Aortic Valve Disorder

Before the sophisticated medicine and treatment we have today, aortic valve disease was the most common valvular problem. There are typically three ways that an aortic valve disorder can develop.

Those who are born with a bicuspid aortic valve are at a possible risk later on in life. This is because the bicuspid valve doesn’t open as widely as its tricuspid counterpart. This causes more pressure on the aortic valve leaflets, and leads to increased wear and tear over time, resulting in aortic valve stenosis. About 10% of bicuspid aortic valves become significantly narrowed, resulting in this aortic valve disorder.

Aortic Valve Stenosis

The most common cause of aortic valve stenosis is due to protein collagen on the aortic valve being destroyed (commonly with elderly people). Calcium begins to deposit on the aortic valve leaflets, and the mobility of the aortic valve is decreased. This can cause aortic valve leakage, which can lead to other complications.

Less common in first world countries, aortic valve disease can also be caused by an infection that develops with rheumatic fever (an illness that follows strep throat if it is left untreated). The infection causes the edges of the aortic valve to fuse (bind together) and become weakened, thus resulting in a leaky aortic valve.

Symptoms of Aortic Stenosis

Major symptoms of aortic stenosis are chest pain (angina), fainting (syncope), and shortness of breath (due to aortic valve leakage and heart failure). In 4% of patients with aortic stenosis, the first symptom is sudden death, usually resulting from strenuous physical activity.

In about one third of all patients diagnosed with aortic valve stenosis, chest pain is usually the first sign. The pain is described as uncomfortable pressure below the rib cage, becoming worse during physical exertion and usually relieved during rest. Because the aortic valve is narrowed, this increases pressure in the heart. It also increases the oxygen demand for the blood flowing into the heart because there is less blood being pumped by the heart due to the narrowing of the aortic valve. This can also attribute to shortness of breath.

Fainting (syncope) is another symptom of aortic valve disease and is usually associated with physical exertion or excitement. This is because the narrowed aortic valve cannot supply the right amount of pressure to blood veins in the body, resulting in a drop of blood pressure. Since blood flow to the brain is decreased as a result of this, fainting can occur.

Shortness of breath is caused by an increased pressure load on blood vessels of the lung. This is due to the fact there is increased pressure on the aortic valve, and therefore pressure is increased on all blood flow leading to the aortic valve. Initially, patients suffering from aortic valve stenosis will feel a shortness of breath during physical activity, although as the aortic valve disease progresses, shortness of breath can also occur during rest.

Aortic Valve Surgery

Patients with mild aortic stenosis do not require to be treated to refrain from any activity. Once the aortic valve stenosis becomes categorized as “moderate”, patients are typically advised to avoid strenuous activities such as sprinting or weight lifting. Doctors and their patients are most often aware of aortic valve stenosis as it progresses. That being said, patients are then monitored annually by use of echocardiography (ultrasonography of the heart). Patients with a serious progression of aortic valve stenosis are likely to be given antibiotics prior to any sort of procedure in which bacteria may enter the blood stream. This includes but is not limited to dental work and minor surgery.

Patients categorized with severe aortic valve stenosis are usually recommended to go in for aortic valve surgery. There are two main types of procedures in which aortic valve surgery is performed: aortic valve repair and aortic valve replacement.

Aortic Valve Repair

Aortic valve repair can usually be performed on valve defects that are congenital. Although valve repair is more commonly used to treat mitral valve defects, it’s still a viable procedure. The following are six procedures that surgeon use depending on how the aortic valve appears to be defective:
Commisurotomy, which is used when the aortic valve becomes too narrow. The leaflets of the aortic valve are too wide and can obstruct the flow of blood. The surgeon cuts the points where the leaflets are too wide.
Valvuloplasty, an action taken when the leaflets of the aortic valve are weakened. A ring-like device is attached to the outside of the aortic valve for support.
Reshaping, which involves the cutting and re-stitching of misshapen aortic valves.
Decalcification, which involves the removal of calcium which can build up on the aortic valve leaflets, allowing them to close properly and preventing aortic valve leakage.
Repair of structural support, where cords that support the aortic valve are shaped to the right length, allowing the aortic valve to close properly.
Patching, where holes in the aortic valve leaflets are patched, thus preventing aortic valve leakage.

