Beta-blocker therapy for valvular disorders.

Valvular disorders are common, and result in a neurohormonal milieu similar to the heart failure state. Although valve surgery is the therapy of choice in symptomatic severe lesions, many patients do not receive surgery for a variety of reasons. Beta-blockers have a role in the management of many patients with valvular disorders, especially in the case of patients with mitral stenosis, where they reduce the transmitral gradient. They may also serve as life-saving therapy in pregnant women with pulmonary edema. Other uses of beta-blockers include the reduction of valve-related hemolysis, the prevention of atrial fibrillation, and the relief of dynamic left and right ventricular outflow tract obstruction. The prevention of aortic root dilation, potentially with beta-receptor blockade, may reduce the risk of aortic insufficiency in Marfan syndrome, and also in those with bicuspid aortic valves or following the Ross procedure. In this review, the potential role of beta-blockers is explored for the treatment of severe mitral and aortic regurgitation and asymptomatic severe aortic stenosis.