Treatment of Acquired Valve Disease

Regretfully, there is nothing that can cure heart valve disease. Medicines and lifestyle changes can sometimes alleviate the symptoms and delay heart failure for many years. To repair the damaged valve, the patient will ultimately still need surgery.

The main goals for treatment are:

• Protecting the heart from further damage.
• Prevention, treatment, and relief of the symptoms of other related heart diseases.
• Replacing/repairing the heart valves when the symptoms of the heart valve disease become life-threatening.

Protecting the heart from further damage

Infective endocarditis is a disease that is often responsible for acquired valve disease.  It can often be prevented by taking good care of your gums because inflammation of the valves is a major risk factor for developing infective endocarditis. Good dental hygiene is essential for avoiding this serious disease. The situation is even more serious if the person’s heart valve has been replaced with a synthetic one, since this is also a risk factor for developing infective endocarditis.

Prevention, treatment, and relief of the symptoms of other related heart diseases

Firstly, the doctor might ask you to follow a healthy diet and stop smoking, since smoking and poor diet play an important role in the development of atherosclerosis.

A healthy diet should be rich in proteins, whole grains and low-fat dairy products. This includes foods such as lean meats, poultry, seafood, nuts, beans, seeds and peas.

Moreover, a healthy diet should almost completely exclude simple carbohydrates and limit refined grains and solid fats.

The doctor may also prescribe drugs to treat the following conditions:

• Heart failure and hypertension- Diuretics, beta-blockers, and ACE inhibitors are primarily used to treat these conditions. Diuretics help the body remove excess water that accumulates within the body. Beta-blockers and ACE inhibitors improve the quality of life of the patient and increase life expectancy.
• High blood cholesterol - Currently, statins are one of the most popular treatments for high blood cholesterol. The only thing to keep in mind when using statins is that they inhibit coenzyme q10 (CoQ10), which plays an important role in aerobic cellular respiration and other vital functions. If you are taking statins, it is also important to take CoQ10 supplements.
• Coronary heart disease - Aside from the drugs mentioned above, nitroglycerine is used to alleviate the symptoms of this condition. Nitroglycerine causes the release of nitric oxide (NO) which dilates the coronary arteries.
• Arrhythmias - Arrhythmias are primarily treated using beta-blockers. In severe cases, a pacemaker needs to be installed.
• Prevention of blood clots - If the person has a synthetic valve, a blood thinner should be administered in order to prevent the formation of blood clots. These drugs are also prescribed if the person has mitral stenosis, aortic stenosis and other valve defects that increase the risk of blood clots.

Repairing and Replacing Heart Valves

Even if you have no symptoms, your doctor might recommend that you undergo an operation to repair/replace your heart valve. The reason for this is that heart valve defects often lead to dire consequences (such as hypertrophy and consequently dilation of the myocardium) which are irreversible. Therefore, it is better to treat the heart valve defect sooner rather than later.

Whether the heart valve has to be repaired or replaced depends on several factors including:

• The age of the patient.
• Severity of the heart valve defect.
• Whether the patient has other heart conditions which demand surgery (e.g. bypass surgery to treat coronary artery disease).

If it is possible, heart valve repair is more preferable than heart valve replacement. When the heart valve is repaired, the function and strength of the heart muscle is preserved. Moreover, artificial valves increase the risks of infective endocarditis and therefore it is better to repair the heart valve rather than replace it. Repairing a heart valve is more difficult than replacing it. Only mitral and tricuspid valves can be repaired. Pulmonary and aortic valves are usually replaced.

Repairing Heart Valves

The heart valve can be repaired by:

• Reshaping or removing the valve tissue to enable it to close tighter.
• Separating valve flaps that have fused together.
• Adding tissue to tears in the valve to increase its strength.

In some cases, cardiac catheterization can be used to perform the operation. However, this procedure is not suitable for everyone. Cardiac catheterization is primarily used for heart valve stenosis. In such a case, a balloon valvuloplasty can be performed.

Balloon valvuloplasty - during this procedure, the catheter that is threaded into the heart contains an inflatable balloon at the end. When the catheter is in place, the balloon is inflated and this opens up the heart valve. Afterwards, the balloon is deflated and removed with the catheter.

Balloon valvuloplasty does not work for every patient and the condition of the patient may worsen over time. It may remove some symptoms, but the patient might still need to go through an operation in the future.

This procedure works very well for patients with mitral stenosis and makes it the method of choice.

Replacing Heart Valves

In some cases, the valve cannot be repaired and the only choice is an operation. During this operation the faulty valve is removed and an artificial one is put in its place. The artificial valve can either be synthetic or biological.

• Biological valves are crafted from human, cow, or pig tissue. These valves are specially treated to prevent rejection. These valves are usually implanted into children and then replaced with synthetic ones. Previously, biological valves lasted for about 10 years. The modern biological valves, however, can last for 15 years and more.
• Synthetic valves are more durable than biological valves and do not have to be replaced. The downside of synthetic valves is that the person with a synthetic valve has to take blood thinners in order to prevent blood clotting. Moreover, synthetic valves increase the likelihood of infective endocarditis.

If you are athletic or a woman who still plans on having children, then a biological valve should be your first choice. Elderly patients may also prefer to have a biological valve installed since it will most likely last them for the rest of their lives.

New Methods of Repairing and Replacing Heart Valves

The newer procedures for repairing and replacing heart valves tend to be less invasive, shorten the recovery time and have fewer complications.

• Some surgeons explore catheter procedures during which clips or other devices are threaded through the catheter and installed on the faulty heart valve. These devices reshape the heart valve preventing regurgitation. After such an operation, the recovery time is much shorter and the risk of infection is less.
• Modern advancements also allow for the aortic valve to be replaced using catheters. This procedure is called TAVI (transcatheter aortic valve implantation). During this procedure, a catheter is inserted into a blood vessel located in the arm or groin. This catheter has a deflated balloon on the end with a folded replacement valve around it. Once the end of the catheter is in place, the balloon is expanded and the new valve is guided over the old one. This procedure can also be performed if the previously installed biological valve is failing.

Prognosis

Heart valve disease varies from person to person. Some people might live their entire life without ever experiencing symptoms. For others, the condition may gradually worsen until the heart valve disease leads to heart failure.

People who have worsening symptoms will eventually need to undergo a heart valve repair or replacement procedure. People with synthetic heart valves have to take blood thinners for the rest of their lives to prevent blood clots.

As for pregnancy, mild and moderate heart valve disease usually poses no risks for the fetus or mother. Most of the symptoms can be managed with bed rest and medicine. However, the pregnancy is contraindicated if the woman has severe heart valve disease since it poses a great risk for the mother and child.