Aortic Valve Replacement

Aortic valve replacement is a much more common procedure than aortic valve repair, because patients usually don’t develop life threatening complications that can be solved by aortic valve repair. There are two different types of aortic valve replacements: biological and mechanical. Both biological and mechanical aortic valve replacements have their advantages and disadvantages, and communication between a doctor and his/her patient should determine which aortic valve replacement is best.

Mechanical aortic valve replacement materials usually consist of things such as plastic, carbon or metal. These last much longer than their biological counterpart. The downside of a mechanical aortic valve replacement is that patients will have to take blood-thinning anticoagulants for the rest of their lives to prevent blood clotting to the mechanical parts of the valve.

Biological aortic valve replacements are either made from animal tissue, or the human tissue of a donated heart. Because the aortic valve replacement is made from biological materials as opposed to mechanical ones, patients usually do not require to take anticoagulants to prevent blood clotting. However, biological valves need to be replaced after 10 years or so. In children and young adults, the biological aortic valve replacement naturally breaks down quicker, so these replacements are most often used in elderly patients.

A bicuspid valve which functions normally opens when a pressure change is formed in between the left atrium and left ventricle. As the left atrium gets filled with blood the pressure inside it increases due to which bicuspid valve opens to allow the flow of blood into left ventricle. When the lefty atrium get emptied into left ventricle the pressure is changed again and this pressure change results in the closure of the bicuspid heart valve. Flow of blood occurs due to atrial contraction and at the end of this contraction the bicuspid valve is closed.

The area of a normal bicuspid valve is 4-6 square cm. It has two cusps named as the anteromedial leaflet and the posterolateral leaflet and these leaflets control the opening and closing of the bicuspid valve. The opening of the valve is surrounded by a fibrous ring known as the mitral valve annulus. Anterior leaflet comprises most of the part of the ring while posterior valve has larger surface area and the chordae tendineae are attached to the posterior surface of the valve to prevent the prolapsing of the leaflets.

These inextensible chordae tendineae are attached from one side with the leaflets and from other side to the papillary muscles. Papillary muscles are finger-like projections from the wall of the left ventricle. During diastole when the left ventricle contracts the intraventricular pressure force the leaflets to close and the tendons avoid the opening of the leaflets in wrong direction thus preventing the back flow of blood into left atrium. The chords are of different thickness and the thinnest and the thickest chords are present at the free margin of the leaflet and away from free margin respectively.

During the left ventricular diastole the ventricular myocardial relaxes and results in the drop of pressure in left ventricle and the bicuspid valve opens to allow the flow of blood from left atrium into left ventricle. The active relaxation of the ventricular myocardium causes a pressure gradient which results in the rapid flow of blood from left atrium through bicuspid valve. About 70-80% of the blood is passed into left ventricle by this early filling phase of left ventricle. On Doppler echocardiography this early filling is shown as E wave. After this early filling there is a phase of slow filling.

Left atrial contraction or left atrial systole which occurs during left ventricular diastole causes added blood to flow across the mitral valve immediately before left ventricular systole. This late flow across the open mitral valve is seen on doppler echocardiography of the mitral valve as the A wave. The late filling of the LV contributes about 20% to the volume in the left ventricle prior to ventricular systole, and is known as the atrial kick.

The shape and size of the mitral annulus changes throughout the cardiac cycle. The annulus becomes small during atrial systole as this reduction in size is necessary for the proper coapting of the leaflets of the bicuspid valve.

