Non-rheumatic-acquired valvular disease in the elderly

The analysis of the clinical data permit some conclusions about the state of the art of valvular lesions. (i) Mitral stenosis is not the predominant lesion any more, particularly above 65 years of age, although is it still more frequent in females. The decreased appearance of new cases goes parallel with the reduced incidence of rheumatic fever, showing indirectly that the latter is the most common cause of the disease. (ii) Mitral insufficiency is the fourth most common lesion, without any age- and sex-dependent differences. Ischemic heart disease, floppy mitral valve and bacterial endocarditis are the usual causes above the age of 65 years. (iii) Aortic stenosis is becoming the predominant valvular lesion, especially in females over 65 years of age; two thirds of cases have good left ventricular function, emphasizing that surgical removal of the stenotic valve in persons above 75 years may be performed more frequently. (iv) The incidence of aortic regurgitation has not changed during the last 10 years; however, rheumatic fever and syphilis are not any more the main causes, but aortic annular ecstasy and bacterial endocarditis are the most common pathologies leading to the insufficiency of the aortic valve. Taking together these facts, and considering also the problems linked to the surgical treatment (or to the possibility of mitral angioplasty), the disease of the heart valves represent major problems even today.