Valve disease

 

The heart has four valves: tricuspid valve, mitral valve, aortic valve and pulmonary valve. Heart valve disease occurs when one or more of the valves do not open or close properly.

 

There are three main reasons why:

  • Stenosis: when the valve opening becomes narrow and restricts blood flow.

  • Prolapse: when a valve slips out of place or the leaflets do not close properly.

  • Regurgitation: when blood leaks backwards through a valve.

Severity:

Valve disease can be classified as mild, moderate or severe. If left untreated, it can lead to heart failure or heart enlargement.

 

Causes of valve disease:

  1. Congenital valvular disease (disease develops before or at birth)

  2. Acquired causes: rheumatic fever

  3. Infective endocarditis

  4. Age

  5. Radiation therapy

 

Symptoms:

  • Shortness of breath,

  • Chest discomfort (between the neck and the upper abdomen)

  • Palpitations

  • Fatigue

  • Light-headedness, dizziness

  • Swelling

 

Types of valve replacements:

  • Mechanical valves: made from durable metals, carbon, ceramics and plastics. They are designed to last a lifetime.

 

  • Biological valves: made from animal tissues, donated human tissue or a patient’s own tissues. Usually not used on young adults or in those individuals who do a lot of contact sports as the stresses placed on the tissue valve may cause it to wear out more quickly.

 

 

TAVI

(Trans catheter aortic valve implantation)

 

An alternative to open heart surgery is TAVI. This procedure is less invasive and is mostly used in patients who are not well enough for an open heart. This intervention is done to reduce the symptoms of shortness of breath, chest pain or fainting. It also reduces the risk of heart failure and death. Although it has the same level of risk as surgery, it has a quicker recovery.

 

In this intervention, a replacement valve is inserted through a catheter with a balloon at its tip, through the groin artery. The catheter is positioned within the opening of the aortic valve. The balloon is gently inflated and the new tissue valve is placed in its new position. The balloon is deflated, and the catheter and balloon are removed. The new valve is left sitting inside the damaged valve.

Mitraclip

Mitraclip is indicated for patients who suffer from mitral regurgitation (MR). MR can either be primary (degenerative), which is related to birth defect, age or heart illness, or secondary (progressive), which is caused by heart disease and leads to enlarged left ventricle.

Signs and symptoms of mitral regurgitation include:

  • Fatigue or inability to exercise

  • Decrease in appetite

  • Dry, hacking cough; which gets worse when lying down

  • Shortness of breath

  • Fainting

  • Lower limb oedema and lung oedema.

If MR is left untreated, symptoms may get worse, and the quality of life may be impeded.

Transcatheter mitral valve repair (Mitraclip) is a less invasive intervention used to treat mitral regurgitation. It is offered to patients who are not candidates for an open heart surgery, have advanced heart failure, or suffer from serious medical conditions.

How is the procedure performed?

The patient will be asleep during the procedure. The Mitraclip is passed through the catheter, which is inserted through the femoral artery and guided to the right side of the heart. A small puncture is done in the upper chambers of the heart and passed to the left side of the heart. This is done by using both ultrasound and X-ray pictures to guide the clip into place. The Mitraclip is then positioned on the leaky portion of the valve and it will be attached to the mitral valve leaflets.

®© Mario Scicluna
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