Valvular Heart Disease in Women

Valvular heart disease is an important clinical problem in women as a number of congenital and acquired diseases affecting the cardiac valves occur with greater frequency in women. Women also have differences in physiognomy and physiology that influence the clinical presentation, diagnostic approach, therapeutic options, and results of therapy. Women, on average, tend to be smaller than men. This not only applies to their external dimensions, but also to the dimensions of the cardiovascular system. For example, the heart of a normal woman weighs on average approximately 100 g less than men1 (Robbins, Pathology, 3rd ed. W.B. Saunders Company, Philadelphia, 1967, p. 512). They experience differences in cardiovascular remodeling in response to the hemodynamic alterations that result from valvular dysfunction, physiologic changes that accompany a normal pregnancy and the pathologic effects of pregnancy-related complications can deleteriously accelerate valve-related hemodynamic alterations and symptoms of valve dysfunction. In this chapter, we will define those areas of valvular heart disease than directly applies to women, and identify those gender-related issues in the diagnosis, evaluation, and treatment of valve disease.