Valvular Heart Disease Treatment in Delhi, India

The heart had four valves - mitral, aortic, pulmonary and tricuspid. These valves are placed between chambers and vessels to maintain unidirectional blood flow. When one or more of these valves have a defect or are damaged, the condition is known as valvular heart disease. This disease may be either from birth (congenital) or may develop in later part of life (acquired). One of the most common valvular heart diseases to affect individuals in our country is an aftermath of rheumatic fever. Rheumatic valvular heart disease is the commonest valvular involvement.

Mitral valve is between the left atrium and left ventricle. Aortic valve is between the left ventricle and aorta. Whereas the tricuspid valve is between the right atrium and right ventricle and pulmonary valve is between right ventricle and pulmonary artery. Commonest acquired valve affliction is to the mitral and aortic valves. The valve may become narrowed (stenosis) or it may start leaking back (regurgitation).

• Rheumatic Fever – usually during childhood one may have fever and joint pains. This also affects the heart and with repeated episodes of sore throat, joint pain and fever. Valves get damaged further till a critical stenosis or regurgitation occurs.
• Degeneration of valve due to age, high blood pressure or atherosclerosis.
• Infection of the inner lining of muscles and valve lead to severe valve damage (infective endocarditis).
• Other rare conditions like carcinoid, rheumatoid arthritis, systemic lupus erythematosus, syphilis, etc. can cause various valve problems.
• It may be a part of systemic disorder, like Marfan’s syndrome, osteogenesis imperfecta.

Numerous factors can increase an individual's risk of developing heart valve disease, including:

• Advanced age.
• A history of certain infections that can affect the heart.
• A history of certain forms of heart disease or heart attack.
• High blood pressure, high cholesterol, diabetes, and other risk factors for heart disease.
• Heart conditions present at birth (congenital heart disease).

Heart valve disease can lead to a number of complications, including:

• Stroke: This occurs when a blood clot blocks or bursts a blood vessel in the brain.
• Blood Clots: These can form in the heart or blood vessels and can travel to other parts of the body, such as the brain or lungs.
• Heart Rhythm Abnormalities: These can occur when the electrical signals that control the heartbeat are disrupted.
• Heart Failure: This occurs when the heart is unable to pump blood effectively.
• Death: In severe cases, heart valve disease can be fatal.

• Breathlessness - Severity becomes more and more over years.
• Sudden weight gain.
• Palpitations and chest pain.
• General fatigue.
• Swelling in feet, hands or abdomen.
• Dizziness, fainting.
• Unexplained fever may occur.

To diagnose a heart valve condition, a physician conducts a physical examination, specifically listening for a heart murmur. Additional diagnostic tests may be ordered:

• Echocardiography: This non-invasive test uses sound waves to produce moving images of the heart, assessing its structure, valve function, and blood flow. It may include 3D echocardiography and, in some cases, transesophageal echocardiography for more precise valve evaluation.
• Electrocardiogram (ECG): Electrodes on the skin record the heart's electrical impulses, helping detect chamber enlargement, heart disease, and irregular rhythms.
• Chest X-ray: It evaluates heart size and can provide insights into lung health.
• Cardiac MRI: This imaging technique provides detailed heart images, aiding in condition severity assessment.
• Exercise or Stress Tests: These measure exercise capacity and heart response to exertion.
• Cardiac Catheterization: A less common diagnostic tool, it involves a catheter insertion to view heart arteries, functionality, and chamber pressure.

Once the diagnosis of critical valve disease is made treatment is planned according to the lesion and valve diseased. Early disease can be managed for some time with medicines. Also, if required, proper surgical intervention should be done in time so that maximum benefit occurs.

The treatment of valvular heart disease aims to alleviate symptoms, improve heart function, and prevent further complications. The choice of treatment depends on several factors, including the type and severity of the valve disorder, the patient's overall health, and their age. Here is an overview of common approaches to valvular heart disease treatment:

• Medical Management: For mild cases, medications may be prescribed to manage symptoms and slow the progression of the disease. These medications may include diuretics to reduce fluid buildup, blood thinners to prevent clot formation, and medications to control blood pressure and heart rate.
• Lifestyle Modifications: Patients are often advised to make lifestyle changes to support heart health. This includes adopting a heart-healthy diet, engaging in regular exercise, quitting smoking, and managing stress. These changes can improve overall well-being and help manage the condition.
• Valve Repair or Replacement: In more severe cases, surgical intervention may be necessary. Valve repair involves fixing the damaged valve, while valve replacement entails removing the faulty valve and replacing it with a mechanical or biological valve. The choice between repair and replacement depends on the valve condition and the patient's health.
• Transcatheter Procedures: Some patients, particularly those at high surgical risk, may be candidates for minimally invasive transcatheter procedures. These involve repairing or replacing the valve through a catheter inserted into a blood vessel, typically in the groyne, and guided to the heart.
• Regular Monitoring: Regardless of the chosen treatment, patients with valvular heart disease require ongoing monitoring by a cardiologist. Regular check-ups and diagnostic tests help assess the valve's function and the effectiveness of treatment.
• Cardiac Rehabilitation: After surgical or interventional procedures, patients may benefit from cardiac rehabilitation programs. These programs focus on improving physical fitness, heart health, and recovery under the guidance of healthcare professionals.
• Preventive Measures: Preventive measures, such as antibiotics before dental procedures (for certain patients) and adherence to medication regimens, are important to prevent complications and maintain heart health.

