Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in approximately 1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.

Bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. A significant challenge when comparing the durability of different types of bioprostheses is the lack of a standardized terminology for the definition of a degenerated valve. This issue becomes especially important when we try to compare the degeneration rate of surgically inserted and transcatheter bioprosthetic valves. This document, by the VIVID (Valve-in-Valve International Data), proposes practical and standardized definitions of valve degeneration and provides recommendations for the timing of clinical and imaging follow-up assessments accordingly. Its goal is to improve the quality of research and clinical care for patients with deteriorated bioprostheses by providing objective and strict criteria that can be utilized in future clinical trials. We hope that the adoption of these criteria by both the cardiological and surgical communities will lead to improved comparability and interpretation of durability analyses.

Valvular heart disease (VHD) encompasses a number of common cardiovascular conditions that account for 10% to 20% of all cardiac surgical procedures in the United States. A better understanding of the natural history coupled with the major advances in diagnostic imaging, interventional cardiology, and surgical approaches have resulted in accurate diagnosis and appropriate selection of patients for therapeutic interventions. A thorough understanding of the various valvular disorders is important to aid in the management of patients with VHD. Appropriate work-up for patients with VHD includes a thorough history for evaluation of causes and symptoms, accurate assessment of the severity of the valvular abnormality by examination, appropriate diagnostic testing, and accurate quantification of the severity of valve dysfunction and therapeutic interventions, if necessary. It is also important to understand the role of the therapeutic interventions vs the natural history of the disease in the assessment of outcomes. Prophylaxis for infective endocarditis is no longer recommended unless the patient has a history of endocarditis or a prosthetic valve.

These data indicate that CP-751,871 is well tolerated and may constitute a novel agent in the treatment of multiple myeloma.

Chronic degenerative mitral regurgitation (MR) is a complex problem, which requires an integrated assessment of etiology, pathophysiology, and severity to enable informed clinical decision-making. A multidisciplinary approach is required, with input from the clinician, imager, and surgeon. This review begins with a discussion of essential echocardiographic and surgical mitral valve (MV) anatomy, which dictates suitability for repair when indicated. The echocardiographic and Doppler principles, which underlie the quantitation of MR severity, are summarized in the next section, followed by a critical examination of left ventricular systolic function in this disorder. A brief discussion of the important role of imaging in the developing field of percutaneous MV repair is included. The methodical and objective noninvasive assessment of degenerative MR herein reviewed is intended to help guide management decisions for patients with this challenging valve lesion.

Surgical correction of mitral regurgitation results in an early decrease in ejection fraction, particularly in symptomatic patients with increased left heart dimensions.

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