HEART VALVE DISEASE AND REPLACEMENT SURGERY IN BANGLADESH

 In General

Valvular heart disease (VHD) is defined as a structural or functional abnormality of a cardiac valve. It is a major health problem afflicting elderly people in particular. Heart Valve Disease is caused by either damage or defect in one of the four heart valves, aortic, mitral, tricuspid, or pulmonary. Defects in these valves can be congenital or acquired. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes contribute to the risk of disease. Disruption of the anatomic integrity of a cardiac valve may produce valvular stenosis, valvular regurgitation, or a combination of the two.

Structural abnormalities of a cardiac valve often produce surface phenomena, which may be associated with platelet aggregation and microorganism accumulation predisposing to thromboembolism and infective endocarditis.

Basic knowledge of cardiac valve

The normal heart has four chambers (right and left atria, and right and left ventricles) and four valves. The mitral valve, also called the bicuspid valve, allows blood to flow from the left atrium to the left ventricle. The tricuspid valve allows blood to flow from the right atrium to the right ventricle. The aortic valve allows blood to flow from the left ventricle to the aorta. The pulmonary valve allows blood to flow from the right ventricle to the pulmonary artery.

  • The valves are open and close to control or regulate the blood flowing into the heart and then away from the heart. Three of the heart valves are composed of three leaflets or flaps that work together to open and close to allow blood to flow across the opening. The mitral valve only has two leaflets.
  • Healthy heart valve leaflets are able to fully open and close the valve during the heartbeat, but diseased valves might not fully open and close. When the opening of the valve is narrowed and stiff and the valve is not able to open fully when blood is trying to pass through; this is called
  • Diseased valves can become “leaky” when they don’t completely close; this is called regurgitation. If this happens, blood leaks back into the chamber that it came from and not enough blood can be pushed forward through the heart.

The function of the heart valve

The four cardiac valves consist of either cusps or leaflets that are close to prevent the blood from flowing backward. When pressure behind the valve builds up, the valve opens, after blood has passed through, the pressure is reduced and the valve closes, actively or passively.

Risk factors & causes of valvular Heart Disease

There are several causes of valvular heart disease, including congenital conditions, infections, degenerative conditions (wearing out with age), and conditions linked to other types of heart disease.

  • Valvular heart disease is more common in older adults. The predominance of degenerative etiologies accounts for the higher prevalence in the elderly.
  • Rheumatic disease can happen after an infection from the bacteria that causes strep throat is not treated with antibiotics. The infection can cause scarring of the heart valve. This is the most common cause of valve disease worldwide
  • Endocarditis is an infection of the inner lining of the heart caused by a severe infection in the blood. The infection can settle on the heart valves and damage the leaflets. Intravenous drug use can also lead to endocarditis and cause heart valve disease.
  • Congenital heart valve disease is malformations of the heart valves, such as missing one of its leaflets. The most commonly affected valve with a congenital defect is a bicuspid aortic valve, which has only two leaflets rather than three.

Manifestation of valvular heart disease

Heart valve disease can develop quickly or over a long period. When valve disease develops more slowly, there may be no symptoms until the condition is quite advanced. When it develops more suddenly, people may experience the following symptoms: shortness of breath, chest pain, fatigue, dizziness or fainting, fever, rapid weight gain, and irregular heartbeat.

Treatment

If the condition isn’t too severe, it might be managed with medicines to treat the symptoms. If the valve is more seriously diseased and causing more severe symptoms, surgery may be

HEART VALVE DISEASE AND REPLACEMENT SURGERY IN BANGLADESH

Heart Valve Disease Patient 

recommended. The type of surgery will depend on the valve involved and the cause of the disease. For some conditions, the valve will need to be replaced by either opening the heart during surgery or replacing the valve without having to open the heart during surgery. Surgical valve replacement (MVR, AVR) is the widely accepted treatment of choice for valvular heart disease, with either mechanical or biological prostheses.

Heart valve surgery

Heart valve surgery repairs or replaces a valve that’s too narrow or doesn’t close right. Heart valve surgery fixes or replaces one or more valves in your heart. The two types of heart valve surgery options are:

  • Valve repair surgery to fix the damaged or faulty valve, while preserving much of the person’s own tissue. The mitral valve is the most commonly repaired valve, but repair surgery can treat problems with the aortic and tricuspid valves.
  • Valve replacement surgery to remove the faulty valve and replace it with a biological or mechanical (metal or carbon) valve. All valve replacements are biocompatible, which means the patient’s own immune system won’t reject the new valve.

 Importance of the surgery

Heart valve surgery can ease a patient’s symptoms, improve life expectancy and help prevent death. The potential advantages of heart valve surgery are reduced risk of thromboembolic disorder, improve cardiac function, reduced risk of heart failure, stroke, and peripheral vascular disease, lower risk of infection, and reduced need for lifelong anticoagulant medication.

Is surgery better than medication?

Medications often help during the first stages of valve disease, but they don’t work as well as the disease gets worse. Patients don’t need to wait until his/her symptoms become unbearable before having surgery. In some cases, it’s best to have surgery before symptoms start.

Overview of the risks associated with the surgery:

Possible risks of heart valve repair or replacement surgery include: bleeding during or after the surgery, blood clots that can cause heart attack, stroke, or lung problems, infection, pneumonia, pancreatitis, breathing problems, arrhythmias (abnormal heart rhythms), the repaired or replaced valve doesn’t work correctly, etc.

How long will the valve last?

The duration or longevity of valve repair or replacement lasts depends on several things: age, nature or type of surgery, and type of valve replacement. Mechanical valve offers multiple advantages over tissue valve. For instance, mechanical valves are easy to implant, free from structural degeneration, have more orifice area, and are more durable. However, lifelong anticoagulation therapy is a high-profile counterpoint that needs to account for choosing a mechanical valve.

Most of the major guidelines have recommended mechanical prostheses in young adult patients requiring valve replacement. Biological valves may need to be replaced, especially if patients are younger.

Factors Affecting Risk in Bangladesh

Bangladesh is a developing country. With rapid urbanization and changes in lifestyle, cardiovascular disease increases dramatically. Risk factors include: age (older age is a risk factor), a family history of early coronary heart disease can also raise your risk of developing a heart valve disease, lifestyle habits (these include a lack of physical activity, unhealthy eating patterns, smoking and obesity), other conditions: High blood pressure, diabetes, autoimmune disorders such as lupus, and other heart conditions) can raise the risk of heart valve diseases.

Conclusion

Stenosis, or a narrowing of the blood vessels, causes a less-than-normal amount of blood to flow to the heart. This causes the muscle to work harder. Leaky valves can also pose a problem. Instead of closing tightly, a valve may remain slightly open, letting blood flow backward. This is called regurgitation. The valves of the heart are responsible for allowing nutrient-rich blood to flow through the chambers of your heart. Each valve is supposed to close completely after ushering in blood flow.

Diseased heart valves aren’t always able to perform the job as well as they should. Heart valve surgery is a solution for valvular heart disease. Mechanical and biological valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve.

They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. For this reason, need to take an anti-coagulant. Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. A bioprosthetic doesn’t last as long as a mechanical valve and may require replacement at a future date.

 

 

 

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