Valvular heart disease (VHD) is a type of heart disease that involves the heart valves. Degenerative valve disease is the most common form of VHD in the United States, while rheumatic heart disease accounts for the majority of valve pathology in developing countries. Diseases of the valve could be due to regurgitation, insufficiency or stenosis. VHD may be present at birth or acquired.
Causes of valvular heart disease
The presence of heart murmur does not always indicate heart disease. It may be detected as incidental findings on imaging or non-invasive testing. Before the advent of antibiotics, rheumatic heart disease was the most common cause of VHD. Valve disease may be congenital, like bicuspid aortic valve or pulmonic stenosis. Acquired diseases could be from, myxomatous or calcific degeneration, infection, coronary artery disease, cardiomyopathy, radiation treatment, connective tissue disorders, tumors, and use of anti-obesity drugs like Fen-phen, which have been removed from the market after being linked to VHD.
Signs and symptoms of valvular heart disease
Symptoms depend on the type and severity of valve disease. If the onset of valve disease is acute, symptoms can occur quickly. If chronic, the heart has time to adjust until the valves deteriorate. Patients with diseased heart valves may present with symptoms of shortness of breath, fatigue, weakness, dizziness and loss of consciousness. Symptoms may be more pronounced with activities, although they could occur even at rest. Some patients complain of palpitations, chest pain, leg swelling and weight gain.
Diagnosis of valvular heart disease
Patients with known or suspected VHD should undergo a thorough history and physical as well as chest x-ray and electrocardiogram. Echocardiogram assesses structural abnormalities and ventricular function, severity of stenosis or regurgitation. Cardiac catheterization identifies the presence of coronary artery disease and severity of regurgitation. Cardiac CT or MRI may also detect abnormalities of the valves.
Treatment of valvular heart disease
The goals for treatment of VHD are to protect the valves from further damage, lessen symptoms, repair or replace the valves. Patients without symptoms or have minimal symptoms may be observed for some time until there are indications to repair or replace the valves. Patients should maintain a healthy life style, avoid excessive salt intake, refrain from smoking and excessive alcohol intake, control risk factors for hypertension and heart disease. Medications are given to improve symptoms, reduce the workload of the heart and regulate heart rhythms. Anti-platelet medications like aspirin or Plavix prevent clots and may be prescribed for patients with VHD who have experienced transient ischemic attacks.
Balloon valvuloplasty for stenosed valves uses a catheter inserted through the blood vessel into the narrowed valve which is then stretched. Surgical repair or replacement may be necessary depending on the patient’s age, medical condition and specific valve affected. Replacement valves may be bioprosthetic or mechanical. Patients with mechanical valves are maintained on life-long anticoagulation with Warfarin due to higher risk of blood clots. Surgery may be done as open heart or with minimally invasive techniques.
TAVR ( transcatheter aortic valve replacement), has been developed for patients who have severe aortic stenosis who are poor surgical candidates for traditional surgical aortic valve replacement. The procedure is performed in a hybrid suite with cardiac catheterization and surgical capabilities by a team comprised of interventional cardiologists, cardiothoracic surgeons, imaging specialists and anesthesiologists.
Recent advances in the treatment of VHD can save the lives of patients who are deemed ineligible to undergo the standard open heart approach.
Dr. Sandra Dee specializes in women’s heart health, clinical, vascular, non-invasive and interventional cardiology with the Jackson Clinic. She received her medical degree at the University of Santo Tomas, Manila, Philippines. She completed her Cardiology Fellowship at the University of Tennessee in Memphis and Interventional Cardiology Fellowship at the University of Virginia. Dr. Dee is board certified in Cardiology.
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