Understanding heart valve diseases and treatment options

Introduction

Heart valve replacement surgery is no longer a foreign term now, with heart valve diseases becoming a leading cause of concern and their cases on the constant rise. Studies suggest an increasing prevalence of Rheumatic Heart Disease, Aortic Stenosis, Aortic Regurgitation, and Mitral Valve Regurgitation globally. Aortic valve diseases account for approx. 61%, while Mitral valve diseases mark 15% of the total valvular heart diseases. This statistic is alarming, and it is high time we prioritize our heart health, create awareness about various heart issues, the ways to prevent and/or treat them, and the importance of a healthy lifestyle.

However, make sure to attend the special mention of the World Heart Day celebration in September every year to create awareness about heart health. This marks a positive step towards creating an aware and informed society about the severity of heart health issues and their associated risks, the causes, types, and the respective treatment options for each heart health problem.

Continue reading this blog that discusses the various heart valve diseases, their causes, types, symptoms, and treatment options, i.e., heart valve repair or heart valve replacement.

Heart Valves and their functions

As the primary organ of your circulatory system, pumping blood throughout your body is the responsibility of your heart. The four chambers, and the network of blood vessels in the heart, ensure that the blood flows in the right direction, thus regulating blood pressure and controlling the pulse rate. 

The four chambers of the heart are divided into the right atrium, right ventricle, left atrium, and left ventricle. The upper two chambers are called atria, and the lower two are called ventricles. Each chamber has a valve that functions like a door that opens and closes, ensuring a smooth and interrupted blood flow in the right direction. The opening and closing of your valves create a rhythmic sound known as your heartbeat. These valves have leaflets or cusps of thin yet strong tissues that open and close for the blood to flow through these chambers.

There are four valves, namely, Tricuspid Valve (between the right atrium and right ventricle), Mitral Valve (between left atrium and left ventricle), Aortic Valve (in the left ventricle that opens for the blood to flow to the Aorta, the largest artery supplying blood to the body) and the Pulmonary Valve (in the right ventricle that opens for the deoxygenated blood to flow to the pulmonary arteries).
These valves function in harmony, enabling the heart to pump blood that flows throughout your body.

Heart Valve Diseases

When one or more of the heart valves is damaged or diseased, it does not function properly, leading to your heart pumping harder or less blood being pumped in the right direction. Such diseased or damaged heart valve condition is called heart valve disease or valvular heart disease. The type of heart valve disease is known from the damaged or diseased valve. For instance, if the aortic valve is stenotic (becomes stiff due to plaque) or the mitral valve regurgitates (pushes the blood backward), it is known as Aortic Valve Stenosis or Mitral Valve Regurgitation, respectively.

The three primary heart valve conditions that cause valvular heart diseases and eventually the need for heart valve repair or heart valve replacement are-

• Valvular Stenosis: The narrowing of the valve interrupts the flow of blood. The Heart valve may become narrow or stiff over time due to plaque; it may be caused by untreated infection where bacteria may accumulate in the valves. Stenosis limits blood supply and hence oxygen to the body, leading to chest pain, fainting, or shortness of breath.
• Valvular Regurgitation: When the valve leaflets do not close completely, it pushes the blood backward. This creates pressure in the chamber of the heart where the blood accumulates. One of the reasons for such a condition could be valve prolapse, where the valve leaflets get stretched or enlarged, bulging back. This pushes the blood backward, causing valve regurgitation.
• Valvular Atresia: When the valve is not formed, and the tissue blocks the flow of blood through the chambers of the heart.

Causes of Heart Valve Diseases

Heart valve diseases could be acquired or congenital. Heart valve diseases may be caused due to the following-

• Advancing age & calcium build-up: Aging may lead to calcium buildup, restricting blood flow through the heart.
• Genetic Predisposition: Congenital disabilities that are not treatable, causing diseases like valve atresia.
• Coronary artery disease like a heart attack, weakens the heart tissues.
• Rheumatic Heart Disease: The accumulation of infection-causing bacteria.
• Inherited connective tissue disorder called Myxomatous degeneration
• Radiation Exposure

Symptoms of Heart Valve Diseases

Individuals suffering from mild or moderate heart valve disease may not experience any symptoms. Some may notice the symptoms suddenly, or some may even develop these symptoms quickly. The severity of the disease may not always be based on the symptoms. The symptoms listed below are common in heart valve diseases.

• Pain or Tightness in Chest with Activity (Angina)
• Shortness of breath (Dyspnea)
• Tiredness (Fatigue)
• Feeling of Dizziness or Fainting during Activity
• Irregular heartbeats (Arrhythmia) or Heart Palpitations Abnormal blood pressure levels
• Swelling of ankles or legs

How to Diagnose Heart Valve Disease?

Accurate and timely diagnosis saves patient’s valuable time, resources, and life. The treatment plan for any disease starts with its proper diagnosis. When you consult your doctor on symptoms of a health valve problem and if your doctor, through preliminary medical checking, finds a heart murmur or abnormal heartbeat, he may suggest a few diagnostic tests, like-

• Echocardiography- the most common test to monitor your heart's shape and functioning through sound waves that create moving images of the heart.
• Electrocardiogram- a simple test used to detect and record the electrical pulses of your heart. It records the speed and rhythm of your heartbeats, the strength and regularity of the electrical pulses of your heart, and traces abnormalities, if any.
• CT Scan- A cardiac computed tomography (CT ) scan uses many X-rays from different angles to construct images of your heart using a scanner and computer. This quick but detailed and high-resolution scan shows your healthcare provider problems with your heart structure, valves, arteries, aorta and more.
• Stress Tests- The tests study the impact of stress on the functioning of your heart. They measure your heart's health and how it works under stress, like exercising. Any chest pain, shortness of breath, or an abnormal heartbeat may indicate heart valve problem.

