Management of patients with prosthetic heart valves

More than 15,000 valve replacements are annually performed in Germany resulting in a significant improvement of function, symptoms and prognosis. Nevertheless, prosthetic heart valves bear a small risk of serious complications and these patients remain cardiac patients all their life. Therefore, cardiologic checkups are recommended at regular intervals and, if needed, also on a short-term appointment. Despite the presence of unspecific symptoms most patients do not reveal problems concerning their prosthetic valves, which can be quickly determined using the standard examination techniques of a cardiologist. The routine "basic examination" should be extended to an "advanced examination" in case of abnormal findings (in the "basic examination"). Apart from history taking, physical examination, ECG and laboratory tests, echocardiography (either transthoracic or, if necessary, transesophageal) is the most important method for evaluation of prosthetic valves. Occasionally, complementary stress tests, right/left heart catheterization or MRI are needed. Common complications include valve thrombosis with or without embolization, endocarditis, structural failure, hemolysis and paravalvular regurgitation which can be reliably detected and treated by the cardiologist. Furthermore, it is the cardiologist's responsibility to define the patients' antithrombotic treatment regimen and to guide the patients through special situations like gravidity or before and after an operation. With some restrictions, patients with prosthetic heart valves can be fully rehabilitated in respect of professional life and sports.