Guidelines for the management of patients with valvular heart disease: executive summary

• DOI: 10.1007/s12055-000-0010-9
• Publication Date: 2007-07-29T01:20:57Z
• Authors: Robert O. Bonow; Blase Carabello; Antonio C. de Leon; L. Henry Edmunds; Bradley J. Fedderly; Michael D. Freed; William H. Gaasch; Charles R. McKay; Rick A. Nishimura; Patrick T. O’Gara; Robert A. O’Rourke; Shahbudin H. Rahi...; James L. Ritchie; Melvin D. Cheitlin; Kim A. Eagle; Timothy J. Gardner; Arthur Garson; Raymond J. Gibbons; Richard O. Russell; Thomas J. Ryan; Sidney C. Smith
• Keywords: Cardiothoracic surgery; Vascular surgery; valvular heart disease; Executive summary; Disease management

This executive summary and recommendations appears in the November 3, 1998, issue of Circulation . The guidelines in their entirety, including the ACC/AHA Class I, II, and III recommendations, are published in the November 1, 1998, issue of the Journal of the American College of Cardiology . Reprints of both the full text and the executive summary and recommendations are available from both organizations. During the past 2 decades, major advances have occurred in diagnostic techniques, the understanding of natural history, and interventional cardiological and surgical procedures for patients with valvular heart disease. The information base from which to make clinical management decisions has greatly expanded in recent years, yet in many situations, management issues remain controversial or uncertain. Unlike many other forms of cardiovascular disease, there is a scarcity of large-scale multicenter trials addressing the diagnosis and treatment of valvular disease from which to derive definitive conclusions, and the literature represents primarily the experiences reported by single institutions in relatively small numbers of patients. The Committee on Management of Patients With Valvular Disease was given the task of reviewing and compiling this information base and making recommendations for diagnostic testing, treatment, and physical activity. These guidelines follow the format established in previous American College of Cardiology/American Heart Association (ACC/AHA) guidelines for classifying indications for diagnostic and therapeutic procedures: Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment IIa. Weight of evidence/opinion is in favor of usefulness/efficacy IIb. Usefulness/efficacy is less well established by evidence/opinion. Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful and in some cases …