An updated set of guidelines jointly released by the American College of Cardiology and the American Heart Association is based on recent advances in diagnosis and treatment of valvular disease in various patient populations including patients with coronary artery disease and pregnant women.
Valvular disease caused about 20,000 deaths in the USA in 2003. An estimated 95,000 Americans underwent inpatient valve procedures in 2003.

The guidelines discuss evaluating patients with heart murmurs, preventing and treating endocarditis, managing valve disease in pregnancy, and treating patients with coronary artery disease, as well as more specialized issues regarding specific valve lesions.

"These guidelines highlight major advances in noninvasive testing and surgery for patients with valvular heart disease," said Robert O. Bonow, MD, lead author of the joint statement, chief of cardiology at Northwestern Memorial Hospital.” There have always been areas of uncertainty and differences of opinion on how to diagnose and treat patients with valvular heart disease. Today we have more much solid data to draw on."

The new guidelines update a set released in 1998. One of the key changes in the 2006 document is a focus on the proper timing of valve surgery. The guidelines include more precise and quantitative definitions of mild, moderate and severe valvular disease, based on the patient's symptoms and the results of exercise testing, echocardiography, and other tests. This change may prompt earlier referral of some patients for surgery, even before they develop noticeable symptoms.

"The guidelines encourage physicians to look behind the scenes, rather than waiting for symptoms to develop," said Patrick T. O'Gara, MD, director of clinical cardiology at Brigham & Women's Hospital. "For example, an abnormal response to exercise could help identify patients with aortic stenosis who may be candidates for surgery sooner rather than later."

Other highlights of the guidelines include surgical advances that increasingly permit repair, rather than replacement, of heart valves in many patients. These are particularly important for some patients with leaky mitral valves and are increasingly used in selected patients with aortic valve regurgitation.

The new guidelines also address use of echocardiography in the operating room to guide surgery. This procedure, known as transesophageal echocardiography allows surgeons to see real-time pictures of the heart.

The guidelines also go further to clarify use of anticoagulants in patients who have undergone heart valve surgery and discuss preventive medical treatment for some heart valve conditions.

The guidelines also acknowledge the complexity of managing many patients
with valvular heart disease, including criteria for selection of replacement heart
valves in individual patients.

"It is important for patients to understand that we have much better data today, but we still don't have all the answers," Dr. Bonow said. "Patients need to discuss their care with their physicians and play a major role in making treatment decisions."

The full text of the guidelines will be published online at http://www.acc.org.

A summary of the guidelines will be published in the August 1, 2006 issue of Journal of the American College of Cardiology and the August 1, 2006 issue of Circulation: Journal of the American Heart Association