Valvular heart disease (VHD) refers to any condition that affects one or more of the heart’s four valves: the aortic, mitral, tricuspid, and pulmonary valves. These valves play a critical role in ensuring blood flows in the correct direction through the heart. When they become damaged or dysfunctional, it can lead to serious complications, including heart failure, arrhythmias, and even death. In this blog post, we’ll explore the pathology and pathophysiology of valvular disease, its diagnosis, and the various treatment options available, including surgical and transcatheter interventions.

1. Pathology and Pathophysiology of Valvular Disease

Valvular heart disease can manifest in two primary ways:

• Stenosis: The valve becomes narrowed, restricting blood flow.
• Regurgitation (or Insufficiency): The valve doesn’t close properly, causing blood to leak backward.

Common causes of VHD include:

• Congenital Defects: Some people are born with abnormal valves.
• Degenerative Changes: Aging can lead to wear and tear on the valves.
• Infections: Endocarditis (infection of the heart valves) can cause damage.
• Rheumatic Fever: A complication of untreated strep throat that can lead to valve scarring.
• Other Conditions: Hypertension, cardiomyopathy, and connective tissue disorders can also contribute.

The pathophysiology of VHD depends on the affected valve and the type of dysfunction. For example, aortic stenosis increases the heart’s workload, while mitral regurgitation can lead to volume overload and heart failure.

2. Diagnosis and Evaluation of Valvular Heart Disease

Early and accurate diagnosis is essential for managing VHD. Common diagnostic tools include:

• Physical Examination: Listening for heart murmurs, which are often the first sign of valve dysfunction.
• Echocardiography: The primary imaging tool for assessing valve structure and function.
• Electrocardiogram (ECG): Detects arrhythmias or signs of heart strain.
• Chest X-ray: Evaluates heart size and lung congestion.
• Cardiac MRI or CT: Provides detailed images of the heart and valves.
• Cardiac Catheterization: Measures pressures within the heart chambers and assesses severity.

3. Surgical Valve Repair vs. Replacement

When valvular disease progresses to a severe stage, surgical intervention is often necessary. The two main options are:

• Valve Repair: The surgeon modifies the existing valve to restore proper function. This is often preferred for mitral valve disease, as it preserves the patient’s own tissue and avoids the need for long-term anticoagulation.
• Valve Replacement: The damaged valve is replaced with either a mechanical or biological prosthesis.
• Mechanical Valves: Durable but require lifelong anticoagulation therapy.
• Biological Valves: Made from animal or human tissue, they don’t require anticoagulation but may need replacement after 10–15 years.

The choice between repair and replacement depends on the patient’s age, overall health, and the specific valve involved.

4. Transcatheter Aortic Valve Replacement (TAVR)

TAVR is a minimally invasive alternative to open-heart surgery for patients with severe aortic stenosis who are at high or intermediate surgical risk. During the procedure:

• A catheter is inserted through a small incision, usually in the groin.
• A collapsible replacement valve is guided to the heart and expanded within the diseased aortic valve.
• TAVR offers faster recovery times and is a game-changer for older or frailer patients.

5. Medical Management of Valvular Heart Disease

While surgery is often the definitive treatment for severe VHD, medical management plays a crucial role in stabilizing patients and managing symptoms. Key strategies include:

• Medications:
• Diuretics: Reduce fluid overload in heart failure.
• Beta-blockers and ACE Inhibitors: Manage blood pressure and reduce heart strain.
• Anticoagulants: Prevent blood clots in patients with mechanical valves or atrial fibrillation.
• Lifestyle Modifications: A heart-healthy diet, regular exercise, and smoking cessation can help slow disease progression.
• Regular Monitoring: Patients with mild to moderate VHD require ongoing surveillance to detect worsening symptoms or valve dysfunction.

Conclusion

Valvular heart disease is a complex and potentially life-threatening condition that requires careful diagnosis and tailored treatment. Advances in imaging, surgical techniques, and minimally invasive procedures like TAVR have revolutionized the management of VHD, offering hope to patients who may not have been candidates for surgery in the past. If you or a loved one are experiencing symptoms like shortness of breath, chest pain, or fatigue, consult a healthcare professional to explore your options. Early intervention can make all the difference in preserving heart health and improving quality of life.