Role of vasodilators in regurgitant valve disease

Abstract

Vasodilator therapy is designed to reduce regurgitant volume and improve left ventricular function. Acute administration reduces vascular resistance and decreases regurgitant volume and left ventricular filling pressure. These effects may be clinically useful in acute regurgitations, but less consistent results have been reported in long-term therapy. In chronic mitral functional regurgitation, vasodilator therapy has proved to have clinical or prognostic benefit only when heart failure or poor ventricular function is present. The indication of vasodilator treatment in aortic regurgitation has raised significant controversy. Several studies with small series have shown beneficial effects on regurgitant volume, ejection fraction, and mass of the left ventricle. Nevertheless, in the only two randomized long-term follow-up studies, results differed completely. In our experience, both nifedipine and enalapril failed to reduce the need for valvular surgery or show benefits in echocardiographic parameters. Vasodilator therapy would be indicated only in patients with severe aortic regurgitation and systemic hypertension, or when surgery is contraindicated.

Acute Valvular Regurgitation

“…Medical therapy is not a substitute for surgery, however. 21,22 Intra-aortic balloon pump use is contraindicated in acute aortic regurgitation because balloon inflation during diastole is detrimental to left ventricular hemodynamics. Figure 2.…”

Angiotensin II–Converting Enzyme Inhibition Improves Survival, Ventricular Remodeling, and Myocardial Energetics in Experimental Aortic Regurgitation

“…1 Many clinical trials have evaluated the efficacy of various drugs with vasodilator properties in the treatment of severe AR. 2,3 Unfortunately, their results have been inconclusive. Angiotensin-converting enzyme inhibitors (ACEI) were tested in AR, but conflicting results were obtained.…”

Cardiogenic shock without hypotension in acute severe primary mitral regurgitation: a case report

“…In the context of relative hypertension, as seen here, vasodilators would likely have been a viable option to lower blood pressure and hence, SVR; they also improve coronary blood flow directly via their action on vascular smooth muscle [ 11 ]. Studies show that sodium nitroprusside is beneficial in acute MR by reducing afterload; the LV volume is transiently reduced due to reduced pressures across the aortic valve, which leads to a smaller mitral annulus size, and subsequent reduction in mitral effective regurgitant orifice area and regurgitant volume [ 12 , 13 ].…”