ABSTRACT
Mitral valve disease in the elderly differs from that in the younger patients in several ways. Since rheumatic fever is now uncommon in North America and Western Europe, most rheumatic heart disease is seen in younger patients not born in the United States or in older patients. In patients born in North America or Western Europe, mitral stenosis (MS) is predominantly seen in patients over the age of 50–60 years, many of whom have had one or more surgical or balloon valvuloplasties. At present, balloon valvuloplasty is the procedure of choice, even in the elderly and even in patients who have had previously valvulotomy and are who now have mitral restenosis. Mitral regurgitation (MR) has many etiologies, the most common of which are degenerative or mitral valve prolapse, functional MR due to ischemia, or cardiomyopathy. In patients with grade I or II ischemic MR, revascularization alone can reduce or eliminate the MR. With grade III or IV ischemic MR, revascularization and concomitant annuloplasty or valve replacement can markedly reduce the degree of MR and result in better outcomes. With mitral valve disease, atrial fibrillation (AF) is a common complication and if valve surgery is indicated, consideration should be given to a concomitant Maze procedure or ablation for AF. Mitral annular calcification (MAC) is most frequently seen in the elderly patient and is probably a marker for vascular atherosclerosis and an independent predictor of adverse cardiovascular events such as myocardial infarction and stroke. The American Heart Association recommendations for antibiotic prophylaxis for valvular disease has been markedly altered so that now prophylaxis is no longer recommended for valvular regurgitation. However, many physicians still prescribe antibiotic prophylaxis for their patients with valve disease.
