Valvular Heart Disease

Heart is an amazing muscular organ which continuously pump five to six liters of blood per minute, 10400/ days & beats two & half billion times throughout one lifecycle. The heart has four chambers & is divided in two circulations i.e. Right sided ( Pulmonary) & Left sided (Systemic) circulation. There are four valves, two on each side within heart which are responsible for maintaince of forward flow of blood into next chamber only. Valvular heart disease arise either due to obstruction to forward flow (STENOSIS) or leaking of valve (REGURGITATION).

Some people are born with the defect in heart valve (Congenital heart disease) or may develop valve disease later in lifespan (acquired heart disease). There are many possible causes of acquired valve disease such as Infection ( rheumatic & endocarditis), Degenerative (myxomatous),Ischemic and Systemic diseases ( rheumatoid arthritis).With improvement in health care delivery, there is decline in incidence of rheumatic infection but an increase in prevalence of degenerative pathology.  The commonest valve involved with rheumatic pathology is mitral valve, but aortic & tricuspid valve can also be involved. Rheumatic heart disease is still the commonest valvular heart disease in children & young adults.

Valve dysfunction (obstruction or leak) effect blood circulation & causes the symptoms such as breathing difficulty, palpitations, pedal oedma,easy fatiquability, chest pain or loss of consciousness. So type of dysfunction & symptom status determine the treatment options such as  medical or surgical.valve surgery options are in form of Valve repair or Replacement of disease valve. Valve repair is always a superior option whenever feasible as it preserve the native valve function . Valve repair procedure involves reconstruction of valve leaflets, subvalvular structures, ventricular geometry & valvular annulus. So it is technically more demanding procedure , lead to avoidance of long term anticoagulation (blood thinning medication) & improved life quality with life expectancy

Advance damaged heart valve cannot be repaired & needs replacement. Ideal valve prosthesis is still a utopian concept. Artificial valve prosthesis (device) is of two types i. e. Mechanical valves  & Tissue valves. Mechanical valve are made of pyrolytic carbon & Tissue are derived from many animals ( pig, cow or horse). Selection of valve prosthesis depends upon aspiration of patient, monitoring of anticoagulation, cost with availiabilty of valve, monitoring of valve function & its complications, probability of reoperation ,life expectancy of patient & Socioeconomic and educational background. It is always advisable for patient to discuss the    choices of operation with the surgeon.

With latest technological innovations such as Newer generation of artificial valve, Minninally invasive approaches of surgery, Percutaneous valve replacement devices ( TAVR) & Newer valve repair techniques, valvular surgery outcomes are improving. Patient should also not wait till end stage of disease process for good surgical outcome.

In conclusion, Heart valve disease can involves all ages. Rheumatic heart disease is still more prevalent than Degenerative valve disease in our country. Heart valve surgery is very safe & good option for patients which will lead to a more active & fulfilling life. As a recipient of heart valve, Patient should be actively involved in health care management. Actually it is a team effort, patient is the key player in the team along with expert valve surgeon for successful outcome.



Copyright by Dr Sanjay Kumar Agarwal 2019. All rights reserved.

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