Valvular heart disease is a condition characterized by damage or defects in one of the heart's four valves - mitral, aortic, pulmonary, and tricuspid. These valves are placed between chambers and vessels to maintain the unidirectional flow of blood. The disease may occur at birth (congenital) or later in life (acquired).
One of the most common forms of valvular heart disease in our country is rheumatic valvular heart disease, which is a consequence of rheumatic fever. Mitral valve involvement is the most common type of valve damage seen in this disease.
The mitral valve is located between the left atrium and left ventricle, while the aortic valve is between the left ventricle and aorta. The tricuspid valve is between the right atrium and right ventricle, and the pulmonary valve is between the right ventricle and pulmonary artery. The most common acquired valve afflictions occur in the mitral and aortic valves. These valves may become narrowed (stenosis) or may start leaking back (regurgitation).
Valves can be categorized into two types: mechanical valves and biological valves.
Mechanical valves are composed of materials such as titanium and pyrolite carbon. They are very durable and can last a patient's lifetime. However, after valve replacement with a mechanical valve, the patient must take blood thinners for the rest of their life. This type of valve is usually recommended for younger patients.
On the other hand, biological valves are made from animal tissue. They have a lifespan of around 15-20 years, so they are preferred for use in patients who are around 60 years of age. With this type of valve, the patient does not need to take blood thinners.
Rheumatic Fever typically occurs during childhood and can cause fever and joint pains. If left untreated, it can damage the heart and lead to critical stenosis or regurgitation due to repeated episodes of sore throat, joint pain, and fever.
Valve degeneration can occur due to factors such as age, high blood pressure, or atherosclerosis. Infection of the inner lining of the muscles and valve (infective endocarditis) can also cause severe valve damage.
Various valve problems may result from rare conditions such as carcinoid, rheumatoid arthritis, systemic lupus erythematosus, syphilis, or other systemic disorders like Marfan's syndrome or osteogenesis imperfecta.
Symptoms of valvular heart disease can include breathlessness, rapid weight gain, palpitations and chest pain, general fatigue, swelling in the feet, hands or abdomen, dizziness and fainting. These symptoms can become more severe over time. Patients may also experience unexplained fever. The specific symptoms depend on the severity of the valve damage and which valve is affected.
Typically, a doctor can diagnose a person with valve disease through physical examination, chest x-ray, ECG, and echocardiography, which can determine the exact diagnosis and severity of the disease.
Once a critical valve disease diagnosis is made, treatment is planned based on the valve lesion and disease. Early-stage disease can be managed with medication, but timely surgical intervention is crucial to achieve maximum benefit.
In cases of Mitral Stenosis, a balloon mitral valvotomy can be performed if the valve is pliable, providing relief to the patient. However, if the valve is bad and calcified, replacement is necessary. Aortic Stenosis is mostly caused by valve calcification and fusion, which typically requires replacement.
Patients with Mitral and Aortic regurgitations can tolerate symptoms for an extended period. Valve replacement becomes necessary if symptoms worsen or the heart enlarges to a critical level. Valve replacement and repair are routinely performed, with less than 1% mortality in typical cases.
Transcatheter Aortic Valve Replacement (TAVR) has become a viable option for elderly patients who are not considered good candidates for traditional open-heart surgery. This procedure involves threading a catheter through an artery in the leg and up to the heart, where a replacement valve is then implanted to replace the damaged one. This is a less invasive option than traditional surgery and can result in a quicker recovery time for the patient. TAVR has been shown to have good outcomes and is becoming more widely used as a treatment option for aortic valve disease.
Post-surgery care is crucial to maintain the health and functionality of the replaced valve. It is important to take steps to prevent infections such as maintaining proper oral hygiene, avoiding skin or lung infections, and covering any minor surgical procedure with higher antibiotics. With proper care, the patient can lead a comfortable life after valve replacement surgery.