Anterior Mitral Leaflet

Fig. 6. Anatomy of the aortic valve.

2.4. Prosthetic Heart Valve

Endocarditis and Performance Tracking

All patients with prosthetic valves also need appropriate antibiotics for prophylaxis against infective endocarditis. This discussion is beyond the scope of this chapter, but refer to guidelines published by a joint committee from the American Heart Association and American College of Cardiology for the applicable protocols. A registry has been established to track the long-term performance of all clinically approved implanted valve prostheses (9).

Established standards were revised in 1996 and are summarized in Table 3. As alluded to in Chapter 21, investigators seeking approval for all new valves must also report any such complications that occur in the preclinical animal testing phase to the appropriate regulatory authority.


The remainder of this chapter is devoted to a generalized summary of the most common valvular diseases affecting patients in the Western world. Of the four heart valves, significant clinical disease can primarily affect all but the pulmonary valve. Indications for diagnostic, therapeutic, and follow-up intervention are discussed for each disease. A complete evi-denced-based summary of recommendations for intervention and physical activity in individuals with valvular disease is available from several excellent reviews, including those of Bonow et al. (7) and Cheitlin et al. (10).

3.1. Aortic Valve Disease

Anatomically, the normal aortic valve is composed of the annulus and the left, right, and noncoronary leaflets (sometimes referred to as "cusps") (Fig. 6). Diseases affecting these structures can be subdivided into aortic stenosis or regurgitation or some combination thereof. Overall, aortic stenosis is considered a surgical disease, with aortic valve replacement considered the standard of care. Treatment of aortic regurgitation is also surgical, although the exact method chosen will vary based on the etiology of the disease.

Table 4 Degree of Aortic Stenosis
Your Heart and Nutrition

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