Frequently asked questions about valvular heart disease

In principle, coronary disease, which is associated with the risk of presenting angina or a heart attack, is not related to having valvular heart disease. Heart attack risk is more closely related to the cardiovascular risk factors you may have (smoking, diabetes, hypertension, and high cholesterol) than to valve disease.

Echocardiograms are carried out according to the progression of the disease. For this reason, in mild cases the second control may be done after three years of follow-up, while in severe cases these tests can be repeated every six months and associated, if necessary, with other explorations such as transoesophageal echocardiograms or exercise echocardiograms.

Surgery is usually decided upon based on the patient’s medical history and certain findings on the echocardiogram that indicate incipient myocardial damage. Usually symptoms and echocardiogram abnormalities present at the same time, but sometimes this is not the case, and the echocardiogram may detect damage in asymptomatic patients. In these cases, surgery is also recommended, because if we wait for symptoms to appear, the damage could be irreversible.

Often the patient denies the symptoms because they have adapted to their limitations, so they no longer recognise them as such; in these cases we can perform a stress test to see if the patient’s exercise tolerance is what is expected for their age. This test often unmasks symptoms and helps indicate surgery in a patient who was considered asymptomatic.

A transoesophageal echocardiogram is a special type of echocardiogram carried out using a probe placed inside the oesophagus. The patient must fast before this test. The patient will be sedated to increase their tolerance to the procedure, and most patients do not consider it traumatic at all. This test shows the cardiac structures much more precisely, so that we can confirm the diagnosis, if this is not clear from a conventional transthoracic echocardiogram. It also allows us to define the anatomy of the lesion much better so the surgeon can decide the best surgical technique to apply.

There is a very delicate balance between the salt concentration inside and outside the cells (known as the third space). When we eat salt, it is absorbed and to maintain the concentration balance liquid is simultaneously reabsorbed, so that, on the one hand, the blood pressure increases and, on the other, fluid also accumulates in the third space, manifesting as shortness of breath and oedema (swelling). In addition, the effectiveness of anti-hypertensive treatment is greatly reduced by eating salt, so it is important to avoid excess salt.

This is not necessary if you follow a varied and balanced diet (unless advised to do so by your healthcare professionals).

In principle, yes, but it is advisable to discuss this with your healthcare professionals to check that these infusions do not interfere with the medication you are taking.

This depends on the type of sport and the stage of the disease. It is not a good idea to raise the heart rate excessively (excess adrenaline can be harmful).

They are not recommended. It is better not to use them as they are harmful.

You should try to plan and see if this is feasible. The cardiologist and the gynaecologist should coordinate in the visits, as the pregnancy may be high-risk and require intensive monitoring.

Just like other valvular heart diseases, aortic stenosis can be mild, moderate, or severe. You may have non-severe valve stenosis for many years and not need aortic valve replacement. Valve replacement is indicated if the aortic stenosis is severe and associated with symptoms or decreased heart strength, or if heart surgery is performed for another reason. In most patients, the replacement requires surgery. If you have a high risk of complications, you may consider replacing the valve via a catheter. In a small percentage of patients, the risk of aortic valve replacement by surgery or percutaneously is very high. These patients are treated using medication.

 

Aortic valve replacement by surgery is the treatment of choice for patients with severe aortic stenosis, and this treatment has been proven to be very effective. Transcatheter aortic valve implantation (TAVI) is currently limited for patients who have a high surgical risk. It is possible that, in the next few years, TAVI will be extended to patients with a lower surgical risk, as experience is gained and long-term effectiveness is proven.

The main difference between conventional surgery and implanting a TAVI through an incision in the chest, is that conventional surgery requires the use of a heart-lung machine (the heart has to stop). In contrast, during a non-inguinal implantation of a TAVI, the valve is placed through a catheter inserted directly into the heart or aorta, without the need to stop the heartbeat and use a heart-lung machine.

If the TAVI is carried out through the inguinal canal, you will be in the hospital for around five days. If the TAVI is implanted non-inguinally (with no incision into the chest) you can expect to be in hospital for up to seven days. After having a MitraClip implanted, you have to stay in the hospital for about two or three days. This length of time is considering no incidents in the surgery and that no special care is necessary (for example, dialysis).

A relatively frequent complication of valvular heart disease is infective endocarditis. This is especially serious in patients with prosthetic heart valves. To reduce the risk, it is important to have good dental hygiene, and visit the dentist periodically. You must also inform the doctors that you have a prosthesis before undergoing any procedure, and you will be told if you need to take antibiotics before invasive procedures.

The main differences between the two types of prostheses are their durability and the risk of blood clots.

Mechanical prostheses are remarkably resilient and can operate for many years without their performance being affected. They are typically used in young patients. Their disadvantage is that as they are made using artificial materials (essentially carbon and titanium) they may favour the formation of clots that can clog their mechanism or produce embolisms. For this reason, all patients with mechanical prostheses must take blood thinners for life.

Biological prostheses, on the other hand, do not increase clot risk, but they do have a more limited lifetime, and they “age” over time. This type of prosthesis is ideal for older patients and for anyone who cannot take anticoagulants.

Most aortic valve procedures are minimally invasive, although each case must be evaluated individually with the surgeon. Certain situations mean that this alternative is not the most appropriate, for example when there is concomitant pathology of the aortic valve or coronary arteries. In addition, it cannot be performed if there is a serious damage to the arteries or the aorta, or if the patient has had a prior operation on the right side of the chest.

Although each case is special and unique, there are several tools we can use to estimate a person’s risk when undergoing heart surgery. These calculations are based on databases including thousands of patients who have undergone surgery in many centres across the globe, and they give an approximate risk that can be calculated in advance. These tools are yet another element in the preoperative risk calculation, but it is important to remember that not all clinical situations and not all types of operations can be simulated with the same precision. For these reasons, nothing can replace the personalised information the surgeon offers the patient on an individual basis.

Although this depends, in part, on the general preoperative condition of each patient (age, functional capacity, presence of other diseases, etc.), on the whole, the vast majority of patients recover a high level of activity just one week after the operation. It is recommended that certain restrictions be kept in place until the wounds have completely healed, which takes about six weeks. If the operation is minimally invasive, the patient’s recovery is faster and it is possible to recover their complete range of activity much more quickly.