Advances in the Management of Valvular Heart Diseases

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Citation
Asia Pacific Cardiology - Volume 2 Issue 1;2008:2(1):62-63

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Valvular heart disease is a paradigm of the changing aetiology of human disease. We have witnessed dramatic changes in the incidence of rheumatic heart disease in the industrialised world. The frequency of valve disease is still high due to the rise in new diseases such as degenerative valve disease. In developing countries the prevalence has increased due to rheumatic burden, degenerative lesions and ‘emerging valve disease’. The three main modern sources of the disease are AIDS, drug-related effects from drugs such as appetite suppressants and new types of idiopathic disease such as ‘antiphospholipid syndrome’.1
Surgical interventions for valvular heart disease are increasing due to increases in average life expectancy, changing demographics and increased accessibility to and affordability of sophisticated healthcare for the populations of developing countries.
The era of valvular therapy was ushered in on the afternoon of 10 June 1948 when Dr Charles Philamore Bailey2 performed the first closed mitral commissurotomy at the Episcopal Hospital in Philadelphia, US. The fact that Dr Bailey transported his patient from Philadelphia to Chicago, Illinois on the 10th post-operative day (as an exhibit for the scientific session of the American College of Chest Physicians) illustrates the competitive environment rampant at that time. The first open heart surgical procedure, mitral valve repair, was performed by Dr Forest Dewey Dodrill on 3 July 1952 at the Harper Hospital in Detroit, Michigan.3 Fifty-six years later, valvular therapy has seen dramatic and rapid advances, with seminal contributions from many experts from all parts of the world.
The introduction of mechanical prostheses and bioprosthesis gave tremendous impetus to replacement therapies. Scores of new valves were introduced to the market, although the US Food and Drug Administration (FDA) approved only a few of these. Research institutes from developing countries introduced indigenous valves (Chitra Valve, India; Biomed, Mexico; and Braile Biomedica, Brazil). These valves provided acceptable economically viable long-term solutions. There were also landmark innovations in surgical techniques, notably the ‘Ross I’ (pulmonary autograft) 4 and ‘Ross II’ by Sir Donald Ross. Reparative valve work was soon found to be superior to conventional replacements, the ‘torchbearer’ of such work being Dr Alain Carpentier (the ‘French Correction’).5
Simultaneously, rapid strides in percutaneous therapy were applied to the treatment of valvular lesions. ‘Balloon’ mitral therapy and pulmonary and aortic valvotomy are examples of such treatments. Dr Randall Chitwood of North Carolina, US, explains advances in robotic cardiac surgery in reference 6.

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References
  1. Soler J, Galve E, Worldwide Perspective of Valve Disease, Heart, 2000;83:721–5.
  2. Rainer GW, The 50th Anniversary of Mitral Valve Surgery, Ann Thorac Surg, 1998;65:1519.
  3. Silbergleit A, Forest Dewey Dodrill, MD Pioneer Cardiovascular Surgeon, Curr Surg, 2002;59(3):344–5.
  4. The International Registry for the Ross Procedure, Ross Registry, Rapid City.
  5. Carpentier A, Cardiac Valve Surgery—the “French correction”, J Thorac Cardiovasc Surg, 1983;86(3):323–7.
  6. Felger JE, Chitwood WR Jr, Nifong WL, Holbert D, Evolution of Mitral Valve Surgery: Toward a Totally Endoscopic Approach, Ann Thorac Surg, 2001;72:1203–9.
  7. Mack MJ, Is there a Future for Minimally Invasive Cardiac Surgery?, Eur J Cardiothorac Surg, 1999;16:S119–S125.
  8. Mohr FW, Onnasch JF, Falk V, et al., The Evolution of Minimally Invasive Mitral Valve Surgery – 2-year experience, Eur J Cardiothorac Surg, 1999;15:233–9.
  9. Cribier A, Eltchaninoff H, Bash A, et al., Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis First Human Case Description, Circulation, 2002;106:3006.
  10. Walther T, Falk V, Dewey T, et al., Valve-in-a-Valve Concept for Transcatheter Minimally Invasive Repeat Xenograft Implantation, J Am Coll Cardiol, 2007;50:56–60.
  11. Coats L, Bonhoeffer P, New Percutaneous Treatments For Valve Disease, Heart, 2007;93:639–44.