Treatment of valvular heart disease
When it is less advanced, valvular heart disease is treated pharmacologically, and when symptoms appear, or according to the echocardiogram findings, an operation is performed to repair or change the affected valve. Recently, non-surgical and therefore less invasive techniques have appeared, but in many cases it has still not been demonstrated that they are as effective as surgery.
Valvular heart disease patients should live a healthy lifestyle and be more or less strict, depending on the progression of the disease. This means that patients in the very early stages can lead an absolutely normal life, even do sport, but when the symptoms begin to appear, diet and the amount of exercise should be monitored more closely.
Controlling the risk factors. In general, you should control the cardiovascular risk factors well, seek help to quit smoking, control your blood pressure, and eat a Mediterranean diet rich in fruits and vegetables, and preferably consume more fish than meat. White meat is better than red meat, which should only be eaten occasionally.
Moderate salt intake. Salt favours fluid retention. You must therefore stop eating processed foods with a high salt content.
Exercise. This should be tailored to the stage of the disease. It is good to walk and stay active without getting too tired. If you want to do sport, always check with your cardiologist about what kind of exercise you want to do and how intense it can be.
Before any surgical operation, no matter how small (such as a simple tooth extraction), it is important to let the professionals involved know that you have valvular heart disease and which medication you take, especially if you have been prescribed an anticoagulant.
Finally, you should also remember that good dental hygiene is important, as germs in the mouth are particularly prone to adhering to diseased valves and infecting them, something known as infectious endocarditis
There is no medical treatment that can reverse and cure valvular heart disease. The medication is aimed at slowing down its progression as far as possible and minimising the related symptoms, while preserving the function of the heart.
Treatment for controlling blood pressure. If your blood pressure is elevated, treatment will always be prescribed. This normally involves ACEi drugs and their derivatives (enalapril, losartan, valsartan, candesartan, etc.) either with or without a beta-blocker (bisoprolol, carvedilol), depending on the type of valvular disease and its severity. The treatment to lower your blood pressure should be taken as indicated by your cardiologist, and always at the same time of day.
Diuretic treatment. Any fluid retention must be treated to eliminate excess liquid. Diuretics can be adapted according to what you have planned during the day, although they should be avoided at night so they do not prevent proper rest.
Oral anticoagulants. If the valve problem is complicated by cardiac arrhythmia, principally atrial fibrillation, an oral anticoagulant may be prescribed, normally acenocoumarol, often marketed as Sintrom® in Spain, to avoid the risk of an embolism. If necessary, a drug may be taken to control the heart rate if the arrhythmia tends to make the heart beat too fast.
When the patient requires an operation, the heart valves are repaired whenever possible, rather than replaced, as this helps preserve heart function and avoids the complications associated with the use of artificial prostheses. In these cases, the damaged valve segment that does not close properly is removed and then the cut edges are brought together. This allows the valve to function properly and stop the leak. The ring around the valve is then strengthened by implanting an artificial ring (a procedure called annuloplasty).
In some people, such as those with mitral or aortic valve narrowing (stenosis) and highly calcified valves, the valves cannot be repaired. In these cases the operation involves heart valve replacement, for which various types of prostheses can be used:
- Biological prostheses. Made from animal tissues (especially from pigs and cows). These have an excellent thromboembolic risk profile (low risk of causing clots and embolisms) so they do not require anticoagulant treatment (Sintrom®), but they do have a limited durability as they deteriorate over time. They are the best option for older patients or patients with contraindications for anticoagulation medication.
- Mechanical prostheses. These are primarily made of titanium and carbon. They are very durable, which is why it is very rare for people to need repeat surgery, but patients do need to take anticoagulants indefinitely (Sintrom®), since without this treatment there is a risk of embolism.
- Sutureless and unsupported (stentless) prostheses. These are the latest variations of biological prostheses. Sutureless prostheses can be implanted in less time, and unsupported prostheses minimise or eliminate the presence of artificial (non-biological) material, improving their haemodynamic performance.
- Homografts. These are human heart valves obtained from donors, and which have the greatest possible compatibility. They offer the benefits of biological prostheses (lower risk of embolism without the need to take anticoagulants) and mechanical prostheses (excellent durability and haemodynamic performance), although they are more complex to implant.
Until recently, surgery was the only treatment option for patients requiring valvular replacement or repair. This fact limited the number of patients with valvular heart disease who could be treated, since some patients have an unacceptable or very high surgical risk due to age, the presence of concomitant diseases, or a history of cardiac surgery.
In recent years, techniques have been developed to repair or replace heart valves through a catheter (inserted through the groin in most cases). These percutaneous treatments are an option for patients with a high surgical risk.
The two main catheter treatments for valvular heart disease are: transcatheter aortic valve implantation (TAVI), for treating aortic stenosis; and percutaneous mitral valve repair using a MitraClip device, for treating mitral regurgitation.
In addition to percutaneous treatment, there are also less aggressive surgical options. Minimally invasive surgery uses tools that allow heart valves to be repaired using smaller incisions than those employed in conventional surgery, but with the same results.
Over the last 20 years, minimally invasive heart surgery has been the most-widely performed type, as growing evidence indicates that it provides excellent results.
Benefits of a minimally invasive procedure:
- Better cosmetic results (almost invisible).
- Less mechanical ventilation required and better lung function achieved.
- Less pain.
- Faster return to normal activities and work.
- Less loss of blood and fewer transfusions.
- Lower risk of wound infection.
- No risk of mediastinitis (severe infection of the interior of the chest) or sternal dehiscence.
Situations treated using a minimally invasive technique:
- Repair or replacement of the mitral valve.
- Repair or replacement of the aortic valve.
- Repair or replacement of the tricuspid valve.
- Atrial fibrillation ablation.
- Atrial septum defects (interauricular communication).
- Pericardiectomy.
Substantiated information by:
Published: 23 January 2020
Updated: 23 January 2020
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