Treatment Options for Heart Valve Diseases

Treatment options for heart valve diseases vary from medication to heart valve repair or replacement.

In severe cases of heart valve diseases and problems, surgery may be the only recommended course of treatment. This includes either valve repair or replacement (through traditional open heart surgery or minimally invasive procedure).

Medications

Medications do not guarantee a complete cure but may help reduce and provide relief from associated complications and symptoms. Medications may help control blood pressure or abnormal heart rhythm and work.

The repair or replacement of the diseased or damaged heart valve depends on the severity of the damage to the valve, the age, and the patient's overall health conditions.

Heart Valve Repair

Heart valve repair is recommended in cases where there is a need to remodel the abnormal heart tissue or narrow the enlarged valve by inserting a prosthetic ring. The purpose is to save the patient's valve and restore the valve's functioning. In valve repair, the patient's tissues are used to treat the damaged valve.

• Valvuloplasty- Balloon valvuloplasty is a procedure to open the narrowed or blocked valve (caused due to accumulation of plaque) and improve the blood flow through the valve. A catheter, with a balloon at its tip, is guided to the narrowed valve. When the catheter is positioned correctly, the balloon is inflated to widen the narrowed valve and make passage for the blood to flow interruptedly.

Heart Valve Replacement

In cases where valve damage is extensive and severe and cannot be treated through repair, replacement is needed. The diseased or damaged valve is entirely replaced with a new valve. The new valve may be a tissue valve (animal valve or human-donated valve) or a mechanical valve (metal, plastic, or artificial).

The surgery may be-

•  Traditional open heart surgery:  Most open heart surgeries are performed through sternotomy. The patient is placed under general anaesthesia and the breastbone is cut open. The heart is stopped, and a heart lung machine takes over the function of the heart temporarily. The surgeon will then completely remove the diseased aortic valve and place a new valve. The heart is then restarted, and the chest incision is closed. Open surgery is an invasive procedure that takes longer operative time and recovery.
• Minimally invasive procedure:The valve replacement through smaller incisions in the chest or a transcatheter valve replacement procedure. TAVR procedure can be done without general anesthesia and does not require stopping the heart or opening the chest cavity. It is a minimally invasive, catheter based technique during which the doctor replaces the patient’s diseased valve with a bioprosthetic valve. Once in place, the valve immediately begins functioning. The patient will be discharged from the hospital within a few days and will have a much shorter recovery period compared to open heart surgery. This novel, interventional technique is somewhat similar to angioplasty and is done in the Cardiac Catheterization Lab (Cath-lab).

   

   

  Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Replacement (TMVR) are increasingly used to treat aortic valve stenosis or mitral valve stenosis. Aortic Valve Replacement using TAVR procedure is proving to be a standard of care with its high efficacy and increasing success in treating patients with severe aortic stenosis.

Tabular presentation of the various treatment options for heart valve disease.

Recovery

Recovery after valve repair or replacement calls for -

• Regular follow-up with your doctor.
• Timely medications.
• Taking care of incisions and avoiding infection.
• Pain and stress management.
• Following your doctor's advice and recommendations regarding lifestyle changes, diet, quitting unhealthy habits, and exercise.

MYVAL^TM from Meril

Meril has a cleverly iterated diverse vascular intervention medical devices portfolio that is used in more than 100 countries. MYVAL^TM from Meril is an indigenously developed transcatheter heart valve designed for precision in Aortic Valve Replacement outcomes. The MYVAL-THV (Heart valve) is a biological tissue valve designed to work like one's own heart valve. It is available in multiple sizes and the specialized Heart Team will determine which size is right for the patient. The upper half of the valve has an ‘open’ cell design which ensures that the coronary blood flow is not affected, and the lower half of valve provides effective anchoring support. The unique ‘hybrid honeycomb’ valve design allows the doctor to accurately place the new heart valve at the natural position. This precise positioning ensures that there is no conduction system disturbance thus eliminating the need for a new pacemaker as seen with other valve technologies.

Conclusion

Heart valve diseases can have severe consequences if left untreated. To avoid this, incorporating healthy lifestyle changes, a healthy diet, a routine exercise regime, managing stress, and staying aware and informed about your blood pressure, sugar levels, cholesterol level, and other related statistics is a must. Consult your doctor immediately in case of any abnormality experienced with chest pain, heartbeats, breathing, and/or physical movement. Stay alert and aware of your heart health to address, prevent, and/or treat any heart health issue timely.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9228968/
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/symptoms-of-heart-valve-problems
https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-valve-diseases#:~:text=Medicines%20are%20not%20a%20cure,to%20prevent%20abnormal%20heart%20rhythms.
https://www.healthpartners.com/blog/what-is-a-tavr-procedure/#:~:text=No%2C%20TAVR%20is%20a%20minimally%20invasive%20procedure.
https://my.clevelandclinic.org/health/body/21704-heart
https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/symptoms-causes/syc-20353727