How Is Heart Valve Disease Treated?
The goals of heart valve disease treatment are
to:
- Prevent, treat, or relieve the symptoms of other
related heart conditions.
- Protect your valve from further damage.
- Repair or replace faulty valves when they cause
severe symptoms or become life threatening. Man-made or biological valves are
used as replacements.
Currently, no medicines can cure heart valve
disease. However, lifestyle changes and medicines often can successfully treat
symptoms and delay complications for many years. Eventually, though, you may
need surgery to repair or replace a faulty heart valve.
Prevent, Treat, or Relieve the Symptoms of Other
Related Heart Conditions
To relieve the symptoms of heart conditions related
to heart valve disease, your doctor may ask you to quit smoking and follow a
healthy eating plan low in salt, cholesterol, and fat.
Examples of healthy eating plans are the National
Heart, Lung, and Blood Institute's
Therapeutic
Lifestyle Changes (TLC) and
Dietary
Approaches to Stop Hypertension (DASH) eating plans. TLC is for people who
have high
blood cholesterol. DASH is for people who have
high
blood pressure (or for anyone who wants to follow a healthy eating
plan).
Your doctor also may ask you to limit physical
activities that make you unusually short of breath and fatigued (tired). He or
she also may ask that you limit competitive athletic activity, even if the
activity doesn't leave you unusually short of breath or fatigued.
Your doctor may prescribe medicines to help prevent
or treat other related heart conditions, such as
heart
failure, high blood pressure,
irregular
heartbeats,
coronary
artery disease (CAD), and life-threatening blood clots. Heart valve disease
can cause these conditions or worsen them.
People who have heart valve disease are commonly
prescribed medicines to:
- Treat heart failure. Heart failure medicines
widen blood vessels and rid the body of too much fluid.
- Lower blood pressure or blood cholesterol
levels.
- Prevent irregular heartbeats.
- Thin the blood and prevent clots (for people who
have man-made valves). These medicines also are prescribed for mitral stenosis
or other valve defects that make you prone to developing blood clots.
Protect Your Valve From Further Damage
If you've had previous heart valve disease and now
have a man-made valve, you may be at increased risk for a heart infection
called
endocarditis. This infection can worsen your heart valve
disease. Even if you don't yet have symptoms of a valve problem, you're at
increased risk for this infection.
To help prevent this serious infection, floss and
brush your teeth and see a dentist regularly. Gum infections and tooth decay
can cause endocarditis.
Let your doctors and dentists know if you have a
man-made valve or if you've had endocarditis before. They may give you
antibiotics before medical or dental procedures (such as surgery or dental
cleanings) that could allow bacteria to enter your bloodstream. Talk to your
doctor about whether you need to take antibiotics before such procedures.
Repair or Replace Heart Valves
Your doctor may recommend repairing or replacing
your heart valve(s), even if you do not yet have symptoms of heart valve
disease. This can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on
a number of factors, including:
- How severe your valve disease is.
- Your age and general health.
- Whether you need
heart
surgery for other conditions, such as
bypass
surgery to treat CAD. Bypass surgery and valve surgery can be done at the
same time.
When possible, heart valve repair is preferred over
heart valve replacement. Valve repair preserves the strength and function of
the heart muscle. People who have valve repair also have a lower risk for
endocarditis after the surgery, and they don't need to take blood-thinning
medicines for the rest of their lives.
However, heart valve repair surgery is harder to do
than valve replacement. Also, not all valves can be repaired. Mitral valves
often can be repaired. Aortic or pulmonary valves often have to be
replaced.
Repairing Heart Valves
Heart valves can be repaired by:
- Separating fused valve flaps
- Removing or reshaping tissue so the valve can
close tighter
- Adding tissue to patch holes or tears or to
increase the support at the base of the valve
Heart surgeons do most heart valve repair surgeries.
Cardiologists do some repair surgeries using
cardiac
catheterization. Although catheterization procedures are less invasive,
they also may not work as well for some patients. You and your doctor will
decide whether repair is appropriate and the best procedure for doing it.
Balloon valvuloplasty. Heart valves that
don't open fully (stenosis) can be repaired with surgery or with a less
invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee).
This procedure also is called balloon valvotomy.
During the procedure, a balloon-tipped tube is
threaded through your blood vessels and into the faulty valve in your heart.
The balloon is inflated to help widen the opening of the valve. Your doctor
then deflates the balloon and removes both it and the tube.
You're awake during the procedure, which usually
requires an overnight stay in the hospital.
Balloon valvuloplasty relieves many of the symptoms
of heart valve disease, but it may not cure it. The condition can still worsen
over time. You may need medicines to help with symptoms or surgery to repair or
replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time
than surgery. For some patients who have mitral valve stenosis, it may work as
well as surgical repair or replacement. For these reasons, balloon
valvuloplasty usually is preferred over surgical repair or replacement for
these people. Balloon valvuloplasty doesn't work as well as surgical treatment
for adults who have aortic valve stenosis.
Balloon valvuloplasty often is used in infants and
children. In these patients, valve stenosis is caused by a congenital defect
that can be repaired by a one-time procedure.
Replacing Heart Valves
Sometimes heart valves can't be repaired and must be
replaced. This surgery involves removing the faulty valve and replacing it with
a man-made valve or a biologic valve.
Biologic valves are made from pig, cow, or human
heart tissue and may have man-made parts as well. These valves are specially
treated, so no medicines are needed to stop the body from rejecting the
valve.
Man-made valves are more durable than biologic
valves and usually don't have to be replaced. Biologic valves usually have to
be replaced after about 10 years, although newer biologic valves may last 15
years or longer.
Unlike biologic valves, however, man-made valves
require you to take blood-thinning medicines for the rest of your life. These
medicines prevent blood clots from forming on the valve. Blood clots can cause
a
heart
attack or stroke. Man-made valves also raise your risk for
endocarditis.
You and your doctor will decide together whether
you should have a man-made or biologic replacement valve. If you're a woman of
childbearing age or if you're athletic, you may prefer a biologic valve so you
don't have to take blood-thinning medicines. If you're elderly, you also may
prefer a biologic valve, as it will likely last for the rest of your life.
Other Approaches for Repairing and Replacing Heart
Valves
Some newer forms of heart valve repair or
replacement surgery are less invasive than traditional surgery. These
procedures use smaller incisions (cuts) to reach the heart valves. Hospital
stays for these newer types of surgery are usually 3 to 5 days, compared to 5
day stays for traditional heart valve surgery.
New surgeries tend to cause less pain and have a
lower risk of infection. Recovery time also tends to be shorter2 to 4
weeks versus 6 to 8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring
procedures that use
cardiac
catheterization to thread clips or other devices in a tube through your
blood vessels and into the faulty valve in your heart. The clips or devices are
used to reshape the valve and stop the backflow of blood. It's not yet known
how effective these procedures are.
The Ross operation is a surgical procedure to treat
faulty aortic valves. During this operation, your doctor removes your faulty
aortic valve and replaces it with your pulmonary valve. The pulmonary valve is
then replaced with a pulmonary valve from a deceased human donor.
This is more involved surgery than typical valve
replacement, and it has a greater risk of complications.
The Ross operation may be especially useful for
children because the surgically replaced valves continue to grow with the
child. Also, lifelong treatment with blood-thinning medicines isn't required.
But in some patients, one or both valves fail to work properly within a few
years of the surgery. Experts continue to debate the usefulness of this
procedure.
Serious risks from all types of heart valve surgery
vary according to your age, health, the type of valve defect(s) you have, and
the surgical procedure(s) performed. |