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Heart surgery india

Heart valve disease can put extra strain on your heart and cause your heart to pump less efficiently.

The heart

Your heart is a muscular pump that is divided into two sides. The right side of your heart pumps blood to your lungs to get oxygen, and the left side pumps the oxygenated blood around your body. There are two chambers on each side of your heart - the smaller atria and the larger ventricles.

Heart valves

There are four valves in your heart.

  • Two are between the atria and the ventricles. The mitral valve on the left side and the tricuspid valve on the right.
  • Two are in the arteries leaving the heart. The aortic valve on the left side and the pulmonary valve on the right. Your heart valves are made up of flaps of thin strong tissue attached to the heart with fibrous cords. They can only open in one direction. Your heart valves have two functions.
  • To help blood flow smoothly in one direction.
  • To stop blood from leaking back against this flow.

How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.

Blood flows from your right and left atria into your ventricles through the open tricuspid and mitral valves.

When the ventricles are full, the tricuspid and mitral valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).

As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves shut. These valves prevent blood from flowing back into the ventricles.

This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs, and body.

Heart valve disease

Heart valve disease occurs when there is a problem with one of your valves.

  • Valve stenosis - this is when your valve becomes narrow and your blood can't easily flow into the next chamber or blood vessel. Your heart has to work harder to get blood through. This occurs when a heart valve opening is smaller than normal due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can be stenotic (hardened, restricting blood flow); the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis, or aortic stenosis.
  • Valve regurgitation (also known as valve insufficiency or incompetence) - this is when your valve doesn't close properly and becomes leaky causing blood to flow in the wrong direction. This occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation.

Symptoms of heart valve disease

The symptoms of heart valve disease depend on which valve is affected and how severely. If your valves are only mildly affected, you may not have any symptoms.

Symptoms of heart valve disease may include:

  • breathlessness
  • tiredness or fatigue
  • palpitations (awareness of an irregular, fluttery heartbeat or a fast heart rate)
  • angina (chest pain) because a diseased heart valve makes your heart work much harder
  • swollen ankles or feet
  • dizziness, fainting or blackouts

Complications of heart valve disease

If you have a damaged heart valve, it is more likely to become infected. Endocarditis is an infection of the heart lining. This can affect the heart valves and it can be very serious.

If you have heart valve disease, you may need to take antibiotics before you have surgery to reduce your risk of infection. Ask your GP for more advice.

Causes of heart valve disease

Heart valve disease can be caused by several conditions.

  • Mitral valve prolapse occurs when the left ventricle contracts and one or both flaps of the mitral valve flop or bulge back (prolapse) into the left atrium. If the flaps bulge back far enough, this can prevent the valve from forming a tight seal. As a result, blood may flow backward from the ventricle into the atrium. This backflow of blood is called mitral valve regurgitation. Mitral valve prolapse affects 1-2% of the general population. Find out more about mitral valve prolapse.
  • Degenerative valve disease is a common cause of heart valve disease. Degenerative valve disease, most commonly affecting the mitral valve, is a slow progressive process that over time will cause leakage through the valve. Degenerative valve disease usually begins with mitral valve prolapse (improper leaflet movement), which, over time may cause the attachments of the valve to thin out or rupture and the leaflets to become floppy. This leads to leakage through the valve.
  • Ischemic heart disease, generally caused by buildup of plaque in the coronary arteries, affects coronary blood flow and restricts blood flow to the heart muscle. Buildup of plaque in the coronary arteries, also known as atherosclerosis or coronary artery disease, cause blockages that may lead to a heart attack and subsequent damage to the heart valves.
  • Congenital abnormalities, present at birth, such as a malformed valve or even an absent valve, can cause abnormal blood flow through the cardiovascular system. Depending on the type of heart defect, blood flow can be partially or completely blocked or even flow in the wrong direction. Congenital abnormalities require different types of treatment depending on the severity of the defect. Mild defects may require little to no treatment whereas more severe heart abnormalities may require surgical correction.
  • Calcification due to aging is the process that refers to the accumulation of calcium on the heart's valves, most commonly affecting the aortic valve. Calcification comes with age as the calcium builds up in the heart over the course of a lifetime causing hardening and thickening of the valve. Calcium build-up can cause aortic stenosis, or narrowing of the aortic valve, and as a result the valve cannot open completely. Stenosis limits valve function and can hinder blood flow through the valve forcing the heart to work harder.
  • Rheumatic fever is an inflammatory disease which may develop as a rare complication after an untreated or undertreated Group A streptococcal infection (such as strep throat or scarlet fever). Permanent heart damage resulting from rheumatic fever is called rheumatic heart disease. Rheumatic fever commonly damages the heart valves and can interfere with normal blood flow through the heart. Acute rheumatic fever is most common in children ages 5 - 15, although it can develop in adults. Rheumatic fever isn't as common in the United States today as it was at the start of the 20th century, before the widespread use of the antibiotics; however outbreaks do occur periodically. Rheumatic fever is still common in developing countries.
  • Bacterial endocarditis is a bacterial infection that can affect the valves of the heart causing deformity and damage to the leaflets of the valve(s). Endocarditis typically occurs when bacteria or viruses from another part of the body, such as the mouth, spread through the bloodstream and attach to damaged areas in the heart. Left untreated, endocarditis can damage or destroy heart valves. Endocarditis can be life-threatening; however it is relatively uncommon in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.

