**2. Practical anatomy and physiology of the aortic valve**

The aortic valve is the last gate the blood pumped from the heart to the rest of the organs. It is at the junction between the aorta and the outflow tract of the left ventricle. Its function is to maintain unidirectional blood flow during the diastole while allowing the blood forward flow with minimal resistance during systole. The aortic valve has typically three semilunar cusps (tricuspid) named by their relationship to the coronary Ostia: the left coronary and right coronary, and the third is the noncoronary cusp. Cusps are attached to the aortic annulus at the bottom of slight dilations of the aorta associated with each cusp (sinuses of Valsalva end at the sinotubular junction). The sinotubular junction is the narrowest part of the aortic

**19**

*Aortic Valve Disease: State of the Art*

**3.1 General principles**

*DOI: http://dx.doi.org/10.5772/intechopen.93311*

may try the acumen of a seasoned clinician.

thorough physical examination.

**3.2 History**

abuse raises the TE.

*3.2.1 Dyspnea*

as the geographical location in the world.

somewhat more specific for left ventricular failure.

best way to evaluate the patients and reassure them [27, 28].

this stage drain hours in the wasted investigation later.

or untreated coronary artery disease, radiation therapy.

way of prosthetic valve endocarditis or structural failure.

with the anterior leaflet of the mitral valve [23, 24].

root (**Figure 1**). The fibrous skeleton supports the aortic valve and is continuous

Detection of valvular heart disorder can be difficult. The state of the patient may range in gravity from asymptomatic to cardiogenic shock. Endocarditis may mimic systemic illness, vascular or neurologic condition, while acute aortic incompetence may be presented as a primary respiratory disorder (acute asthmatic episode). Making a timely, accurate diagnosis, while averting excessive laboratory studies,

Commonly, observing a murmur in a well individual or a patient with symptom referable to the cardiovascular system, arouse the suspicion of valvular abnormality. It is essential to reassure the patients; murmur is not synonymous with heart disease. It does represent turbulent blood flow which may result from several possible conditions. These include: (i) increased flow secondary to anaemia, pregnancy, or a hyperadrenergic state; accelerated flow through a restricted orifice (ii) regurgitant flow through a leaking valve; or (iii) abnormal shunting between two chambers. In an unselected population, most systolic murmurs are physiologic, caused by conditions of increased blood flow [25, 26]. The echocardiogram is the

The practical approach to these patients relies upon an open-minded history and

The clinician assessment should not be compromised, trying to spare minutes at

The patient may provide a history of rheumatic fever, pervious episode of infective endocarditis, intravenous drug use, use of anorectic medications, carcinoid tumours, indwelling vascular devices, dental, genitourinary or gastrointestinal procedures; Marfan's syndrome, syphilis; congenital bicuspid aortic valve; treated

Finally, a history of past surgery increases the risk of future valve problems by

Family genetics undoubtedly plays a role in so doing; the clinician may identify a family with a previously unrecognised genetic mutation and allowed early diagnosis of relatives. The social history may provide valuable information. For example, a childhood spent in a no industrialised region of the world dramatically increases the risk of rheumatic valve disease. History of unprotected sex or intravenous drug

Course for valvular heart disease varies widely, ranging from minutes to decades dependent on primary pathology and age and risk factors related to patients as well

Unfortunately, it is also very nonspecific, occurring in nearly any disturbance of cardiopulmonary function. Orthopnoea and paroxysmal nocturnal dyspnea are

As in nearly all of medicine, most cues to a diagnosis are from history.

**3. Managing a patient with suspected valvular heart disease**

**Figure 1.** *Aortic valve anatomy.*

root (**Figure 1**). The fibrous skeleton supports the aortic valve and is continuous with the anterior leaflet of the mitral valve [23, 24].
