<unk>  can be treated either medically or surgically, depending on the acuteness of presentation, the symptoms and signs associated with the disease process, and the degree of left ventricular dysfunction. Surgical treatment in asymptomatic patients has been recommended if the ejection fraction falls to 50% or below, in the face of progressive and severe left ventricular dilatation, or with symptoms or abnormal response to exercise testing. For both groups of patients, surgery before the development of worsening ejection fraction/LV dilatation is expected to reduce the risk of sudden death, and is associated with lower peri-operative mortality. Also, surgery is optimally performed immediately in acute cases. Medical treatment alt Medical therapy of chronic<unk>  that is stable and asymptomatic involves the use of vasodilators. Trials have shown a short-term benefit in the use of ACE inhibitors or angiotensin II receptor antagonists, nifedipine, and hydralazine in improving left ventricular wall stress, ejection fraction, and mass. The goal in using these pharmacologic agents is to decrease the afterload so that the left ventricle is somewhat spared. The regurgitant fraction may not change significantly, since the gradient between the aortic and left ventricular pressures is usually fairly low at the initiation of treatment. Other rather conservative medical treatments for stable and asymptomatic cases include low sodium diet, diuretics, digoxin, calcium blockers and avoiding very strenuous activity. As of 2007, the American Heart Association no longer recommends antibiotics for endocarditis prophylaxis before certain procedures in patients with<unk> . Antibiotic prophylaxis to prevent endocarditis before gastrointestinal or genitourinary procedures is no longer recommended for any patient with valvular disease. Cardiac stress test is useful in identifying individuals that may be best suited for surgical intervention. Radionuclide angiography is recommended and useful when the systolic wall stress is calculated and combined to the results. Surgery A surgical treatment for<unk>  is aortic valve replacement; this is currently an open-heart procedure. In the case of severe acute<unk> , all individuals should undergo surgery, if there<unk> e no absolute contraindications (for surgery). Individuals with bacteremia with aortic valve endocarditis should not wait for treatment with antibiotics to take effect, given the high mortality associated with the acute AI. Replacement with an aortic valve homograft should be performed if feasible. + Indications for surgery for chronic severe<unk>  Symptoms Ejection fraction Additional Findings Present (NYHA II-IV) Any none Absent > 50% Abnormal exercise test, severe LV dilatation (systolic ventricular diameter >55 mm) Absent <=50 % none Cardiac surgery for other cause (i.e.: CAD, other valvular disease, ascending aortic aneurysm)
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
Tricuspid regurgitation
Aortic stenosis
Tricuspid valve stenosis
Mitral valve prolapse
Systolic hypertension