Chronic disease treatment

Management of chronic disease:

• conservative for mild or moderate disease
• valve surgery - repair, valvotomy or replacement in severe disease
• warfarin anticoagulation for mitral stenosis and mitral regurgitation if there is atrial fibrillation or dilated left atrium - larger than 5 cm on echo
• diuretic if required
• digoxin in atrial fibrillation
• antibiotic prophylaxis to prevent endocarditis

Note that surgery must be undertaken before the left ventricle dilates to an end systolic dimension of 5.5cm or more. If this has occurred then there is a reduction in prospects for recovery of left ventricular function.

Vasodilator therapy in aortic regurgitation:

• vasodilator therapy (including hydralazine, calcium-channel blockers, and angiotensin-converting enzyme inhibitors) has been employed in patients with asymptomatic chronic aortic incompetence
  • a systematic review was undertaken and identified one study (out of 10) that suggested that the use of vasodilators slowed the rate of progression to surgery for aortic valve replacement
  • however the authors concluded that vasodilators inconsistently improve hemodynamic and structural parameters in asymptomatic patients with chronic AI (1)

Reference:

• (1) Mahajerin A et al.Vasodilator therapy in patients with aortic insufficiency: a systematic review. Am Heart J. 2007 Apr;153(4):454-61.