A heart valve (or heart valves) can develop problems before birth, or problems can develop during one’s lifetime. Heart valve leakage causes can include a few things. The accumulation of calcium in a heart valve (degenerative calcification) affects about a third of people over the age of 70. Heart valves may also deteriorate over time which is quite common. This is known as Myxomatous degeneration; it can cause the heart valves to become flimsy and thus leak. Rheumatic fever can cause heart valve leakage; though it is a rare childhood illness that only develops once strep throat is not treated properly.

Heart valve disorders can usually be found during a routine physical check-up with a family physician. The doctor can do this by listening to the heart to see if the rhythm is irregular. Heart valves can be inspected by use of an echocardiography (an ultrasound of the heart).

Antihypertensive drugs are typically used to treat heart valve disease by causing the arteries to widen (dilate). This decreases the amount of work the heart has to do and therefore lowers blood pressure.

However, in some instances it may be necessary to have heart valve surgery. Heart valve repair (or heart valve replacement) can be very effective; although it is a higher risk to older individuals, life span can often be prolonged more effectively. Heart valve surgery usually involves removing excess tissue from the damaged heart valve(s), and implanting a supporting ring. This type of heart valve repair is much more effective in the long run. Heart valve surgery usually runs less risk than not having the heart valve repaired.

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Aortic Valve

Mitral Valve

Tricuspid Valve

Bicuspid Valve

What actually a Heart Valve Leakage refers to?

Well, in order to understand this, you must first have a little idea about the blood flow mechanism inside your body. The heart consists of four different chambers and there exists four heart valves viz. Mitral, Tricuspid, Aortic and Pulmonary, at the exit of these four heart compartments. These valves are responsible for ensuring that the blood always flows in the forward direction. However, diseased heart valves may cause backward flow of blood into the heart. This causes the oxygenated blood to mix with the deoxygenated one, resulting into severe health complications. It is very necessary for everyone to identify these disorders and seek for appropriate medical procedures before the conditions get even worse.

How can I understand that I have any heart valve leakage disorder? (General Symptoms)

1. Heart Murmur is generally the first symptom of a heart valve leakage in most of the cases. It can be detected by listening to the sound of your heart through a stethoscope. The sound produces when blood flows into the heart in a turbulent manner.

2. Frequent exhaustion or fatigue can significantly indicate potential mitral regurgitation. You can understand that you are suffering from this particular heart valve leakage symptom, if you often experience unusual tiredness even after simple daily tasks.

3. Any sensation of a missed out heart beat can be serious indication of valve leakage disorders. In this case, you will feel some kind of palpitation as a result of certain disturbance in the normal heart beat rhythm.

4. Excessive and continuous cough, especially when you are lying down. This kind of cough is generally neglected by people. However, this may potentially indicate a diseased valve.

5. Dizziness can be seen very frequently.

6. Abnormally swelling of your feet and ankles. This is another most common symptom seen in patients suffering from heart valve disorders.

7. Urination process frequency is almost doubled per day. If you face excessive urination problem, then it is the high time that you seek for medical consultation.

Well, there can be other indications of a heart valve disease too. However, these are the most common ones. Therefore, it is highly recommended that if you notice any of these above symptoms, immediately consult a good cardiologist. It may happen that in spite of the fact that you are experiencing any of these symptoms; still chances are there that you are not actually suffering from the heart valve leakage disorders. However, ignoring these symptoms can severely cause you serious health conditions including certain fatal heart diseases. In addition, it is not always necessary that a heart valve leakage patient faces these symptoms. He or she can be asymptomatic. So, any abnormal activities warn you to go to a doctor and check your heart’s condition, as nothing is worth more than your life!

Mitral valve leakage Symptoms
Mitral valve leakage can attribute to the following symptoms:

• Shortness of breath
• Chest pain
• Heart palpitations
• Extreme fatigue
• Coughing
• Rapid heartbeat (although fairly uncommon)

Mitral Valve Disease

There are three different forms of mitral valve disease: mitral valve prolapse, mitral valve regurgitation, and mitral valve stenosis.

