Introduction
Valvular heart disease is a common heart condition caused by malfunctioning heart valves. There are 4 valves in the heart that function to keep blood moving in one direction.
When a valve is diseased or abnormal and doesn't close completely, blood can back up instead of going forward. This is called regurgitation or "leaky valve". when a valve opening is too narrow, the heart has to work harder to pump the blood throughout the body. This narrowing of the valve opening is called stenosis. Valvular Heart Disease is a serious condition that causes the heart to work harder. If left untreated Valvular Heart Disease can lead to Congestive Heart Failure, Cardiomyopathy, and even death.
Many patients with Valvular Heart Disease can successfully control their symptoms with medications, however medications cannot cure diseased or abnormal heart valves.
In some cases, patients are unable to tolerate the side effects of the medications or do not respond to the medications and require further intervention. In other cases, the valves are so diseased or abnormal there is no other option except to repair or replace the valve.
Heart valve surgery may be an option for these patients. Traditionally the surgery has been performed through a long chest incision with the breastbone or sternum split and ribs spread apart. Minimally invasive techniques for repairing or replacing diseased or abnormal valves have been developed that require a much smaller incision with partial or no splitting of the breastbone.
Heart Valves
The main function of the heart valves is to regulate and prevent the backflow of the blood.
There are four important valves in the heart. Move your cursor over the labels to find out more.
Tricuspid Valve
The tricuspid valve regulates blood flow between the right atrium and the right ventricle.
It prevents the backflow of blood to the right atrium when the right ventricle pumps blood to the lungs.
Mitral Valve
The mitral valve regulates the blood flow between the left atriuma and the left ventricle.
It prevents the backflow of blood to the left atrium when the left ventricle pumps blood through the aorta to the rest of the body.
Pulmonary Valve
The pulmonary valve regulates the de--oxygenated blood from the right ventricle to the lungs for purification.
Aortic Valve
The aortic valve regulates the oxygenated blood pumped from the left ventricle to the rest of the body.
The left side of the heart has to work harder than the right side because it functions to pump blood to the entire body, not just to the lungs. Because the Mitral and Aortic valves regulate blood flow in the left side of the heart, these valves are the most commonly replaced valves accounting for 98% of all valve replacement surgeries.
What is Valvular Heart Disease?
Valvular Heart Disease is a condition where one or more valves in the heart do not function properly. There are four valves in the heart that open and close to keep blood flowing in one direction. Malfunctioning valves can cause blood to back up instead of moving forward in one direction. This is referred to as regurgitation. Some valves have stiffened and narrowed over time making it more difficult to pump blood through the narrowed opening. This is referred to as stenosis. These conditions cause the heart to try and pump harder to move the same amount of blood. Over time, this extra workload takes it toll on the heart weakening the heart muscle, a condition called Cardiomyopathy. Left untreated, Valvular Heart Disease will ultimately lead to heart failure.
Risk factors for Valvular Heart Disease include the following:
Untreated strep throat that leads to Rheumatic fever-
Infection in the lining of the heart and valves called Infective Endocarditis-
Advancing age causing weakening of the valves or calcification of the valves-
Congenital heart disorders (occurring at birth)-
Coronary Artery Disease-
Myocardial Infarction or heart attack.
Signs and Symptoms of Valvular Heart Disease may be mild, moderate, or severe and can include the following:
Shortness of breath-
Swelling of lower extremities or abdomen-
Arrhythmia: fast or irregular heart beat-
Wet cough-
Palpitations-
Tiredness or lethargy-
Syncope or fainting-
Light-headed or faint-
Chest pain-
Blood clots-
No symptoms at all.
A Cardiologist should evaluate all heart conditions for proper diagnosis and treatment.
Your Cardiologist will perform the following:
Medical History-
Physical Examination.
Diagnostic Studies may include some or all of the following:
(EKG or ECG) Electrocardiogram
EKG is a test to measure the electrical activity of the heart and provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart. It is non-invasive and painless and is performed by attaching electrodes to various parts of the body
Cardiac Catheterization:
This is a surgical procedure performed by inserting a catheter into an artery in the arm or leg and advancing it into the heart. A dye is then injected and x-ray pictures are taken of the heart showing your doctor if any heart valves are damaged.
Chest X-Ray:
A form of electromagnetic radiation that is used to take pictures of bones. Non-invasive and painless, a chest x-ray can show signs of an enlarged heart
Echocardiogram:
Echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray images and involves no radiation exposure. These ultrasound images help identify abnormalities in the heart muscle and valves, and find any fluid that may surround the heart
Management of Valvular Heart Disease depends on the following:
Type of disease-
Severity of symptoms-
Underlying cause-
Your overall health.
The goals of treatment for Valvular Heart Disease are:
Decrease workload on the heart-
Restore normal heart rhythm-
Prevent blood clots and strokes.
Conservative Management Includes:
Lifestyle Modifications-
Medications.
Lifestyle Modifications
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
Healthy Diet Choices
Eating a low fat, low salt, low cholesterol diet while avoiding excessive intake of alcohol and caffeine
Don't Smoke
If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit
Reduce stress through exercise
Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of wellbeing. Always discuss with your doctor before beginning any new exercise program.
Weight Loss
Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice
Medications
Along with life style modification for heart health, medications are needed to control symptoms of Valvular Heart Disease. More than one medication may be prescribed. Some common medications are listed on the left. Move your cursor over the medications to find out more.
Anticoagulants or Thrombolytic agents
These blood-thinning medicines may be prescribed to prevent the formation of blood clots and reduce the risk of stroke in patients with Valvular Heart Disease.
Digitalis
Digitalis makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms.
Ace Inhibitors
Ace (angiotensin converting enzyme) inhibitors are used to treat heart failure by lowering blood pressure. This is achieved by inhibiting the formation of a chemical called angiotensin that raises blood pressure by causing arteries to constrict.
Beta-blockers
Beta-blockers work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle.
Calcium Channel Blockers
Calcium Channel Blockers reduce the frequency and severity of chest pain. They reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure.
Diuretics
Diuretics, also referred to as water pills, increase the excretion of fluids in the body through the urine helping to prevent fluid build-up and congestion in the lungs
Antibiotics
Anti-infective agents such as antibiotics may be prescribed prior to invasive medical or dental procedure to prevent a serious infection called bacterial endocarditis.
Many Valvular Heart Disease patients have good results from medication and lifestyle changes. However, some patients are unable to tolerate the side effects of the medications used to treat the condition and others continue to have symptoms despite medical intervention. In some cases, the valve is so diseased the only option is surgical repair or replacement of the valve.
If conservative treatment options are unsuccessful in treating your Valvular Heart Disease and you are a candidate for the procedure, your surgeon may recommend a surgery called Minimally Invasive Heart Valve surgery.
The smaller incisions with Minimally Invasive Heart Valve surgery mean that fewer tissues are cut resulting in quicker healing and recovery.
Advantages of minimally invasive approach compared to open approach include:
Smaller incision-
Less trauma-
Less blood loss.
