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Valvular Heart Disease

By Dr. Subhash Kumar Sinha in Cardiac Sciences

Jul 15 , 2019 | 3 min read

Valvular heart disease refers to and is characterised by damage to or a defect in one of the four heart valves –mitral, aortic, pulmonary and tricuspid. The disease may be from birth (congenital) or develops in later part of life (acquired). Valves are placed between chambers and vessels to maintain unidirectional flows of blood.

One of the most common valvular heart diseases to effect individuals in our country is an aftermath of rheumatic fever. Rheumatic valvular heart disease is the commonest valvular involvements.

Mitral valve is between left atrium and left ventricle. Aortic valve is between left ventricle and aorta. Whereas tricuspid valve is between 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).

Common causes of diseases are:-

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

Major symptoms of heart valve damage are-

  • Breathlessness - Severity becomes more and more over years.
  • Palpitations and chest pain.
  • General fatigue
  • Dizziness , fainting
  • Unexplained fever may occur

 

Usually diagnosis of a person with valve diseases can be made by doctor’s examination, chest x-ray; ECG Echocardiography usually is able to tell us the exact diagnosis and severity of the disease.

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. However it is important that proper surgical interventation should be done in time so that maximum benefit occurs.

Mitral stenosis- If the valve is pliable a balloon mitral valvotomy gives the patient relief. It is simple and patient gets well. If the valve is bad and calcific it requires replacement

Aortic stenosis- Most of the aortic stenosis occurs due to calcifications and fusion of the valve. Majority of these valves requires replacement.

Mitral and aortic regurgitations the patients tolerate for quite some time. Interference in the form of valve replacement becomes necessary if symptoms became more or the heart enlarges to critical levels.

Valve replacement and repair are done routinely with less than 1% mortality in routine cases.

Type of valves –

Valves can be broadly classified into mechanical and biological valves.

Mechanical valves are made of titanium and pyrolite carbon. It is quite strong and is made to last patient’s life time. After valve replacement with a mechanical valve, blood thinners have to be taken lifelong. It is preferred in younger patients.

Biological valve are made up of animal tissue. It has duration of 15-20 years hence it is preferred to be used in patients around 60 years of age. The patient does not have to take blood thinners with this valve.

Catheter based aortic valve replacement have became a reality. It is used in elderly patients who are relatively unfit for routine surgery.

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 patient can have a comfortable life if proper care is taken.