They are diseases that arise from problems in the functioning of the heart valves.
The valves of the heart prevent the backflow of blood between the heart’s chambers. There are four valves in the heart: the aortic valve, the mitral valve, the tricuspid valve, and the pulmonary valve.
There are different cases depending on the heart valve problem:
- When a valve does not open properly, it is called valve narrowing or stenosis.
- When a valve does not close properly, it is called valve regurgitation or leakage.
The most common valve diseases are diseases of the aortic and mitral valves, either in the form of narrowing or in the form of regurgitation.
The aortic valve separates the left ventricular chamber from the aorta. This valve can calcify and obstruct the ventricle and the aorta with age. This disease mainly affects the elderly.
The aortic valve is usually surgically replaced by stopping the heart. The mitral valve is the one that separates the left ventricle from the left atrium.
This valve can be reduced due to an inflammation generally produced in childhood. Strep throat causes what is known as rheumatic fever.
In adulthood, this valve is damaged, and the inflammatory phenomenon narrows the valve orifice. This is manifested by shortness of breath when exercising.
Causes of valvular heart disease
Valvular heart disease can have several causes, mainly depending on the type of valve, but the main ones are:
- Of degenerative origin, that is, due to the heart’s aging.
- Of infectious origin, due to a germ that circulates in the blood and that fixes in the valve that causes an abscess and is called infective endocarditis.
- Inflammatory or bacterial in origin, inflammatory rheumatism can cause inflammation of the joints and heart.
- Of functional origin.
It is often the case that the disease is silent and that the patient is not necessarily aware of the signs of valve disease.
Therefore, it can progress until symptoms appear, usually indicative of a more severe attack.
However, some signs may indicate valve disease; these may be:
- Heart failure .
- Difficulty breathing at rest.
- Shortness of breath on exertion.
- Pulmonary edema .
Diagnosis of valvular heart disease
The management of these diseases requires an integrated diagnostic and therapeutic approach.
The diagnosis of these diseases is often made through simple cardiac auscultation, but in the evaluation of the case, medical auscultation can detect the existence of:
- Depending on its location, radiation, and intensity, the heart murmur is perceived; depending on its site, radiation, and power, an attempt is made to recognize the difference between insufficiency or narrowing.
- Heart rhythm (tachycardia is a sign), an irregular heartbeat that can signify valvular disease.
The severity of the disease and its impact requires the use of multiple techniques, including:
- Magnetic resonance.
- Cardiac catheterization.
- Certain blood tests.
- Functional evaluation by ergospirometry.
- An echocardiogram.
- Doppler ultrasound.
The treatment of these pathologies implies the integration of different medical-surgical techniques such as:
Preventive medical treatment
Rest, and a salt-free diet are recommended.
Some diuretics (to reduce pressure on the heart) and vasodilators (to dilate blood vessels) may also be prescribed.
Preventive treatments are essential, mainly to prevent infective endocarditis, as well as regular monitoring if the valve disease is poorly developed and does not present symptoms or cardiac repercussions.
A surgical technique that avoids opening the heart can be used to treat valve diseases that present a narrowing. There is also talk of percutaneous intervention.
This involves passing a tube with a tiny balloon into an artery or vein and inflating the balloon to dilate the vessel.
It is also possible with this method to configure prosthetic valves.
Aortic valvuloplasty and percutaneous aortic valve replacement
In patients with advanced age and risk factors for significant surgeries, implanting these valves percutaneously is possible. It passes directly through the skin, either by the femoral route, by direct puncture of the heart, or by puncture of the subclavian artery.
The transcutaneous femoral route can perform a simple treatment and involves dilating the mitral orifice with a balloon.
The results of this technique are excellent, with a low risk of complications. This technique avoids a heavy surgical procedure that would replace the valve with a prosthesis and require heart failure and a chest opening.
When valve repair is not possible, it is replaced with a prosthesis.
It is an open heart operation and is stopped with cardiopulmonary bypass, during which a mechanical or biological prosthesis is placed.
Difference between mechanical or biological prostheses
Valve replacement can be done with a mechanical or biological prosthesis.
Mechanical prostheses: These do not wear out, and anticoagulant therapy will be necessary for treatment with regular coagulation control.
Biological prostheses: they do not require additional anticoagulant treatment, but they must be replaced after a specific time during a new operation because they have a limited life.
Complications of valvular heart disease
Untreated valve disease can develop into heart failure, heart rhythm disorder, and endocarditis.
To prevent valvular heart disease, it is recommended:
- Eat healthy foods without too much salt.
- Get adequate physical activity such as walking, biking, and swimming.