Our heart valves are rightly called the doors of life. There are four of them, each at the entrance and exit of the upper and lower chambers of the heart. Their main function is to control the unidirectional flow of blood through the heart. Like all the other organs of the body, the heart valves too are susceptible to diseases, both congenital (present from birth) and acquired. Earlier these diseases had hardly any treatment and the patients were compelled to lead a very poor quality of life and succumb to death earlier. But now we have moved miles ahead, and even those with very complex valve disorders can enjoy a near-normal life.
Obesity and overweight are associated with a number of factors that raise the risk of cardiovascular disease (heart attack and stroke): High blood lipids, particularly triglycerides, LDL cholesterol, total cholesterol, and HDL cholesterol, as well as low HDL cholesterol. Blood pressure that is too high. Weight Loss can greatly improve heart and vascular health, boost heart function, lower blood pressure and improve metabolism.
How is heart valve disease caused?
There are several factors that can cause heart valve disease, and the most common factors are listed below.
Rheumatic fever leads to heart valve disease
Initially, it manifests as a throat infection, pain in the joints that keeps on shifting, and fever. If improperly treated, rheumatic fever affects the delicate heart valves, causing them to be narrowed or leak. Since it is most commonly seen among people from weaker socio-economic groups, the awareness level about early treatment of rheumatic fever is low, and often, young adults in their teens come down with valve disorders. Rheumatic fever can be effectively treated by long-term use of penicillin injections. But if valves are already affected, then appropriate treatment is necessary.
Sometimes children may be born with improperly formed valves that are very tight or leaky. The valves may even be completely absent, sometimes.
Other acquired defects
Sometimes abnormal deposits of calcium occur on the valve cusps, leading to their deformity. The presence of blood clots, an infectious pathogen like a mass of fungus, bacteria, etc., or even external mechanical injury may cause damage to heart valves. Some medications like the prolonged use of anti-Migraine drugs, radiation treatment to the chest area, etc. Can also precipitate valve damage.
Valve disorders are mainly of two types: valve narrowing (stenosis) and valve leakage (regurgitation). Irrespective of which valve is affected, most valve defects produce similar symptoms that are directly proportional to the severity of the defect, the person’s activity level and general health.
Valve disorders may manifest as:
- Shortness of breath that progressively increases with exertion in the initial stages, and later, even at rest.
- Chest pain
- Swelling of the legs, particularly the ankles.
- Heart palpitations or a rapid heartbeat
- Easy fatigue
- Repeated chest infections
- Severe cough, sometimes coughing up blood
How to detect heart valve disease?
During the diagnosis of heart valve disorder based on the patient’s history, the doctor can suspect a valve disorder. On clinical examination, he/she may hear abnormal heart sounds called ‘murmurs’. This prompts the doctor to refer the patient to a cardiologist for a detailed examination. An Echocardiogram with colour Doppler reveals the nature and exact extent of the disease with the amount of blood flowing across the valves. A chest X-ray and ECG are also done. Rarely, an angiogram is required for associated problems.
How is heart valve disease treated?
Once diagnosed, the cardiologist discusses the treatment for heart valve disease. Most cases of valve narrowing can be treated without heart surgery through Balloon Valvoplasty, where the narrowed valve is widened by wiring a balloon through a large blood vessel. Since it is nonsurgical, it leaves no scar, and patients are discharged within two to three days and can resume normal life almost immediately. Some precautionary medications are advised to prevent further infliction to the valves.
What are the surgical options for heart valve disease?
When there is severe leakage in the valves or the valve is severely deformed due to calcification or other reasons, the viable option of treatment is valve replacement surgery.
Artificial heart valves are of two types:
Mechanical heart valves, as the name implies, are made of metals and are of various types: ball and cage, tilting disc, and bileaflet. It will help the patients to lead a normal, active life. The only significant disadvantage of this type of valve is the tendency to form blood clots or thrombus around the metallic surfaces. To prevent this serious consequence, patients have to be on lifelong anticoagulation. Most often, the drug Warfarin (Coumarine group) is prescribed to prevent clotting and ensure smooth valve function. Patients have to undergo a monthly blood test to check their INR (International Normalized Ratio), which is an index of their clotting ability. The medication is thus adjusted to the minimum safe dosage so as to reduce the risk of serious internal or external hemorrhage.
Biological heart valves are principally harvested from animals. The pig’s (porcine) heart valve is frequently used since it is anatomically very similar to the human heart valve. This type of surgery is called xenotransplantation. The other type of biological valve is made out of the pericardial sac of cows or horses. These valves also work very well. But these valves do not grow with the patient and may need replacement in the future.
The Ross procedure is a surgery where the severely diseased aortic valve is replaced with the patient’s own pulmonic valve, and the pulmonic valve is replaced by a cadaveric valve. The pulmonic valve, working under low pressure, is slow to develop any dysfunction. These types of valves grow with the patient and thus give freedom from the prospect of re-operation. Anticoagulation is also not required for this type of replacement since no metallic surface is present. This is the procedure of choice, particularly for children with severe aortic valve disease. Some hospitals today offer the facility of valve banks, where cadaveric valves are harvested and preserved.
Is life after valve replacement surgery is normal?
The principal purpose of any therapy is to give back a normally active and good quality of life to the patients. Thus, after a successful valve replacement surgery, patients are to be able to pursue their education, job, active social life and would be in no way different from their heart-healthy counterparts. But they need to be under regular medical checkups, as advised by their heart doctor.
Those on anticoagulation therapy should have their blood tests done as scheduled and take the medicines without fail. Rough contact sports like rugby should be avoided to minimize the risk of injury and bleeding. Periodic tests like an echocardiogram may be needed to assess the functioning of the valves. There is no restriction on marriage and having a family. But women who look forward to being mothers should discuss with their cardiologist before planning for conception and keep in constant touch with him throughout the pregnancy and childbirth so that medications can be properly adjusted for the safety of both the mother and the child.
Development of any symptoms like shortness of breath, unexplained exhaustion, swelling of ankles, fever, and severe cough should never be ignored and promptly reported to the cardiology doctor to rule out any valve dysfunction.