Mitral valve prolapse occurs when the valve flap becomes enlarged. This prevents the mitral valve from closing evenly and therefore prevents optimal blood flow. This mitral valve disorder can be identified by use of a stethoscope. It is characterized by a clicking sound followed by a heart murmur.

Another mitral valve disease is known as mitral regurgitation, which is damage caused to the mitral valve due to a heart attack or heart infection. Symptoms are similar to that of mitral valve prolapse and both are more commonly treated with antibiotic medicine than by use of mitral valve surgery. Your doctor should know whether or not the condition is serious enough to undergo mitral valve replacement for either mitral valve prolapse or mitral regurgitation.

Mitral valve stenosis is definitely a more serious condition of the three mentioned. Although it is usually caused by rheumatic fever, mitral valve stenosis can be caused by any condition that causes the mitral valve to become narrow. With older individuals, calcium may begin to build up around the valve where the mitral valve and heart muscle meet. Mitral valve stenosis is less common in developed countries that have medicine to prevent this mitral valve disease, though it is still a threat that exists and should be monitored through regular check-ups.

Mitral valve stenosis symptoms include:

• Shortness of breath and night or following exercise
• Coughing, which in some cases can produce a pink, blood-tinged phlegm
• Fatigue
• Chest pains that worsen during physical exertion, not as noticeable during rest
• Frequent respiratory infections including but not limited to bronchitis
• Heart palpitations (feeling that the heart skipped a beat)
• Swelling of the feet and ankles
• Voice becoming hoarse

Any mitral valve disease can become quite serious if left untreated. Prolonged mitral valve leakage can eventually lead to heart failure or stroke. Blood clots can also develop in various parts of the body due to a leaky mitral valve. It’s best to consult a doctor in regards to whether or not you are in need of mitral valve surgery. It may be necessary in some cases to undergo mitral valve repair or mitral valve replacement.

If that’s the case and a mitral valve disorder poses a threat to one’s life span and cannot be treated with medicine, mitral valve surgery is likely necessary.

Mitral Valve Repair

Mitral valve repair is usually related to congenital valve defects (complications you are born with). There are about six different procedures surgeons use depending on how the mitral valve is defective. These include:

Commissurotomy, which is used when the mitral valve is too narrow. The leaflets are too wide and they could be obstructed. The surgeon opens up the mitral valve by cutting the points where the leaflets are stuck together.

Valvuloplasty, which strengthens weakened leaflets to provide support and allows them to close the mitral valve tightly. This is done by using a ring-like device that is attached around the outside of the mitral valve.

Reshaping, this is when the surgeon cuts out a section of the leaflet, and sews it back together. Pretty self explanatory.

Decalcification, the removal of calcium buildup from the leaflets, allowing them to close properly and prevent a leaky mitral valve.

Repair of structural support. Cords that give the mitral valve support are shaped to the right length, allowing the mitral valve to close properly.

Patching, where holes in the leaflets are patched to prevent mitral valve leakage.

Mitral Valve Replacement

In more severe cases, especially when mitral valve leakage is extreme and the seriousness of mitral valve disease is life-threatening, mitral valve replacement may be essential. There are two different options for mitral valve replacement: mechanical and biological.

Mechanical mitral valves, which are typically made from materials such as carbon, metal, or plastic, are built strong and made to last longer than their biological counterparts. However, blood tends to clot around mechanical mitral valves, and patients will be required to take blood-thinning medicines (anticoagulants) for the rest of their lives once the mitral valve replacement is completed.

The other option for mitral valve replacement is biological mitral valves. These are taken from an animal tissue, or alternatively taken from the human tissue of a donated heart. In some cases, the mitral valve replacement can be performed using a patient’s own tissue if there is enough to spare. The advantage of having a biological mitral valve replacement is that patients don’t commonly have to take anticoagulants. However, biological mitral valves usually have the life span of about 10 years before they need to be replaced, and need to be replaced even more frequently in children and young adults.

