Índice valvar & escore valvar: uma nova forma de comunicação do continuum da história natural da valvopatia

Abstract

Data from the history, physical examination, and laboratory examination qualify and quantify the pathologic continuum triggered by valvular lesion. Following up a patient with valvular heart disease, who usually has a long history, is building a pari-passu of comparisons. Three types of observations are used in our every day practice: 1) to observe cardiovascular adaptation, including prevention of the valvular pathogenic factors (rheumatic fever or infective endocarditis); 2) interventions in events that modify the natural history (recurrent attack of rheumatic fever, infective endocarditis, pregnancy); 3) replacement of the natural history by a postoperative history.Each moment of the valvular assessment is a link between the past steps and predictions of the following pattern. There is the time when the physical manifestation is just a "murmur," and an observation period of the natural history is recommended; there is the time when severe valvular lesion is present and the patient remains with a good quality of life; there is the time when the patient is considered "sick indeed" because of the onset of symptoms; there is the time that goes beyond the natural history and the cardiologist is expected to recommend intervention on the anatomy of the heart disease 1,2 .From the practical point of view, to follow up a patient with valvular heart disease is to accumulate answers about 4 factors, each one symbolized by a letter: 1) how severe is the lesion (V); 2) what is the effect on myocardial function (M); 3) what is the level of the coronary artery obstruction (C) 4) what is the effect on the level of pulmonary artery pressure (P).We understand that gathering 4 answers under the acronym VMCP helps in characterizing the clinical moment and communi-cation between appointments, and we are proposing a 4 x 4 classification, including the 4 variables, each of them with 4 categories. VMCP represents the valvular index (ex, V 3 M 2 C 1 P 2 ) and gives grounds to the valvular score (3+ 2 + 1 + 2 = 8 in the case mentioned) (chart 1).Our intention is to define the subdivision in categories based on the reference points usually used. Thus, the passage from V2 to V3 includes the case in class I of surgical recommendation according to the guidelines 1 . The identification of the case as M3 or M4 implies an influence on the surgical prognosis.