Management of valvular heart disease from a critical care perspective

doi:10.3877/cma.j.issn.2096-1537.2025.04.004

Abstract

Abstract:

The recognition and management of valvular heart disease (VHD) pose a significant challenge for intensivists. The priorities include rapid diagnosis, timely differentiation of potential etiologies, implementation of effective therapies, and creating opportunities for definitive surgical intervention. Key aspects that require optimization cncompass efficient hemodynamic monitoring, tailored pharmacotherapy, judicious application of extracorporeal life support and determining the optimal timing for surgical or transcatheter procedures. This article reviews the current evidence regarding the diagnosis and managementof VHD in critically ill patients, aiming to provide a reference for clinicians to optimize clinical practice in ICU.

Key words: Valvular heart disease, Mitral regurgitation, Aortic regurgitation, Prosthetic heart valves

Wenzhe Li, Xiangyou Yu. Management of valvular heart disease from a critical care perspective[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(04): 345-350.

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References 41

1	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) [J]. Rev Esp Cardiol (Engl Ed), 2022, 75(6): 524.
2	Bohula EA, Katz JN, van Diepen S, et al. Demographics, care patterns, and outcomes of patients admitted to cardiac intensive care units: the Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness [J]. JAMA Cardiol, 2019, 4(9): 928-935.
3	Bernard S, Deferm S, Bertrand PB. Acute valvular emergencies [J]. Eur Heart J Acute Cardiovasc Care, 2022, 11(8): 653-665.
4	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines [J]. Circulation, 2021, 143(5): e35-e71.
5	Cahill TJ, Prothero A, Wilson J, et al. Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation [J]. Heart, 2021, 107(12): 1003-1009.
6	Santangelo G, Bursi F, Faggiano A, et al. The global burden of valvular heart disease: from clinical epidemiology to management [J]. J Clin Med, 2023, 12(6): 2178.
7	Coffey S, Roberts-Thomson R, Brown A, et al. Global epidemiology of valvular heart disease [J]. Nat Rev Cardiol, 2021, 18(12): 853-864.
8	Coffey S, Harper AR, Cairns BJ, et al. Clinical information has low sensitivity for postmortem diagnosis of heart valve disease [J]. Heart, 2017, 103(13): 1031-1035.
9	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [J]. Circulation, 2022, 145(18): e895-e1032.
10	Hamirani YS, Dietl CA, Voyles W, et al. Acute aortic regurgitation [J]. Circulation, 2012, 126(9): 1121-1126.
11	Prêtre R, Chilcott M. Blunt trauma to the heart and great vessels [J]. N Engl J Med, 1997, 336(9): 626-632.
12	Chiappini B, Schepens M, Tan E, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients [J]. Eur Heart J, 2005, 26(2): 180-186.
13	Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study [J]. Eur Heart J, 2019, 40(39): 3222-3232.
14	Chehab O, Roberts-Thomson R, Ng Yin Ling C, et al. Secondary mitral regurgitation: pathophysiology, proportionality and prognosis [J]. Heart, 2020, 106(10): 716-723.
15	Boudoulas KD, Triposkiadis F, Koenig S, et al. Acute mitral regurgitation with and without acute heart failure [J]. Heart Fail Rev, 2023, 28(5): 1201-1209.
16	Watanabe N. Acute mitral regurgitation [J]. Heart, 2019, 105(9): 671-677.
17	Sannino A, Grayburn PA. Ischemic mitral regurgitation after acute myocardial infarction in the percutaneous coronary intervention era [J]. Circ Cardiovasc Imaging, 2016, 9(8): e005323.
18	Redfield MM, Nicholson WJ, Edwards WD, et al. Valve disease associated with ergot alkaloid use: echocardiographic and pathologic correlations [J]. Ann Intern Med, 1992, 117(1): 50-52.