That being said, it’s a good idea to discuss with a doctor to decide which mitral valve replacement method is best.

Mitral Valve Surgery

If diagnosed with mitral valve stenosis, and mitral valve surgery is a viable option for treatment, there are certain preparations that should be taken before the date of surgery. A patient needs to make sure he/she practice good hygiene up to the surgery date. This is to reduce the amount of germs on your skin. Also be sure to go in on an empty stomach, otherwise the anesthetic the surgeon administers could cause complications.

On the day of mitral valve surgery, there will likely be a series of tests. These can include blood/urine tests and a chest x-ray to provide the surgeon with updated information on the patient’s health. Lastly, electrodes will be attached to the chest which monitor the hearts rhythm and electrical activity. Once that’s done, the anesthetic is applied intravenously, and the mitral valve surgery is under way. This usually takes two to four hours, the patient is completely asleep and won’t feel a thing.

Once the mitral valve surgery is completed, patients usually spend between one and three days in ICU (intensive care unit). Following mitral valve surgery, it’s best to limit physical exertion. Those working office jobs typically are able to return in 4-6 weeks; those who work more physically demanding jobs may need to wait longer before they can go back.

You may also like to read: Heart Valve Leakage

Tricuspid valve,

Tricuspid Valve Disorder

Tricuspid valve disorders are rare and most often occur with other heart valve problems, particularly with the mitral valve. All types of tricuspid valve disease occur when the tricuspid valve narrows, causing an increase of pressure in the right atrium, and decreasing the overall efficiency of the heart. If the tricuspid valve does not close properly, this can result in tricuspid valve leakage in which blood flows back into the right atrium.

Tricuspid Valve Disease

Tricuspid valve disease can be caused by rheumatic heart disease, which is an infection that proceeds strep throat if not treated in a proper manner. This is uncommon in people living in countries with access to modern health care’s medicine and technologies. Occasionally, tricuspid valve disease can be attributed to a congenital condition (passed down through family genes).

Tricuspid Valve Stenosis Symptoms

Symptoms of the tricuspid valve disease known as tricuspid valve stenosis may not occur for years in a person developing the disease. When symptoms start to occur, they often include an uncomfortable sensation in the neck or chest, due to irregular heart rhythms. Tricuspid valve stenosis can also produce symptoms of right-sided heart failure. These include discomfort of the upper abdomen, resulting because of swelling of the heart and liver.

Tricuspid valve disease can show certain signs that a doctor should be able to recognize upon a routine check up. When a tricuspid valve disorder is present, the heart may produce murmurs that can be heard by use of a stethoscope. In addition to this, there may be an abnormal pulse in the jugular vein located in the neck. Once a doctor suspects a tricuspid valve disease may be present, x-rays and echocardiograms (ultrasound study of the heart) can be used to reach a diagnosis.

Tricuspid Valve Surgery

If the damage to tricuspid valve is mild, doctors are likely to be able to treat it with medicine. In severe cases of tricuspid valve stenosis, tricuspid valve surgery may be necessary. Tricuspid valve surgery is typically performed when the condition poses a threat to a person’s life. This means that a person can develop a high risk of heart attack and stroke due to tricuspid valve stenosis. This involves either tricuspid valve replacement or tricuspid valve repair.

