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Management and prognosis of surgical aortic and mitral prosthetic valve regurgitation

Authors
Alvaro Marco del Castillo, MD
Pepe Zamorano, MD
Section Editors
Patrizio Lancellotti, MD, PhD, FESC, FACC
Stephen JD Brecker, MD, FRCP, FESC, FACC
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Prosthetic valve dysfunction encompasses prosthetic valve obstruction (stenosis) and prosthetic valve regurgitation. Regurgitation associated with prosthetic heart valves includes regurgitation through the valve (transvalvular) as well as paravalvular regurgitation (also known as paravalvular leak[PVL]). Symptomatic severe prosthetic valve regurgitation is an uncommon complication of surgical valve replacement. However, it is associated with poor outcomes with both conservative management and surgical treatment.

This topic will discuss the prognosis and management of prosthetic valve regurgitation. Clinical manifestations and diagnosis of surgical prosthetic valve regurgitation as well as diagnosis and management of transcatheter heart valve regurgitation are discussed separately. (See "Clinical manifestations and diagnosis of surgical aortic and mitral prosthetic valve regurgitation" and "Transcatheter aortic valve implantation: Complications".)

MANAGEMENT

Approach to management — The approach to management of prosthetic valve regurgitation includes monitoring asymptomatic patients, medical therapy for the cause of regurgitation (when treatable) and medical management of the sequelae of regurgitation, and evaluation of patients with severe prosthetic regurgitation for valve intervention (surgical or transcatheter), starting with determination of surgical risk.  

Diagnosis and evaluation of prosthetic valve regurgitation is discussed separately. (See "Clinical manifestations and diagnosis of surgical aortic and mitral prosthetic valve regurgitation".)

Asymptomatic patients with prosthetic valve regurgitation should be monitored, with frequency of monitoring based upon the severity of regurgitation and associated clinical findings. (See 'Monitoring' below.)

                  
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Literature review current through: Oct 2017. | This topic last updated: Jun 21, 2017.
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