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Your treatment explained

Current clinical guidelines on the management of heart valve disease make a clear distinction between symptomatic and asymptomatic conditions – however what they identify is the need to treat severe cases of heart valve disease.

Without treatment, patients with severe disease face reduced longevity, impairments in physical and social functioning, and lower emotional well-being. All these factors can contribute to poor quality of life.

Your healthcare professional will offer you information about what treatments are available to you.

The information below includes details about the three main treatment options offered to heart valve disease patients.

Heart Valve Replacement

When one (or more) valve(s) becomes stenotic (stiff), the heart must work harder to pump the blood through the valve. Some reasons why heart valves become narrow and stiff include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your health care provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.

Traditionally, open heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve(s). Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays.

The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be made of plastic or tissue (made from animal valves or human valves taken from donors). There are pros and cons of each type, and you and your health care provider will talk about which is best for you.

TAVI: Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an alternative option for patients who may be at high risk for open heart surgery. This is a less invasive procedure than open heart-valve surgery.

In this procedure, the damaged heart valve would be replaced using a heart valve made of natural tissue obtained from the heart of a pig or cow. The new valve is delivered via catheter, thereby avoiding open heart-valve surgery. The procedure resembles a balloon angioplasty, in which a catheter - a long, flexible tube - is threaded through an artery and a balloon device on the end inflates to help open up a narrowing in an artery in the heart. Special imaging equipment is used to guide position and placement of the new valve. In the case of TAVI, the replacement valve collapses to a very small diameter and is crimped onto the balloon device. The surgeon positions the replacement valve inside the patient's natural aortic valve and inflates the balloon. This causes the replacement valve to expand, pushing the faulty valve aside. The replacement valve begins to function as soon as the balloon catheter deflates to permit the flow of blood. The catheterization procedure typically takes 1 to 2 hours, and patients are up and walking within 24 - 48 hours after the procedure. The typical hospital stay is 3 to 5 days.

Patients usually enjoy immediate benefit from the procedure in terms of improved blood circulation. Because the replacement valve is placed using minimally invasive techniques, patients usually experience a much more rapid recovery than they would from a traditional, open-heart valve replacement.

Repair Procedure

For many, valve tightness can be relieved during a procedure called balloon valvuloplasty. It is done as part of a cardiac catheterization, which is less invasive than general surgery or open heart surgery.

In a balloon valvuloplasty, a small catheter holding an expandable balloon is threaded into the heart and placed into the tightened valve. Next, the balloon is expanded to stretch open the valve and separate the leaflets.

In some cases the valve cannot be successfully treated by balloon valvuloplasty, and a different surgical treatment is needed to open the valve and allow better blood flow.

What happens if I don't treat my condition or choose to ignore the recommended procedures?

Heart valve disease should not be ignored. Valve repair and replacement can be very effective and evidence shows that, with proper treatment, most people enjoy a return to good health and add many years to their life. If you ignore a recommended procedure, there is a risk of heart failure, which may be fatal.

Should surgery be considered over medications for valve replacement or repair?

Heart valve disease cannot be reversed with medication alone. In the long-term, the only effective solution is to undergo a surgical repair or, more often, replacement with surgery or new transcatheter procedures. Valve repair or replacement can help people can return to a good quality of life with their friends and family. Please discuss treatment options with your doctor.

Sometimes, medication or balloon valvuloplasty may be considered the best course of action if the patient’s symptoms are currently mild or if replacement is no longer an option.

In some cases, medications may be prescribed for patients with valvular disease to:

1. Reduce unpleasant symptoms that accompany milder forms of the disorder

2. Maintain heart rhythm if a related arrhythmia is present

3. Lower the patient’s risk for clotting and stroke

Heart valve disease is a progressive condition, and the outlook is poor for those who receive no effective intervention. Many who do receive valve replacement go on to live very full and healthy lives, especially when their cardiovascular risks are otherwise low. For some patients, the procedure gives them over 15 years longer lifespan.