Drug Therapy for Heart Valve Diseases

V alvular heart diseases (VHDs) are among the most pre- dictable causes of heart failure and sudden cardiac death. 1 Observational studies suggest that a relatively high proportion of asymptomatic subjects manifest hemodynamically apparent VHDs varying from mild to severe. 1 VHDs comprise 2 overarching groups: primary, involving intrinsic abnormalities of valve structures, and secondary, or "functional," featuring myocardial dysfunction or vascular deformation that secondarily affects valve performance.Clinically, VHDs generally are progressive.When hemodynamically severe but not caused by acute comorbidities (eg, infection, myocardial infarction) they feature long asymptomatic phases while hemodynamic severity may progress, followed by symptoms or objective descriptors that predict morbidity and mortality and are considered to mandate surgery.Treatment depends on VHD type and severity but, when severe and symptomatic, usually involves mechanical intervention.Asymptomatic patients who lack objective descriptors suggesting high morbid or lethal risk are closely observed clinically (and associated cardiovascular risk factors are optimized) until surgical indications develop.Although often prescribed based on theory, no rigorous evidence supports pharmacological therapy in most chronic situations, although drugs may be useful in acute valvular diseases, or as a bridge to surgery in severely decompensated patients.This review examines evidence supporting the use of drugs for chronic VHDs.We will focus only on drugs believed to prevent clinical, cardiac functional, or valve abnormalities or to delay surgery and will avoid discussion of anticoagulants and specific antiarrhythmics that might be appropriate in certain settings.Finally, given the volume of available clinical data and the paucity of drugs developed solely for VHD, we will present animal or experimental data only when they importantly supplement clinical information (Table ).