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HEART VALVES DISEASES (VALVULAR DISEASES OF THE HEART)


Cardiac valves are complex structures that have a function of a valve in blood circulation in the heart. There are four heart valves:

Mithral (bicuspid, left atrioventricular) valve – is located between the left atrium and the ventricle.

Tricuspid (right atrioventricular) valve – is located between the right atrium and the ventricle.

Aortic valve – a valve that provides a one-way flow of blood from the left ventricle into the aorta.

Pulmonary valve – a valve that provides a one-way flow of blood from the right ventricle to the pulmonary artery.

Heart valve diseases cause functional disturbances; whether it is difficult for blood to flow through them due to narrowings (stenosis), whether they pass blood backwards (insufficiency). Heart valve diseases can be inborn and acquired. The most common acquired heart valve diseases are:

  • mitral insufficiency (inadequate closure of the mitral valve and return of blood from the left ventricle to the left ventricle)
  • aortic stenosis (narrowing of the aortic valve opening and difficult flow of blood from the left ventricle into the aorta)
  • aortic insufficiency (inadequate closure of the aortic valve and the return of blood from the aorta to the left ventricle)
  • mitral stenosis (narrowing of the opening of the mitral valve and difficult flow of blood from the left atrium to the left ventricle)
  • Tricuspid insufficiency (inadequate closure of the tricuspid valve and return of the blood from the right ventricle to the right atrium).

Symptoms

They are not specific and depend on which valve is affected, its degree of damage, cardiac function and eventual associated heart disease (comorbidity).

Patients are usually asymptomatic at an early stage of the disease that can last for years.

The most common symptoms are:

  • intolerance of physical effort, nausea, fatigue
  • difficulty breathing at a load, and later at resting
  • Different types of discomfort and pain in the chest
  • heartbeat feeling
  • dizziness, unconsciousness,
  • anxiety
  • inability to lie on a flat surface, swelling of  legs and abdomen.

Causes

The most common cause is the degenerative changes in heart valves that occur in the elderly age, and are worsened in patients with inadequately treated high blood pressure.

Other causes of heart valve damage include: coronary (ischemic) heart disease, congenital heart disease, cardiomyopathy, inflammatory heart and valve disease, rheumatic heart valve disease (in patients who have experienced rheumatic fever) and others.

Diagnosis

  • Anamnesis and clinical examination
  • Electrocardiography (ECG)
  • Transtoracal ultrasound examination of the heart
  • Transseophagous ultrasound examination of the heart
  • Right-sided catheterization of the heart
  • Coronarography (usually directly preoperative)

Treatment

  • Surgical treatment is a gold standard in the treatment of significant heart valve diseases, with long-term results.Surgical treatment includes surgical treatment through standard or minimally invasive approaches (replacement or reconstruction of the valve) and treatment by transcathetic implantation of the valves.
  • Aortic valvula is a valve that is most often surgically replaced. Reconstruction of the aortic valve is rarely possible (valve sparing procedure). Replacement can be done by mechanical or biological valves. Mechanical valves have the advantage of lasting longer, but requiring permanent administration of blood thinning medicines that can lead to bleeding elsewhere in the body. Biological valves only require short-term administration of blood thinners, but its duration is about 10-15 years.
  • Mitral valve is the most common surgically reconstructed valve. Regarding the reconstruction of the mitral valve in mitral insufficiency, most reconstruction methods include installation of a ring that narrows the opening of the mitral valve (anuloplasty with a ring). In the case of mitral stenosis, replacement is done in most of the cases.
  • Tricuspid valve is rarely replaced, but is most often reconstructed in terms of narrowing the opening of the tricuspid valve by seams (sewing anuloplasty) or with implantation of the ring (anuloplasty with a ring).
  • Conservative treatment includes numerous medicines that primarily act symptomatically and are beneficial in the initial stages, but do not prevent progression of the disease. Although damage to the heart valves can not be cured by medicines, they slow down the deterioration of the cardiac function and therefore are the basis of treatment for all patients.
  • Transcatheter implantation of the valve (currently not available in the BH Heart Center Tuzla) is most used for aortic valve disease in patients whose risk of surgery is high and this procedure is called TAVI (transcatheter aortic valve implantation). There are similar procedures for the disease of the mitral valve.

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