US counterpoint to chapter 19

Chapter 19 provides a broad review of prosthetic heart valves, beginning with a historical perspective of early valve development and attempts at surgical replacement to current valve characterization and their postoperative management regimens. The practice at Washington University is essentially the same (see Table 1). The authors of Chapter 19 nicely outline the types of commonly used prosthetic valves and differences in hemodynamics among them. They recommend specific postoperative anticoagulation and endocarditis prophylaxis practices, with which we agree. Recommendations provided in the text are based on the 1998 Guidelines for the Management of Patients with Valvular Heart Disease from the American College of Cardiology and American Heart Association. Online resources for both the physician and the patient are cited in the Appendix to the chapter; these are excellent sources of additional information.