New ACC/AHA guidelines released for valvular heart disease

June 16, 2006

CHICAGO, June 16 - An updated set of guidelines jointly released by the American College of Cardiology (ACC) and the American Heart Association (AHA) draws together the latest information on the diagnosis and treatment of patients with valvular heart disease. The new document is slated for release at ACC's Heart Valve Summit in Chicago.

Valve disease most often strikes the mitral valve, which controls blood flow between the left atrium and the left ventricle, or the aortic valve (most prevalent type), which controls blood flow between the left ventricle and the aorta, the large artery that supplies blood to the rest of the body. Valvular heart disease caused about 20,000 deaths in 2003. The total mentioned mortality (i.e., underlying or contributing number of deaths) is about 42,500. There were 95,000 first-listed hospital discharges in 2003 for valvular heart disease. An estimated 95,000 inpatient valve procedures were performed in the United States in 2003.

The guidelines discuss evaluating patients with heart murmurs, preventing and treating endocarditis, managing valve disease in pregnancy, and treating patients with concomitant 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, M.D., lead author of the joint statement, chief of cardiology at Northwestern Memorial Hospital and the Goldberg Distinguished Professor of Cardiology at Northwestern University's Feinberg School of Medicine in Chicago. "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 an earlier 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, M.D., director of clinical cardiology at Brigham & Women's Hospital and an associate professor of medicine at Harvard Medical School, Boston. "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: The guidelines also acknowledge the complexity of managing many patients with valvular heart disease, including the selection of replacement heart valves. For example, a young woman who has surgery to replace a diseased heart valve with a mechanical heart valve would need blood-thinning medications to prevent blood clotting and stroke. If she became pregnant, blood thinners would pose a toxic risk to the fetus. Implanting a biological heart valve would eliminate the need for blood thinners, but it would be unlikely to last a lifetime, necessitating another open-chest surgery in the future.

"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 and 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.
About the American College of Cardiology:

The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 34,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care.

About the American Heart Association:

Founded in 1924, the American Heart Association today is the nation's oldest and largest voluntary health organization dedicated to reducing disability and death from cardiovascular diseases and stroke. These diseases, America's No. 1 and No. 3 killers, claim more than 910,000 lives a year. In fiscal year 2004-05 the association invested over $473 million in research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives. To learn more, call 1-800-AHA-USA1 or visit

American College of Cardiology

Related Aortic Valve Articles from Brightsurf:

Aortic valve replacement during COVID-19 pandemic
The outcomes associated with deferred compared with expedited aortic valve replacement in patients with severe aortic stenosis during the COVID-19 pandemic are evaluated in this observational study.

Patients deferred for transcatheter aortic valve replacement because of COVID-19
This single-center study of 77 patients describes the outcomes of patients with symptomatic severe aortic stenosis during the COVID-19 pandemic.

Comprehensive evaluation of mitral valve-in-valve and valve-in-ring
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement.

Research reveals link between high cholesterol levels and risk of aortic valve disease
Researchers from The George Institute for Global Health at the University of Oxford have found that while having high cholesterol levels does not influence your risk of aortic or mitral valve regurgitation, it does increase your risk of developing another major heart valve disease -- aortic stenosis.

NEJM: transcatheter aortic valve replacement shows similar safety outcomes as open-heart surgery
A new study from the Smidt Heart Institute at Cedars-Sinai and other centers nationwide shows that patients who underwent a minimally invasive transcatheter aortic-valve replacement (TAVR), had similar key 5-year clinical outcomes of death and stroke as patients who had traditional open-heart surgery to replace the valve.

Young age does not equal low risk for patients needing aortic valve replacement
While transcatheter aortic valve replacement (TAVR) continues to expand its pool of eligible patients, open heart surgery -- resulting in excellent patient survival and fewer strokes when compared to TAVR--is the best option for young and middle-aged adults with aortic valve disease -- at least for now.

Public reporting on aortic valve surgeries has decreased access, study finds
Public reporting on aortic valve replacement outcomes has resulted in fewer valve surgeries for people with endocarditis, a new study has found.

Bioengineers explore cardiac tissue remodeling after aortic valve replacement procedures
Researchers have developed biomaterial-based 'mimics' of heart tissues to measure patients' responses to an aortic valve replacement procedure, offering new insight into the ways that cardiac tissue re-shapes itself post-surgery.

New research addresses incidence of atrial fibrillation after aortic valve replacement
UAB investigators have outlined the incidence and implications of atrial fibrillation after transcatheter aortic valve implantation and surgical aortic valve replacement.

Defects in heart valve cilia during fetal development cause mitral valve prolapse
Genetic mutations in heart valve cells of the developing fetus lead to mitral valve prolapse, report a global collaborative of researchers, including Medical University of South Carolina investigators, in today's Science Translational Medicine.

Read More: Aortic Valve News and Aortic Valve Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to