Valvular regurgitation

Volume overload (e.g., valvular regurgitation, shunts, high-output states)... 

New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)... 

Causes of systolic dysfunction (decreased contractility) are reduction in muscle mass (e.g., myocardial infarction [MI]), dilated cardiomyopathies, and ventricular hypertrophy. Ventricular hypertrophy can be caused by pressure overload (e.g., systemic or pulmonary hypertension, aortic or pulmonic valve stenosis) or volume overload (e.g., valvular regurgitation, shunts, high-output states). 

Nitroprusside is effective in the short-term management of severe HF in a variety of settings (e.g., acute MI, valvular regurgitation, after coronary bypass surgery, decompensated HF). Generally, it will not worsen, and may improve, the balance between myocardial oxygen demand and supply. However, an excessive decrease in systemic arterial pressure can decrease coronary perfusion and worsen ischemia. 

Radionuclide angiocardiography is used to measure ejection fraction (EF), regional ventricular performance, cardiac output, ventricular volumes, valvular regurgitation, asynchrony or wall motion abnormalities, and intracardiac shunts. 

Unlabeled Uses Control of paroxysmal hypertension before and during surgery for pheochromocytoma, peripheral vasospasm caused by ergot alkaloid overdose, treatment adjunct for MI, valvular regurgitation... 

Earlier studies (ref. 440-442) with ordinary air microbubbles (without any synthetic surfactant coating) have already shown that echocardiographic contrast produced by microbubbles is useful in the qualitative analysis of blood flow and valvular regurgitation. In addition, quantitative studies (ref. 440) have shown a correlation between individual contrast trajectories on M-mode echocardiography and invasive velocity measurements in human beings. Meltzer et al. (ref. 441) have shown that velocities derived from the slopes of contrast trajectories seen on M-mode echocardiography correlate with simultaneous velocities obtained by Doppler techniques. (This correlation is expected because both measures represent the same projection of the microbubble velocity vector, that is, in the direction of the sound beam.) More detailed studies (ref. 442) confirmed that microbubble velocity obtained from either Doppler echocardiography or M-mode contrast trajectory slope analysis correlates well with actual (Doppler-measured) red blood cell velocity. Thus, these early studies have shown that microbubbles travel with intracardiac velocities similar to those of red blood cells. 

Risk factors include the following prosthetic heart valves, previous bacterial endocarditis, congenital cardiac malformations, rheumatic and other acquired valvular dysfunction, and mitral valve prolapse with valvular regurgitation. 

Based on a prospective study carried out in 226 obese subjects (183 women and 43 men) with a mean body mass index of 40 kg/m, therapy with fen-phen was associated with low prevalence of significant valvular regurgitation (29). The authors suggested that valvular regurgitation in... 

There is further evidence of the relation between the duration of treatment with fen-phen and the prevalence of valvular abnormalities (42). In 1163 patients who had taken anorexigens within the previous 5 years and 672 control patients who had not, valvular abnormalities primarily involved those who had taken anorexigens for more than 6 months, and predominantly resulted in mild aortic regurgitation. The study had some noteworthy limitations since fenfluramine has been withdrawn from use, a randomized trial was impossible also the lack of baseline echocardiograms before treatment implies that one cannot be certain that the valvular regurgitation developed subsequent to drug treatment. 

Other epidemiological studies have ruled out the possibility that obesity itself causes a high prevalence of cardiac valvular regurgitation (52-54). 

Weissman NJ, Tighe. JF Jr, Gottdiener JS, Gwynne JT. Prevalence of valvular-regurgitation associated tvith dexfenfluramine three to five months after discontinuation of treatment. J Am Coll Cardiol 1999 34(7) 2088-95. 

Roldan CA, GUI EA, Shively BK. Prevalence and diagnostic value of precordial murmurs for valvular regurgitation in obese patients treated with dexfenfluramine. Am J Cardiol 2000 86(5) 535-9. 

Weissman NJ, Panza JA, Tighe JF, Gwynne JT. Natural history of valvular regurgitation 1 year after discontinuation of dexfenfluramine therapy. A randomized, doubleblind, placebo-controlled trial. Ann Intern Med 2001 134(4) 267-73. 

Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, TaUercio CP, Taylor CL, Bailey KR, Seward JB. Age-related prevalence of valvular regurgitation in normal subjects a comprehensive color flow examination of 118 volunteers. J Am Soc Echocardiogr 1990 3(l) 54-63. 

Moderate-risk conditions Mitral valve prolapse with valvular regurgitation or leaflet thickening, isolated mitral stenosis, tricuspid-valve disease, pulmonary stenosis, and hypertrophic cardiomyopathy... 

Philippe L, Mena I, Sarcourt J, French WJ (1988) Evaluation of valvular regurgitation by factor analysis of first-pass angiography. J Nucl Med 29 159-167 Steigman J, Meinken G, Richards P (1975) The reduction of pertechnetate-99 by stannous chloride I. The stoichiometry of the reaction in HCl, in a citrate buffer and in a DTPA buffer. Int J Appl Radiat Isot 26 601-609... 

This drug is useful in the treatment of peripheral vasospasm secondary to ergot alkaloid overdose, and as an adjunct in the treatment of valvular regurgitation. 

Heart valve disease occurs when a valve does not work properly. In valvular stenosis, the valve leaflets tissues become stiffer, narrowing the valve opening and reducing the blood flow. If the narrowing is mild, the overall functioning of the heart may not be reduced. However, the valve can become so narrow (stenotic) that heart function is reduced, and the rest of the body may receive inadequate blood flow. Another valvular heart disease condition, called valvular regurgitation, occurs when the leaflets do not close completely, letting blood leak backward across the valve. 

Fig. 19.5a-d. A 49-year-old man with an ascending aortic aneurysm. MDCT demonstrates the aortic geometry (a-c) and also depicts incomplete adaptation of the valvular cusps during diastole, indicating valvular regurgitation (d)... 

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