ABSTRACT
Acquired and congenital valvular heart disease may occur in any heart valve as stenosis or regurgitation, in a combination of valves as mitral regurgitation and tricuspid regurgitation or as a valvular abnormality associated with other congenital anomalies as aortic stenosis and ventricular septal defect. In evaluating the clinical significance of the valvular problem, obtaining a history to include exercise-induced symptoms and a physical examination to determine the presence and hemodynamic significance of a valvular abnormality is vitally important. Doppler echocardiography has proven to be a very reliable adjunctive test to identify aortic, mitral, and tricuspid disease and in distinguishing mild disease from severe disease. However, at times, it is difficult to evaluate the degree of severity by echocardiography, particularly in regurgitant valvular abnormalities. The sensitivity of echocardiography to detect valvular regurgitant jets is high. Reportedly, tricuspid regurgitation can be seen in 25 to 95%, mitral valve regurgitation in 10 to 40%, and aortic valvular regurgitation in 0 to 30% of the subjects who had an echocardiogram. In evaluating a group of healthy subjects, regurgitant jets were found in greater than 90%, with triple valve regurgitant jets in 20% (1). These regurgitant jets are usually trivial and do not represent significant valvular insufficiency. The addition of a graded exercise test and cardiac catheterization may be required to determine the symptomatic and anatomical significance of the valvular disease.
