Navigating Valvular Heart Disease: Causes, Symptoms, and Treatment Options

The Changing Landscape of Valvular Heart Disease

Valvular heart disease is a prevalent condition in our country, and the landscape has been evolving over the years. Traditionally, rheumatic heart disease, stemming from childhood rheumatic fever, was the leading cause of valvular problems. However, with improved rheumatic fever prophylaxis programs, we are now seeing a declining incidence of rheumatic heart disease and a rise in degenerative valvular heart disease.

Degenerative valvular heart disease is a manifestation of the aging process, where the heart valves, particularly the aortic valve, degenerate and lose their functionality over time. This shift in the underlying causes of valvular heart disease is largely attributed to the increasing longevity and improved health standards, as people are living longer and experiencing more age-related changes in their cardiovascular system.

Understanding the Types of Valvular Heart Disease

Valvular heart disease can present in different forms, depending on how the affected valve impairs blood flow. If a valve fails to open properly, the condition is known as stenosis, and if the valve fails to close appropriately, it is called regurgitation. In many cases, patients may experience a combination of both stenosis and regurgitation.

Aortic Valve Disease

The aortic valve is the most commonly affected valve in degenerative valvular heart disease. Typically, this condition presents in the sixth, seventh, or eighth decade of life, with the majority of patients being in their 70s or 80s. In a small subset of patients, aortic valve disease can be congenital, where the valve is formed with fewer than the normal three leaflets, making it more prone to wear and tear over time.

Mitral Valve Disease

While the aortic valve is the primary focus in degenerative valvular heart disease, the mitral valve can also be affected by the aging process. Mitral valve disease can manifest as stenosis, regurgitation, or a combination of both.Symptoms and Progression of Valvular Heart Disease

Patients with valvular heart disease typically present with a range of symptoms, including:

• Exertional breathlessness: Difficulty in breathing during physical activity or exertion.
• Chest pain: Discomfort or pain in the chest area.
• Rapid heart palpitations: Feelings of a rapid or irregular heartbeat.
• Episodes of dizziness or fainting: Also known as syncope.

As the disease progresses, the symptoms often worsen, and patients may experience a decline in their functional capacity, struggling to perform their normal daily activities. This worsening of symptoms and functional status is a key indicator that the disease has become severe and requires more than just medication management.

Treatment Options for Severe Valvular Heart Disease

When the valvular heart disease reaches a stage where medications are no longer sufficient to manage the symptoms, the definitive treatment is to replace the diseased valve. This can be done through either surgical valve replacement or a less invasive procedure called transcatheter aortic valve replacement (TAVR).

Surgical Valve Replacement

Conventional surgical aortic valve replacement has been the standard treatment for severe aortic valve disease for several decades. This open-heart surgery involves replacing the diseased valve with a mechanical or tissue-based prosthetic valve. Patients typically recover within 5-6 days and can resume their normal activities after the procedure.

Transcatheter Aortic Valve Replacement (TAVR)

For patients who are deemed too high-risk or unsuitable for open-heart surgery, TAVR offers a less invasive alternative. This procedure involves implanting a new valve through a small incision in the groin, without the need for open-heart surgery. TAVR is typically performed under local anesthesia, and patients can often go home within 2 days, resuming their normal lives shortly after the procedure.

Clinical trials have shown TAVR to be as effective as surgical valve replacement, with the added benefit of being a safer option for high-risk or frail patients. The elimination of general anesthesia, the heart-lung machine, and the open-heart surgery significantly reduces the risks and complications associated with the procedure.

Choosing the Right Valve Replacement

The choice between a mechanical or tissue-based prosthetic valve depends on the patient’s age and overall health status. Mechanical valves are more durable and typically recommended for younger patients, but they require lifelong anticoagulation therapy to prevent blood clots. Tissue valves, on the other hand, are better suited for older patients, as they do not necessitate lifelong blood thinners.

In the case of TAVR, the implanted valve is typically a tissue-based valve, as the procedure is primarily reserved for elderly or high-risk patients who may not be suitable candidates for open-heart surgery.

Overcoming Challenges During the Pandemic

The COVID-19 pandemic posed significant challenges in the management of valvular heart disease. Many patients were hesitant to seek medical attention, fearing the risk of exposure to the virus. This led to the postponement or neglect of essential cardiac care, which in some cases, had serious consequences.

Healthcare providers, including the team at Yashoda Hospitals, have worked diligently to create a safe environment for patients to seek medical care. Precautions were taken to ensure the safety of both patients and healthcare workers during cardiac procedures, including COVID-19 testing and postponing surgeries for those with active or recent COVID-19 infection.

Despite the challenges, the team at Yashoda Hospitals continued to perform hundreds of cardiac procedures, including transcatheter valve replacements, throughout the pandemic, ensuring that patients with critical valvular heart disease received the necessary care.

Preventing Valvular Heart Disease

While the degenerative form of valvular heart disease is largely a consequence of the aging process, there are steps individuals can take to reduce the risk of cardiovascular disease, which can also benefit the health of the heart valves.

• Maintain a healthy lifestyle: Adopt a balanced diet, regular exercise, and maintain a healthy weight.
• Control cardiovascular risk factors: Manage conditions like high blood pressure, diabetes, and high cholesterol.
• Stay active and engaged: Maintain an active lifestyle to support overall cardiovascular health.

By taking these preventive measures, individuals can help reduce the risk of developing degenerative valvular heart disease and maintain a healthy cardiovascular system as they age.

In conclusion, valvular heart disease is a prevalent condition that has seen a shift in its underlying causes, with degenerative disease becoming more common. Understanding the symptoms, progression, and treatment options, including the innovative TAVR procedure, is crucial for providing effective care to patients. By working together, healthcare providers and individuals can navigate the challenges of valvular heart disease and promote better cardiovascular health.