Tricuspid Valve Repair

The procedure for tricuspid valve repair is usually performed to treat congenital defects, and usually not those who have developed tricuspid valve stenosis through wear and tear of the tricuspid valve. There are six main actions a surgeon may take to repair a tricuspid valve. These include:
Commissurotomy – Used for narrowed tricuspid valves, where the leaflets are then too large in comparison to the valve. The surgeon opens up the tricuspid valve by cutting away the excess of the leaflets.
Valvuloplasty – Performed when the leaflets of the tricuspid valve are weak. A ring-like device is inserted to the outside of the valve opening, allowing the valve to close and preventing tricuspid valve leakage.
Reshaping – The surgeon cuts a section of the leaflet, and sews it back where necessary in order to reshape the tricuspid valve and allowing it to function properly
Decalcification – The removal of calcium buildup from the leaflets. This allows the leaflets on the valve to close and prevent having a leaky tricuspid valve.
Repair of structural support – Either shortening or replacing the cords that give the tricuspid valve support. When the cords that attach to the tricuspid valve leaflets are the right length, the valve can close and prevent tricuspid valve leakage.
Patching – The surgeon covers holes and/or tears in the leaflets by use of patches made of tissue.

Tricuspid Valve Replacement

Tricuspid valve replacement is performed when a patient suffers from a life-threatening case of tricuspid valve stenosis and cannot be fixed by a tricuspid valve repair. There are two types of replacement methods used to treat severe tricuspid valve stenosis: one using mechanical tricuspid valve replacement, the other using biological tricuspid valve replacement. Both types of tricuspid valve replacement have their advantages and disadvantages, and it’s best discussed with a doctor which procedure better suits his or her patient.

Mechanical tricuspid valve replacements are generally used with materials such as plastic, carbon, or metal. The mechanical tricuspid valve replacement is much stronger than the biological one, and these usually last indefinitely. However, patients are required to take anticoagulants (blood thinning medication) because blood tends to clot on the mechanical tricuspid valve parts. Blood clotting on the mechanical tricuspid valve can lead to heart attack and stroke, so anticoagulants are a must.

Biological tricuspid valve replacements on the other hand are made from either animal or human tissue. They are not as strong as mechanical tricuspid valve replacements, and need to be replaced about every 10 years or so (they break down even quicker in younger patients). The main advantage of having a biological tricuspid valve replacement is that patients typically do not require to take anticoagulants.

Tricuspid Valve Post-surgery Precautions

Before going in for tricuspid valve surgery, patients are carefully monitored to see if there are any changes in their health. Patients are advised to tell their doctor which (if any) medications they are taking. Even having a common cold should be reported to your doctor, as it can lead to infections during surgery and hinder post-surgery recovery.

Most patients that go in for tricuspid valve surgery spend a few days in ICU (intensive care unit). Joining a cardiac rehabilitation program is also recommended to be sure a patient makes a full recovery. The majority of patients should expect to return to work in 4-6 weeks, but are advised against highly strenuous physical activity such as weight lifting or sprinting.

Heart valve surgery

Heart valve Surgery and Causes

* One of the main reasons why heart valve surgery is necessary is because the heart valve won’t open up all the way. The main cause of this is because the valve has become hard or stiff from the buildup of calcium deposits or scarring from a past incident. When the valve doesn’t open all the way it is impossible for enough blood to get through.

* The heart valve not closing all the way will call fur surgical repair. The heart valves failure to close completely is most often caused by a tear in the valve. A tear can occur naturally and slowly over time. When this happens the blood will back up through the valve in the wrong direction. The end result is that enough blood does not make it through the heart.

* Repairing a valve during heart valve surgery is a less risky option than a total replacement. Heart valve repair will consist of working with the existing valve. Typically, a ring is sewn around the base of the valve to help support it. The extra support will give the valve the additional strength it needs to function properly.

* Heart valve replacement involves the removal of the dysfunctional valve and replacing it with a mechanical or natural valve. Mechanical valves are usually made from man made materials. They will last forever in most cases, however, there are some drawbacks. A person with a mechanical valve will have to be on blood thinner for the rest of their life in order to prevent clotting. A person who gets a valve replacement with a natural valve, such as a human donor valve, will never have to be on medication to thin the blood. However, natural replacements do not last as long as the mechanical ones. They will need replaced about every ten years.