Diagnosis and Treatment
The first step toward diagnosing cardiac valvular disease is with a stethoscope. Healthy valves produce no murmurs as the heart beats, so the examining cardiologist will only hear the normal two beats of the heart as the atria and ventricles contract. Blood flowing through a defective valve, however, will produce a whooshing or swishing sound called a murmur. Blood squeezing through a valve that doesn’t open completely (stenosis) will make a lower-pitched whooshing sound, while backflow or leakage (regurgitation or insufficiency) will swish at a longer and higher-pitch. On the other hand, mild heart murmurs may be found in some otherwise healthy individuals because of high flow and don’t always imply valvular disease. For further diagnosis, physicians will listen to breathing within the lungs to detect possible fluid buildup – indicative of decreased heart pumping action resulting in fluid retention.
A number of diagnostic tests will confirm valvular defects. A chest x-ray and an EKG may be ordered as they can help determine whether there is heart enlargement or an irregular heart rhythm – often a sign of valvular heart disease. A non-invasive echocardiogram offers a more definitive diagnosis. Using high frequency sound waves that bounce off heart tissue, the echocardiogram produces moving images of the heart so physicians can determine valve motion, valve function and heart wall thickness.
Other echocardiograms include a transesophageal echocardiogram (TEE), where a probe is passed through the mouth and into the esophagus for closer positioning to the heart, and Doppler echocardiography, to evaluate how blood flows through the heart to further pinpoint valve defects. New advancements in three-dimensional imaging technology have resulted in the 3D TEE, which has enabled the beating heart to be viewed in superior and lifelike three-dimensional images. MRI scans may also be used for diagnosis. And minimally-invasive heart catheterization, using a flexible catheter through arteries and into the heart, can more clearly confirm stenosis or backflow in certain conditions.
Treatment of valvular disease usually depends on the severity of a valve defect. For patients with limited valve stenosis or insufficiency, maintenance through daily medications may suffice. For these patients, however, it is extremely important to control and reduce symptoms while making necessary lifestyle changes (especially measures to lower blood pressure) to protect the valve from further damage. This also includes guarding against bacterial infection of the valve or endocarditis, by preventing teeth and gum infections, immediately treating strep throat, and for certain patients with specific heart conditions, taking antibiotics before undergoing dental or other surgical procedures that may cause bleeding and subsequent infection.
Medication therapy is effective in reducing blood pressure, and optimizing heart pumping action to lessen stress on the heart and valves. Medications include beta-blockers, blood thinners, diuretics (water pills) to remove excess fluid buildup, anti-arrhythmic drugs, ACE inhibitors and vasodilators. Surgical options, including valve replacement or repair, may be required for more serious cases of valvular disease. Procedures include either open heart surgery or minimally invasive heart catheterization, including percutaneous balloon valvotomy.
Open heart surgery with valve repair or replacement is usually the best solution in the majority of heart valve conditions which no longer can be managed with medicines. Mitral and tricuspid valves are more amenable to valve repair. In cases requiring valve replacement, there are two types of replacement valves – mechanical and biological valves. Mechanical valves are made of durable pyrolytic carbon that can last up to 20 years or more, but require life-long blood thinning drugs to prevent clots. Biological valves are made from either human or animal tissue (bovine or porcine). They may not last as long as mechanical valves in individuals less than 60 years of age, but don’t require the use of blood thinners.
Interventional catheter-based therapies (instead of open heart surgery) are an option for patients who are at high-risk for surgery or those who are not candidates for surgery. The services we provide include opening of narrow valves with a balloon for both the aortic and mitral valves. We also perform treatment of leaking around heart valves, again in cases where surgery is not an option.
MDCA cardiologists are world renowned experts in diagnosing and treating valvular defects and will determine a patient’s best treatment options.