Valvular Heart Disease
Valvular heart disease is a defect of one of heart valves. Valvular defect classification divides them into congenital and acquired. Valvular heart disease treatment depends on severity of symptoms and includes medications, surgical repair or heart valve replacement, as well as lifestyle changes. Below we are going to discuss in more detail the diagnostics methods for this condition, as well as valvular heart disease treatment options.
Valvular heart disease is when one of the four heart valves becomes damaged or defective:
The mitral and tricuspid valves are responsible for the flow of blood between the upper and lower chambers of the heart – the ventricles and the atria.
The aortic valve controls blood flow between the heart and the aorta, and subsequently the blood vessels to the rest of the body, while the pulmonary valve is responsible for controlling the flow of blood from the heart to the lungs.
The valves most commonly affected by valvular heart disease are the mitral and aortic valves.
Normally functioning valves ensure that blood flows forcefully enough, in the right direction at the right time. In valvular heart disease, the valves either become narrow and hardened (stenotic), and are unable to open fully, or they become incompetent and are unable to completely close shut.
What happens when a valve becomes incompetent?
An incompetent valve allows blood to seep back into the chamber it previously came from whereas a stenotic valve forces blood to move back up into the adjacent heart chamber. The heart muscle enlarges and thickens in order to compensate for poor pumping action, thus losing elasticity and efficiency. In some cases, blood pooling in the chambers of the heart has a greater tendency to cause clotting, thereby increasing the risk of stroke or a pulmonary embolism.
The severity of valvular heart disease varies from mild to severe. Mild cases usually show no symptoms whereas advanced cases can lead to congestive heart failure and other complications. Treatment options depend largely upon the extent of the disease.
WHAT ARE THE SYMPTOMS OF VALVULAR HEART DISEASE?
Valve disease symptoms can occur suddenly, depending on the speed of the diseases’ development. If progression is slow, then your heart may adjust and you may not notice the onset of any symptoms.
The severity of symptoms you experience may not necessarily correlate to the severity of the valve disease. For example, you could have no symptoms at all, but have severe valve disease and vice versa.
Many symptoms of valve disease are similar to those associated with congestive heart failure, such as swelling of the feet, ankles or abdomen, shortness of breath and wheezing after limited physical exertion. Other symptoms include:
- Chest pain, palpitations
- Dizziness or fainting
- Rapid weight gain
TREATMENT OPTIONS AVAILABLE FOR Valvular Heart Disease
Heart valve disease cannot be cured by medicines at this stage, however, lifestyle changes and medicines are often able to treat symptoms successfully as well as delaying any further complications for many years. Eventually, surgery to repair or replace a faulty heart valve will most likely be required.
The goals of treating heart valve disease might include:
- Repairing or replacing faulty valves
- Heart-healthy lifestyle changes to treat other related heart conditions
Medicines may be prescribed in addition to heart-healthy lifestyle changes. This medicines help to:
- Lower high blood pressureor high blood cholesterol
- Prevent irregular heartbeats (arrhythmias)
- Thin the blood and prevent clots (if you have a man-made replacement valve). Mitral stenosis or other valve defects that raise the risk of blood clots occurring may be aided with certain medicines
- Treat coronary heart disease. Certain medicines can reduce your heart’s workload and relieve symptoms
- Treat heart failure by widening the blood vessels and ridding the body of excess fluid
Repairing or Replacing Heart Valves
Repairing or replacing your heart valve(s), even if your heart valve disease isn’t causing symptoms may be recommended by your doctor, as it can prevent lasting damage to your heart and sudden death.
The decision to repair or replace heart valves is dependant on certain factors, including:
- The severity of your valve disease
- Whether you need heart surgeryfor other underlying conditions, such as coronary heart disease. Bypass surgery and valve surgery can be performed at the simultaneously.
- Your overall health and age
Heart valve repair is preferred over heart valve replacement is preferred wherever possible. This is because valve repair preserves both the strength and function of the heart muscle. On top of this, people with valve repair also have a lower risk of infective endocarditis post surgery. They are also not required to take blood-thinning medicines for the rest of their lives.
Despite the advantages, heart valve repair surgery is harder to do than valve replacement, as well as the fact that not all valves can be repaired. Mitral valves often can be repaired, whereas Aortic and pulmonary valves often need replacing.
Repairing Heart Valves
Heart valves can be repaired by:
- Adding tissue to increase support at the base of the valve or to patch holes or tears
- Removing or reshaping tissue so the valve can close more tightly and effectively.
- Separating fused valve flaps
Cardiac catheterization can sometimes be used to repair heart valves. Although catheter procedures are less invasive than surgery, they may always be suitable. Work with your doctor to decide which method is most appropriate for you.
Heart valves stenosis can be repaired either with surgery or with a less invasive catheter procedure called balloon valvuloplasty.
This procedure involves a catheter (thin tube) with a balloon at its tip being threaded through a blood vessel to the faulty valve in your heart. The balloon is then inflated thus opening the valve. The balloon is then deflated and removed along with the tube. This procedure is performed while you’re awake and usually requires staying in hospital overnight.
