studenthandout-valvularheartdisease.html

Home Student Handout Cardiothoracic Surgery Service LAC+USC Medical Center Student Handout Student Handout Links Introduction Coronary Artery Disease Valvular Heart Disease Prosthetic Valves ... Cardiac Neoplasms Valvular Heart Disease The Aortic Valve The usual AV Area (AVA) is 2.5-3.5 Cm2. The aortic valve is a trileaflet structure that sits at the junction of the left ventricular outflow tract and the beginning of the aorta. The coronary ostia may be found one to two centimeters above the annulus to both the right and left. The valve has a common corridor of tissue with the mitral valve and the conduction system is located near the junction of the right and non-coronary leaflets. The usual pathology of the valve is either calcification with functional and structural stenosis or destruction of the leaflets with resultant insufficiency. Aortic Stenosis (AS): The most frequent etiology for aortic valve stenosis is senile calcific stenosis, second is calcification of a congenital (bicuspid) valve , the third most frequent is rheumatic heart disease. The incidence of rheumatic disease has decreased in the last few decades but it is still prevalent. The pathology is that of CONCENTRIC LEFT VENTRICULAR HYPERTOPHY.

34. Sorry - Www.biomedcentral.com Is Temporarily Unavailable Appetite suppressants and valvular heart disease – a systematic review YoonK Loke , Sheena Derry and Angharad PritchardCopley Department of Clinical http://www.biomedcentral.com/1472-6904/2/6

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35. Sorry - Www.biomedcentral.com Is Temporarily Unavailable Click here to read Appetite suppressants and valvular heart disease asystematic review. Loke YK, Derry S, Pritchard-Copley A. Department http://www.biomedcentral.com/pubmed/12194699

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36. Appetite Suppressants And Valvular Heart Disease Appetite suppressants and valvular heart disease. Three articles from the NEJM. NEngl J Med 1998; 3971332. Appetite suppressants and valvular heart disease. http://www.journalclub.org/vol2/a67.html

Appetite suppressants and valvular heart disease Three articles from the New England Journal of Medicine (September 10, 1998). Background The serotoninergic appetite suppressant drug fenfluramine, its d-isomer dexfenfluramine (Redux) and the sympathomimetic drug phentermine have been widely used for the treatment of obesity. In particular, the combination of fenfluramine and phentermine (fen-phen) began to be widely used for longterm treatment after the publication of several articles in 1992. Dexfenfluramine, alone or in combination with phentermine, became very popular in the U.S. immediately after its introduction in April, 1996. Until July, 1997, the greatest concern with these agents was their potential for causing rare cases of pulmonary hypertension. In July, 1997, the FDA issued a health advisory concerning the potential of fen-phen for causing valvular heart disease (see article summarized here ). A case series of 24 patients was described in the NEJM (summarized here ) in August, 1997 and the three drugs were subsequently withdrawn from the market. Since the morphology of some of the valvular lesions that were seen at surgery resembled valve damage seen with the carcinoid syndrome, which is postulated to be due to high serotonin levels, it has been speculated that the appetite suppressants may cause heart valve damage through a serotonin-related mechanism. The risk for valvular lesions associated with these drugs has been estimated to be as high as 20 to 30 percent, but many feel that this greatly overestimates the risk, particularly for short-term users.

37. Valvular Heart Disease And Fenfluramine-phentermine valvular heart disease associated with fenfluraminephentermine. Valvularheart disease associated with fenfluramine-phentermine. http://www.journalclub.org/vol2/a53.html

Valvular heart disease associated with fenfluramine-phentermine Authors Connolly H, Crary J, McGoon M, Hensrud D, Edwards B, Edwards W, Schaff H. Source New England Journal of Medicine. 337:581-8. August 28, 1997. Institutions Mayo Clinic, Rochester Minn.; MeritCare Medical Center, Fargo, ND. Support None indicated. Background The serotoninergic drugs fenfluramine and its d-isomer dexfenfluramine as well as the adrenergic agonist phentermine have been increasingly prescribed for the treatment of obesity. All of these medications have been implicated in the development of pulmonary hypertension, possibly through a serotonin-related mechanism. Serotonin has also been implicated in the development of specific cardiac valvular lesions seen in the carcinoid syndrome and in patients taking ergotamine preparations. This is the first report of similar cardiac valvular problems in patients taking the combination of fenfluramine and phentermine. Methods Identification of cases This was not a case-control study, and there was no clearly defined methodology for case finding. In May, 1996 a 41 year old woman underwent mitral valve repair at the Mayo Clinic for severe mitral regurgitation. At surgery, the valve had a glistening white appearance, suggestive of ergotamine-induced damage, but there was no history to support this. Two months later the same patient was found to have severe tricuspid regurgitation and thickened leaflets; at this time a history was obtained indicating fenfluramine-phentermine use for 25 months prior to her surgery.

38. Duke Heart Center - Valvular Heart Disease Program valvular heart disease The Duke approach With the development of our Valvular HeartDisease Program, Duke has become a national center for patient referrals. http://heartcenter.mc.duke.edu/heartcenter.nsf/webpages/ValvularHeartDiseaseProg

Ischemic Heart Program Valvular Heart Disease Program Peripheral Vascular Program Arrhythmia Services ... Patient Support Program Valvular Heart Disease The condition: The heart contains four valves that open and close to allow the blood to flow in only one direction. If these valves become diseased, blood may not be able to flow forward through the heart, or it may leak backwards. This condition becomes more prevalent with advanced age. The Duke approach: With the development of our Valvular Heart Disease Program , Duke has become a national center for patient referrals. In addition to the latest medical therapies for heart failure associated with valve disease, Duke Heart Center physicians employ the latest tools and techniques for diagnosis and repair of diseased valves. Non-surgical interventions for valvular heart disease at Duke Heart Center include balloon valvuloplasty, in which a balloon stretches open a diseased aortic, mitral, or pulmonic valve that has been narrowed or constricted by disease. Valve surgery at Duke Heart Center incorporates the latest techniques for repair of diseased valves. Duke cardiovascular surgeons use state-of-the-art ultrasound techniques to assess heart and valve function during open heart surgery. This information allows surgeons to make adjustments to improve the outcome of the operation while surgery is still under way.

39. Valvular Heart Disease valvular heart disease ACC/AHA Practice Guidelines Guidelines for the Managementof Patients With valvular heart disease, Full Text, 1998, 710153. http://www.americanheart.org/presenter.jhtml?identifier=3004595

40. Medem: Medical Library: Valvular Heart Disease valvular heart disease. Overview. Clinical Presentation. SYMPTOMS Common symptomsof valvular heart disease may include the following Weakness on exertion; http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZLNKW728C&sub_cat=2

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