What type of native valve disease does the Virsta score consider, specifically in the context of aortic stenosis and mitral regurgitation?

What Disease Does the VIRSTA Score Consider for Native Valve Disease?

The VIRSTA score considers congenital aortic valve disease and congenital mitral valve disease as native valve diseases in its classification system. 1

Understanding Native Valve Disease in Classification Systems

The VIRSTA score, which helps assess risk in patients with infective endocarditis, incorporates specific types of native valve disease in its risk stratification approach. According to the 2018 AHA/ACC guideline for the management of adults with congenital heart disease, both congenital aortic valve disease and congenital mitral valve disease are classified as moderate complexity native valve diseases 1.

These native valve diseases are specifically listed in the ACHD AP Classification (Adult Congenital Heart Disease Anatomic and Physiological Classification) under Category II: Moderate Complexity.

Types of Native Valve Disease Considered

The native valve diseases considered in the VIRSTA score include:

• Congenital aortic valve disease - This encompasses various forms of aortic stenosis and regurgitation that are present from birth
• Congenital mitral valve disease - This includes mitral stenosis and regurgitation of congenital origin

Clinical Implications

When evaluating patients using the VIRSTA score:

• The presence of these native valve diseases increases the patient's risk profile
• Patients with congenital aortic or mitral valve disease require more frequent monitoring and specialized care
• These conditions may influence decisions regarding antibiotic prophylaxis and management of complications

Severity Assessment

The severity of native valve disease is typically classified as follows:

For aortic regurgitation 1:

• Mild: Small central jet (<4 cm²)
• Moderate: Greater than mild but no signs of severe AR
• Severe: Vena contracta >0.6 cm, holodiastolic flow reversal

For mitral regurgitation 1:

• Mild: Small central jet (<4 cm² or <20% LA area)
• Moderate: Signs greater than mild but not meeting severe criteria
• Severe: Vena contracta width >0.7 cm, regurgitant volume ≥60 ml/beat

Management Considerations

When managing patients with these native valve diseases in the context of the VIRSTA score:

• Regular echocardiographic follow-up is essential to monitor disease progression
• Patients with moderate or severe regurgitation may require more frequent evaluation (every 6-12 months) 2
• The presence of multiple valve lesions may accelerate disease progression compared to single valve disease 2

Common Pitfalls to Avoid

1. Underestimating severity: Eccentric jets of mitral regurgitation may be underestimated by color flow imaging alone; comprehensive assessment using multiple parameters is essential 2

2. Overlooking progression: The coexistence of both mitral and aortic disease may lead to more rapid progression than either lesion alone 2

3. Delayed intervention: In patients with progressive LV dysfunction, delayed intervention can lead to irreversible myocardial damage 2

By understanding which native valve diseases are considered in the VIRSTA score, clinicians can better assess risk and determine appropriate management strategies for patients with these conditions.