1. Valvular Heart Disease, In general
Q: What is Valvular Heart Disease?
Valvular Heart Disease (VHD) is the disease where mitral valve, aortic valve, and/or tricuspid valve (occasionally pulmonary valve) is broken.
VHD has 2 types of diseases: insufficiency or regurgitation (leak) where blood goes backward through the valve, and stenosis where valve orifice becomes narrow and hard for blood to go through it. In either case, some part of the heart (e.g., left ventricle, left atrium, right ventricle, or right atrium) suffers from burden.
Q: What are causes of valvular heart disease? What type of causion we have to have?
In VHD, rheumatic one used to be dominant. Recently, we see more and more atherosclerotic or degenerative (i.e., aging). Also we see more infectious endocarditis (IE, a disease where bacteria grows on/around the valve and destroy it). In total, the incidence of VHD is increasing.
When a VHD is mild, oral medication and/or controlling the degree of excersise is enough to keep the heart and general condition in a good shape. But, once the VHD becomes bad enough to give a burden to the heart, in many cases operation is recommended to stop progression of the disease and secondary problems. In some cases, by the time when a patient has an obvious symptoms, the heart becomes damaged badly. It is beneficial to consult specialists of the heart at earlier stage.
In infectious endocarditis (IE), bacteria often move from the valve/heart and go to brain or other important organs, causing emboli and damage to the organs. In such cases, early sutgery is necessary, since otherwise the patient may suffer from cerebral embolism (i.e., stroke) or other organ damage which may become serious or even fatal. After myocardial infarction, mitral valve often develop leaking (i.e., ischemic mitral regurgitation) and it is increasing in number.
Q: What types of surgery are there for VHD?
In surgery for VHD, valve repair or plasty fixes the diseased valve, and valve replacement eventually replace the diseased valve by artificial one. We try to repair the valve as much as possible since it is more natural and its results more favorable for patients. Patients who have mechanical valve (i.e., metal valve) have to take Warfarin (Coumadin, the blood thinner) for life which prevents thrombi formation. Warfarin is an excellent drug when used properly. But, if it is taken in a wrong way, it becomes dangerous drug. Another problem is Warfarin occasionally causes problems such as cerebral bleeding (brain hemorrhage) even though a patient takes it properly.?
