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J Thorac Cardiovasc Surg 2004;127:4-6
© 2004 The American Association for Thoracic Surgery

Editorial

Valvular heart disease in women: The surgical perspective

A. J. Carpenter, MD, PhDa,*, Margarita Camacho, MDb

a Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Tex, USA
b Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital, Manhasset, NY, USA

Received for publication September 22, 2003; revisions received October 6, 2003; accepted for publication October 22, 2003.

* Address for reprints: A. J. Carpenter, MD, PhD, Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, TX 78015, USA
carpentera2@uthscsa.edu

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


Dr Carpenter


The efforts of many to increase the awareness of cardiovascular disease in women have focused on the primary killer: coronary artery disease. Unlike acquired coronary disease, valvular disease tends to affect women in all age groups and may particularly pose a serious problem in women of childbearing age. Given the simplicity of such screening methods as cardiac auscultation and transthoracic echocardiogram, more women with previously undiagnosed valvular disease can be identified, and guidelines for follow-up and treatment, when necessary, can be recommended. We will review the surgical issues of valvular heart disease that are specific to women during the childbearing and postmenopausal years.

Aortic valve

Significant aortic stenosis (AS) is not common during the childbearing years. In this age group, stenotic lesions are most commonly congenital in origin in the Western world and are due to rheumatic disease in developing countries. The most common cause of AS in the postmenopausal years is senile calcification that appears in the sixth decade for bicuspid valves or the seventh decade for tricuspid valves. Medical therapy has little role in the management of AS. Any woman with symptoms of AS, including congestive heart failure, syncope, or angina, should have aortic valve replacement (AVR). With improvement in surgical outcomes, there is a trend toward earlier referral for AVR. Asymptomatic women with aortic valve areas 1 cm2 or smaller should be considered for AVR, especially younger women who anticipate future pregnancy.

Aortic insufficiency (AI) during the childbearing years is most commonly associated with endocarditis or Marfan syndrome and related connective tissue disorders. In older women with AI the cause is usually hypertensive aortic dilatation or mixed AS/AI lesions of calcific valves. There is a significant role for . . . [Full Text of this Article]






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