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J Thorac Cardiovasc Surg 2004;127:1-3
© 2004 The American Association for Thoracic Surgery

Editorial

Gender and valvular surgery

Rita F. Redberg, MD, MSca,*, Nelson B. Schiller, MDa

a University of California, San Francisco, Department of Medicine, San Francisco, Calif, USA

Received for publication August 8, 2003; accepted for publication September 9, 2003.

* Address for reprints: Dr R. F. Redberg, Director, Women's Cardiovascular Services, School of Medicine, Division of Cardiology, 505 Parnassus Ave, Suite M-1180, San Francisco, CA 94143-0124, USA
redberg@medicine.ucsf.edu

The first 20% of the full text of this article appears below.

Cardiovascular disease is currently the leading cause of death among American women. Although the majority of these deaths can be attributed to coronary artery disease, a significant number of women have valvular heart disease. In fact, of 123,000 patients discharged from the hospital in 1987 with diagnoses of aortic or mitral valve disease, 71% were women.1 In addition, more than 60% of heart valve replacement procedures are performed in women. In contrast, 39% of patients discharged from the hospital with diagnoses of myocardial infarction (MI) were women.2 Thus, while men are 15 times more likely to be discharged with diagnoses of MI, women are just 4 times more likely to be discharged with diagnoses of MI than vascular disease.1

Gender differences in pathophysiology of valvular heart disease

Gender differences affect the pathophysiology of valvular heart disease. Women have a 5% to 10% higher cardiac output (CO) at any level of submaximal oxygen uptake than do men. The difference may be attributed to women's lower hemoglobin levels (~-10%). Women also have a maximal aerobic capacity that is 50% lower than that of men (10%-15% lower when adjusted for lean body mass), which may be related to lesser blood volume. In addition, women have greater capacity to perform isotonic exercise, possibly because the estrogen influence on fatty acid is a preferential energy substrate during exercise and sparing of glycogen stores.

Such gender differences have important implications in the care . . . [Full Text of this Article]






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