Balloon valvuloplasty may not always cure the disease but it does relieve many symptoms of heart valve disease. This condition can worsen over time and still may need medicine in order to treat symptoms or surgery to repair/replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery and may work well as surgery for some patients who have mitral valve stenosis. Balloon valvuloplasty works more effectively in infants and children rather than for adults.
heart valve replacement
Man-made or biological valve may be the preferred option, as sometimes heart valves can’t be repaired and must be replaced. This involves removing the faulty valve and replacing it with a man-made or biological valve.
Biological valves are made from, human, pig or cow heart tissue and may have man-made parts as well. These valves are specially treated, so medicines that stop your body from rejecting the valve wont be required.
Man-made valves last longer than biological valves and usually don’t have to be replaced. Although newer ones may last up to 15 years or longer, most biological valves usually have to be replaced after about 10 years. Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the remainder of your life. These medicines will stop blood clots from forming on the valve thus preventing heart attacks or strokes. Man-made valves also heighten your risk of developing ineffective endocarditis.
With you doctor, you will decide whether a man-made or biological replacement valve is the right option for you.
If you’re athletic or a woman of childbearing age, you may prefer a biological valve so you don’t have to take blood-thinning medications, whereas If you’re elderly, you also may prefer a biological valve, as it is likely to last for the remainder of your life.
The Ross procedure is another option that involves your doctor removing your faulty aortic valve and replacing it with your pulmonary valve. A pulmonary valve from a deceased human donor is then used to replace your pulmonary valve.
This is more involved surgery than typical valve replacement, and comes with a higher risk. Because the surgically replaced valves continue to grow with the body, it is a suitable option for a child. In addition, lifelong treatment with blood-thinning medicines is not necessary. In some cases however, within a few years one or both valves can cease to work. This procedure is still being developing and improved.
Other Approaches for Repairing and Replacing Heart Valves
There are procedures that use smaller incisions (cuts) to reach the heart valves and are considerably less invasive. Hospital stays for these newer types of surgery usually are 3 to 5 days, as opposed to a 5-day stay for traditional surgical methods.
New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also has also been cut from 6-8 weeks down to 2- 4 weeks.
HOW IS VALVULAR HEART DISEASE DIAGNOSED?
Heart murmurs or other signs of heart valve diseases can be detected by your primary care doctor, however, it is usually a cardiologist who will diagnose the condition. A cardiologist is a doctor who specializes in diagnosing and treating heart problems.
To diagnose heart valve disease, your doctor will ask questions about your signs and symptoms and will perform a physical exam and examine results from other tests.
- Physical Exam: During a physical exam your doctor will listen to your heart using a stethoscope. This is a good starting point to seeing whether you have any heart valve issues.
- Your doctor also will listen to your lungs as you breathe see whether there is build up of fluid or not, as well as checking for swollen ankles and other signs that your body is retaining water.
- Tests and Procedures:Echocardiography (echo) is the primary test for diagnosing heart valve disease, however, EKGs (electrocardiogram) or chest x rays are common practice when trying to reveal certain signs of the condition. Once the signs are present, an echocardiography is usually performed to confirm the diagnosis. Your doctor also may recommend other tests and procedures such as cardiac catheterization, stress testing, or cardiac MRI (magnetic resonance imaging) if you’re diagnosed with heart valve disease. These tests and procedures help your doctor to ascertain the severity of your condition and thus make an appropriate treatment plan.
- EKG:An EKG can detect an irregular heartbeat as well as the signs of a previous heart attacks by detecting the heart’s electrical activity. It also can show whether your heart chambers have becoming enlarged.
- Chest X Ray:Chest x rays can determine whether you have fluid in your lungs, or whether calcium deposits are present in your heart as well as whether your heart is enlarged in certain sections. A chest x ray can shed light on which type of valve defect you have, it’s severity, and whether you have any other heart dysfunctions.
- Echocardiography:A device called a transducer is placed on the surface of your chest, which sends waves through your chest wall and to your heart, thus creating a moving picture of your heart as it beats. This picture is viewed on a computer screen. Echocardiography can allow your doctor to see:
- Your heart’s pumping ability
- The shape and size of your heart valves and chambers
- Whether a valve is narrow or there is backflow present.
In some cases, transesophageal echo, or TEE, may be required to get a better picture of your heart. TEE involves feeding a transducer that attached to the end of a flexible tube, down your throat and into your esophagus (the passage leading from your mouth to your stomach). From there, your doctor can get detailed images of your heart. Medicine will be administered to help you relax during this procedure.
- Cardiac Catheterization: Cardiac catheterization is the insertion of a catheter into a blood vessel in your neck, arm, groin (upper thigh) and threading it to your heart. Your doctor uses x-ray images to guide the catheter. Diagnostic tests and imaging are done through the catheter to show whether backflow is occurring through a valve as well as how fully the valve opens. Medicine will be administered to help you relax during this procedure as you will be awake. If your signs and symptoms of heart valve disease don’t match your echo results cardiac catheterization may be recommended. Assessing whether your symptoms are caused by specific valve problems or by coronary heart disease are also possible with this procedure. All of this information will aid in figuring out your treatment plan.
- Stress Test: During stress testing, you elevate your heart rate with exercise while heart tests and imaging are performed. If you can’t exercise, you may be given medicine to help stimulate your heart rate. This test can assist in diagnosing the severity of your heart valve disease.
- Cardiac MRI: A cardiac MRI image can confirm information about valve defects or provide your doctor more detailed information. This is done using a powerful magnet and radio waves to make detailed images of your heart.