TREATMENT OPTIONS FOR VALVULAR STENOSIS

The specific course of treatment depends upon the nature and severity of the valve disease. Some conditions, when mild, often require little treatment besides taking antibiotics before any dental or medical procedures. Some conditions, such as mitral valve prolapsed with mild mitral regurgitation, often require little treatment except for taking antibiotics before dental, medical or surgical procedures. Other valve abnormalities may require medication and/or surgery. Regardless of the nature and severity of the valve defect, early detection and diagnosis can decrease the potential for significant and sometimes irreversible damage.

Drugs will not cure the underlying disease, but they can minimize symptoms by easing the heart’s workload and regulating the heart rhythm. Medications that may be prescribed include the following:

1.       Inotropes: Increase the force of the heart’s contractions and slow rapid heart rhythms. As a result, the heart beats less frequently and more effectively, pumping more blood into the arteries.

2.       Antiarrhythmics: Maintain a regular heartbeat.

3.       Antibiotics: Help to prevent or treat infection.

4.       Diuretics: Lower the salt and fluid levels in the body.

5.       Anticoagulants: Thin the blood and help to prevent the formation of blood clots.

 

In aortic stenosis, researchers have found that statins, a type of cholesterol-reducing drug, are effective in reducing calcium deposits in and around the heart. Early studies show that, while lower cholesterol levels did not have an impact and aortic stenosis, statin therapy slowed its progression. This could be due to its effect on calcium and reducing C-reactive protein and over all inflammation.

If medications are not successful, then medical procedures and/or surgery may be necessary. These interventions include the following:

·         Heart valve repair or replacement. Using a prosthetic valve mechanical (plastics, carbon or metal alloys) or tissue (from a pig or cow), defective valves is replaced with healthy ones. This is an open-heart surgery that requires the use of a heart-lung machine. Patients who have received a mechanical valve are at an increased risk of blood clot formation and must take anticoagulants for the rest of their lives. Surgeons are exploring heart valve replacement without the need for open heart surgery. The new, less invasive procedure, known as percutaneous transcatheter heart valve implantation, involves the use of balloon catheters and large stents introduced through a puncture in the skin (in the groin area, near the femoral vein). The new heart valve is transported via the stent to the site, where the stent is then expanded to implant the valve. For patients not able to undergo open-heart surgery, due to age and/or physical condition, percutaneous heart valve implantation may impact significantly on survival and quality of life.

·         Certain minimally invasive heart valve surgeries. This includes robotic visualization surgery. Ongoing studies find that robotic surgery can be performed for some types of valve repairs. Robotic surgery involves voice-activated robotic “hands” at the operating table, with the cardiac surgeon manipulating the hand controls. The surgeon views the procedure through an endoscope, a slim optical tube with an attached camera positioned inside the chest. Advantages of this and similar procedures are small incisions, less surgical trauma and a shorter operative and recovery period.

·         Commissurotomy. The surgeon widens a narrowed valve by cutting or shaving the hard, thick points where the valve leaflets meet.

·         Other surgical replacement of valves. Surgeries include the Ross Procedure in which the patient’s pulmonic valve is moved to the aortic position with the pulmonic valve being replaced with a pig valve.

·         Balloon valvuloplasty. A procedure in which a balloon-tipped catheter is used to widen and separate stenotic valve flaps.

                                                                                                                                                                                      

ACUTE MITRAL REGURGITATION PIPILLARY MUSCLE RUPTURE

Acute mitral regurgitation after acute MI (Heart Attack) predicts poor prognosis. Nevertheless, MR of mild to moderate severity is found in 13% to 45% of patients after acute MI. Although most MR is transient and asymptomatic, MR caused by papillary muscle rupture (the muscles that control the movements of the valve) is a life-threatening complication.

MECHANISM

MR can occur as a result of multiple mechanisms including:

1.       Mitral annular (ring between upper and lower chambers on which the valve base is attached) dilatation secondary to the left ventricular dilatation (4^th Chamber).

2.       Papillary muscle dysfunction with associated ischemic regional wall motion abnormality in close proximity to the insertion of the posterior papillary muscle.

3.       Partial or complete rupture of the papillary muscle as a result of papillary muscle infarction.

                                                                                                       

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This article is written by Dr. Bimal Chhajer (Heart Specialist India)