It is crucial for individuals with valvular heart disease to work closely with their healthcare team to develop a personalised treatment plan that aligns with their specific condition and needs. Effective management and treatment can significantly enhance the quality of life for individuals living with valvular heart disease.

After surgery it is also important that care for the valve should be meticulously done. Proper oral hygiene to prevent any oral infection should not develop skin or lung infections. Any other minor surgical procedure should be properly covered with higher antibiotics. Valve replacement is a good procedure and patients can have a comfortable life if proper care is taken.

1. What is degenerative heart valve disease?

Degenerative heart valve disease is a condition where one or more of the heart's valves become damaged or weakened over time. It can result in the valve not opening or closing properly, causing blood flow problems in the heart.

2. What are the most common types of valvular heart diseases?

The four main types of valvular heart disease are aortic stenosis, mitral regurgitation, mitral stenosis, and tricuspid regurgitation.

3. Can heart valve disease be cured?

In many cases, heart valve disease can be managed and treated effectively. However, complete cure often depends on the type and severity of the disease, and some cases may require surgical intervention.

4. How long can one live with heart valve disease?

With appropriate medical management and, if necessary, surgical intervention, people with heart valve disease can live healthy and fulfilling lives. The prognosis varies based on individual factors and the specific condition.

5. Is heart valve disease genetic?

Heart valve disease can have a genetic component, but it can also result from various other factors, including age, infection, and other medical conditions.

6. Is valvular heart disease a fatal condition?

Valvular heart disease can be serious, but it is not always fatal. The outcome depends on the type, severity, and timely management of the condition.

7. Which valve is most commonly affected by rheumatic heart disease?

Rheumatic heart disease commonly affects the mitral valve in the heart.

8. How to prevent heart valve disease?

To reduce the risk of heart valve disease, it's important to manage conditions like high blood pressure and bacterial infections promptly. Leading a healthy lifestyle, including regular exercise and a balanced diet, can also contribute to overall heart health.

9. How does heart valve disease affect the body?

Heart valve disease can disrupt the normal flow of blood in the heart, potentially leading to symptoms such as fatigue, shortness of breath, chest pain, and, in severe cases, heart failure.

10.  How long does it take to recover from heart valve surgery?

The recovery period after heart valve surgery varies depending on the type of surgery, overall health, and individual factors. In general, it may take several weeks to months to fully recover and resume normal activities. Your healthcare provider will provide specific guidance for your case.

11. What are the two main types of valves used in heart valve replacement surgery?

Valves used in heart valve replacement surgery can be broadly classified into two main types -  Mechanical Valves and Biological Valves.

• Mechanical Valves: They are made of titanium and pyrolytic carbon. They are quite strong and are made to last a patient's lifetime. After valve replacement with a mechanical valve, blood thinners have to be taken lifelong. It is preferred in younger patients.
• Biological Valves: They are made up of animal tissue. They have a life expectancy of 15-20 years and hence it’s preferred to use them in patients around 60 years of age. The patient does not have to take blood thinners with this valve.

12. What is Catheter based aortic valve replacement?

Catheter-based aortic valve replacement, or TAVR, is a minimally invasive procedure to treat aortic valve disease. It is often used for patients at high surgical risk.  For instance, Catheter based aortic valve replacement is used in elderly patients who are relatively unfit for routine surgery.

13. What are the common heart valve problems?

Heart valve problems can manifest in a variety of ways:

• Regurgitation: The valve leaflets fail to close properly, resulting in blood leaking backward within the heart. This is frequently caused by a condition known as prolapse, in which the valve leaflets bulge backward.
• Stenosis: The valve leaflets become thickened or rigid, and they may even fuse together. This results in a narrowing of the valve opening and a reduction in blood flow through the valve.
• Atresia: In this condition, the heart valve does not fully form, resulting in the presence of a solid sheet of tissue that obstructs or blocks the normal flow of blood between the heart chambers.

14. What is Mitral Stenosis?

Mitral Stenosis is a condition where the mitral valve becomes narrowed. When the mitral valve narrows, it restricts the flow of blood from the left atrium to the left ventricle. This can lead to decreased blood flow to the body and increased pressure in the left atrium. Common causes of mitral stenosis include rheumatic fever, congenital heart defects, and other conditions that can damage the valve.

15. What is Aortic Stenosis?

Aortic Stenosis stenosis occurs when the aortic valve, positioned between the left ventricle and the aorta, becomes narrowed or obstructed. This narrowing reduces the flow of oxygen-rich blood from the heart to the rest of the body. Aortic stenosis is often caused by the degeneration of the valve with age, but it can also be due to congenital abnormalities or infections.

Reviewed by Dr. Rajneesh Malhotra, Vice Chairman & Head - CTVS, Cardiac Sciences, Cardiac Surgery (CTVS), Robotic Surgery on 16 Jan 2024.

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