Heart valve failure symptoms are shortness of breath, fatigue, swollen legs etc and usually you can see on the ultrasound. Calcium deposits are the main reason for heart valve failure. This blockage of the valve is called stenosis.This is mainly an age related disability and diet or other modifications will not affect their progression. Typically from the time you hear the murmur, it takes about 10 years before it develops to an extent that they would need surgery. Transcathertic aortic valve replacement (TAVR) for aortic valves can be fixed through open heart strategy but now it can be done by catheter based valve placement. But a 5-10% chance of a pacemaker because the electrical system is near the location and may get pushed out. There is a pacemaker called micra – it is small but can run out of batteries and sometimes the leadless pacemaker has only 1 wire, so may not be perfect. Sometimes TAVR can leak around the valve (perivalvular leak) but it is not very often and it can be plugged with a catheter too.
Valves do not want to intervene too early because they lost only about 10-15 years and they do not fail suddenly but they fail faster than a native valve. But intervene when there is a chance of heart failure or stroke and the trend is towards fixing it.
Treat moderate stenosis is new thinking.
Aortic regurgitation usually associated wyth aneurysm in the aorta. Different types – root, ascending or fusiform and are associated with high blood pressure. More complex surgery – Bentall procedure to fix aorta and the valve. TAVR is not appropriate for it. However, others such as jena valve is one possibility to fix it – this allows you to fix it in specific position.
These valves are not rejected though they are animal valves but now there are some polymers that are being tried.
The TAVR is possible inside another TAVR and it is also possible to do a TAVR with a surgical valve too. 600 TAVR’s were done here. They can be done in 15-30 minutes.
Group B streptococcus – immune reaction can sometimes affect the valve – rheumatic heart disease but is not seen very often.
Mitral valve:
Attached by mitral muscle. These are usually thinner valve and mitral valve prolapse is that it becomes floppy. Usually primary regurgitation – problem with valve tissue. These prolapse/murmur goes into thee left atrium and then become regurgitation.
Open heart surgery – usually can repair it with surgery. With sutures or can be done annuloplasty ring that helps the valve remain correct. During open heart surgery – they have to shut the heart and adds risk. Mitral valve can be replaced by mechanical valve – which will last for ever…but need to be on coumadin to prevent clotting. A biological valve is also possible.
Traditional is sternotomy approach but sometimes can be done with keyhole approach for mitral valve replacement. Mitraclip – Transcatheter edege to edge repair (TEER). If cords stretches out then they get floppy and can break. Mitral clip can clip many places but not every place. Less invasive is this option and can get 50% reduction.
Secondary MR: – when there are other complications such as HF etc.
Sapien M3 valve can surround the base and then form a new valve.
Tricuspid valve:
Three leaflets. Primary regurgitaiton – problem with valve tissue, secondard regurgidation – heart dilation. Symptom may involve abdominal swelling.
Right side of heart not so great so not very responsive to open heart strategy. Clips similar to Tricuspid valve. This is done under general anesthesia.
Evoque transcatheter tricuspid valve replacesment. This adds a full new valve into the tricuspid valve.
When open heart surgery is done then it is one valve at a time – one valve leaking causes other valves to leak such as aortic can make other valves leak. For open heart, sometimes fix multiple but usually you fix the major one and then go in later with catheter based surgery. For catheter you usually only fix one at a time. With catheter they do not cause any atrial fibrillation issues.
Valvular disease itself makes a patient prone to atrial fibrillation.
With valve you get complete reduction rather than clip which do not fix it all. Evoque gives you a better result.