19	Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine [J]. N Engl J Med, 1997, 337(9): 581-588.
20	Waller BF, Howard J, Fess S. Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part Ⅲ [J]. Clin Cardiol. 1995 Apr;18(4): 225-30.
21	Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) [J]. Am J Cardiol, 1999, 83(6): 897-902.
22	Kostyunin AE, Yuzhalin AE, Rezvova MA, et al. Degeneration of bioprosthetic heart valves: update 2020 [J]. J Am Heart Assoc, 2020, 9(19): e018506.
23	Stout KK, Verrier ED. Acute valvular regurgitation [J]. Circulation, 2009, 119(25): 3232-3241.
24	王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识 [J]. 中华内科杂志, 2016, 55(11): 900-912.
25	Otto CM, Prendergast B. Aortic-valve stenosis--from patients at risk to severe valve obstruction [J]. N Engl J Med, 2014, 371(8): 744-756.
26	Dahou A, Levin D, Reisman M, et al. Anatomy and physiology of the tricuspid valve [J]. JACC Cardiovasc Imaging, 2019, 12(3): 458-468.
27	Sadeghpour A, Hassanzadeh M, Kyavar M, et al. Impact of severe tricuspid regurgitation on long term survival [J]. Res Cardiovasc Med, 2013, 2(3): 121-126.
28	Nath SS, Parashar S. Perioperative management of patients with prosthetic heart valves-a narrative review [J]. Ann Card Anaesth, 2022, 25(3): 254-263.
29	Van den Brink RB. Evaluation of prosthetic heart valves by transesophageal echocardiography: problems, pitfalls, and timing of echocardiography [J]. Semin Cardiothorac Vasc Anesth, 2006, 10(1): 89-100.
30	Masha L, Vemulapalli S, Manandhar P, et al. Demographics, procedural characteristics, and clinical outcomes when cardiogenic shock precedes TAVR in the United States [J]. JACC Cardiovasc Interv, 2020, 13(11): 1314-1325.
31	Kilic A, Sultan I, Chu D, et al. Mitral valve surgery for papillary muscle rupture: outcomes in 1342 patients from the Society of Thoracic Surgeons Database [J]. Ann Thorac Surg, 2020, 110(6): 1975-1981.
32	Estévez-Loureiro R, Shuvy M, Taramasso M, et al. Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: effect of cardiogenic shock on outcomes (IREMMI Registry) [J]. Catheter Cardiovasc Interv, 2021, 97(6): 1259-1267.
33	Giustino G, Camaj A, Kapadia SR, et al. Hospitalizations and mortality in patients with secondary mitral regurgitation and heart failure: the COAPT trial [J]. J Am Coll Cardiol, 2022, 80(20): 1857-1868.
34	Messika-Zeitoun D, Baumgartner H, Burwash IG, et al. Unmet needs in valvular heart disease [J]. Eur Heart J, 2023, 44(21): 1862-1873.
35	De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock [J]. N Engl J Med, 2010, 362(9): 779-789.
36	van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association [J]. Circulation, 2017, 136(16): e232-e268.
37	Thiele RH, Nemergut EC, Lynch C 3rd. The clinical implications of isolated alpha(1) adrenergic stimulation [J]. Anesth Analg, 2011, 113(2): 297-304.
38	Khot UN, Novaro GM, Popović ZB, et al. Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis [J]. N Engl J Med, 2003, 348(18): 1756-1763.
39	Kalra A, Uberoi AS, Latib A, et al. Emerging transcatheter options for tricuspid regurgitation [J]. Methodist Debakey Cardiovasc J, 2017, 13(3): 120-125.
40	Clark JD, Baden HP, Berkman ER, et al. Ethical considerations in ever-expanding utilization of ECLS: a research agenda [J]. Front Pediatr, 2022, 10: 896232.
41	Sang S, Beute T, Heiser J, et al. Early outcomes for valve-in-valve transcatheter aortic valve replacement in degenerative freestyle bioprostheses [J]. Semin Thorac Cardiovasc Surg, 2018, 30(3): 262-268.

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