Diagnosis of heart valve disease

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may listen to your heart with a stethoscope to check for a murmur - an extra noise to the usual heart sounds. A murmur can be caused by blood passing through a damaged valve.

If your doctor suspects there may be a problem with your heart, you may have other tests in hospital.

  • Echocardiogram (heart ultrasound scan) - to show the pumping action of your heart and the function of the heart valves.
  • Chest X-ray - to rule out other conditions that may be causing your symptoms.
  • Electrocardiogram (ECG) - to measure the electrical activity of your heart to see how well it's working.
  • CT scan or MRI scan - to provide detailed pictures of your heart muscles and valves.
  • Angiogram (or cardiac catheterization) - to see how well your heart valves and muscles are working and also to look at the coronary arteries. Treatment of heart valve disease

Your treatment for heart valve disease will depend on what is wrong with your valve and how seriously it is affecting you.

Watchful waiting

If you only have mild heart valve disease, you may not need any treatment at all. You may still need regular check-ups to monitor your symptoms and ensure your heart valve isn't deteriorating.

Medicines

You may be prescribed medicines to relieve your symptoms and slow down any worsening of the condition. The medicine you're given will be the one that's most effective for your individual needs.

  • Diuretics (eg furosemide, spironolactone). These help to reduce swelling by encouraging your body to get rid of excess water in your urine. This should help you breathe more easily (by removing fluid in the lungs) and be more active (by reducing leg swelling).
  • ACE inhibitors (eg ramipril, perindopril). These help your heart work more effectively by relaxing your blood vessels and so improving blood flow.
  • Digoxin. This stabilises your heart rhythm and helps your heart pump harder.
  • Warfarin. This is an anticlotting medicine that helps to reduce the risk of blood clots forming.

Surgery

Heart valve surgery

Your faulty heart valve may be replaced with an artificial valve (valve replacement) or your valve may be repaired if possible (valve repair). Both procedures are done under general anaesthesia. This means you will be asleep during the operation.

Balloon valve surgery (balloon valvuloplasty)

For children and younger people with a narrowed valve (stenosis), or adults who can't have open valve surgery, your doctor may recommend balloon valve surgery.

A small tube (catheter) is threaded up to your heart through an artery, often from your groin. A guide wire, with a deflated balloon at the end, is passed up the catheter. When it reaches your narrowed valve, the balloon is gently inflated to stretch the valve. The balloon is then deflated and removed, leaving a widened valve that your blood can flow through more efficiently.

Living with heart valve disease

If you have heart valve disease, you may have a yearly check-up with your cardiologist (a doctor specializing in identifying and treating conditions of the heart and blood vessels). This check-up is very important, even if you feel completely well. You might not need treatment for many years, if ever, but a careful, regular watch will make sure that you get any treatment you need at the right time.