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Look after your heart

Tuesday, May 15, 2018

With advancements in technology and cardiac surgery, the management of heart valve disease has improved, says Dr Bipeenchandra Bhamre

The human heart has four chambers. To maintain the blood flow in one direction, from one chamber to other chamber, we have four valves in our heart. These valves open and close in sequence to maintain the blood flow in our body. By doing so, they create a sound we call as "heart-beats". This is heard when the doctor applies a stethoscope to your heart.

Grossly (by the human ear) we hear two sounds for the closure of four valves. If you use special equipment we can hear valves opening and closing sequentially, spaced by a few milliseconds. The names given to these valves are according to their structure and related to the chambers they are separating. The right-sided valves are called as Tricuspid Valve and Pulmonary Valve. The left-sided valves are called as Mitral valve and Aortic valve.
The most common cause of affection of valves in our country is rheumatic heart disease. Four to five persons in a population of 1000 suffer from rheumatic heart disease. This is related to our own immunity turning against our heart valves.

The mitral valve is the commonest valve affected in rheumatic heart disease followed by the Aortic valve. Here the valves become stenotic, meaning the area of the passage of the blood decreases, causing obstruction to the blood flow. Sometimes the valve becomes regurgitant, meaning the unidirectional blood flow becomes two-directional. These lesions affect the function of the heart and cause dilatation and later failure of the heart if not treated.

We can know if we suffer from heart valve disease if we have symptoms of breathlessness on walking, sitting, lying in bed, palpitations, chest pain, syncope or giddiness. It is said that India has about more than 1.5 lakh heart valve patients requiring replacement. We perform about 50,000 such operations per year so we can calculate how much awareness we have to create in our society to understand the valve problems and get treatments to lead a healthy life. This backlog is added every year that passes.

Another cause for heart valve dysfunction is degenerative; in an aged population, owing to wear and tear of a lifetime, the valves becomes degenerative. The most commonly affected valve in this subset is the Aortic valve. This becomes calcific and narrow.

A few people will have defective valves at birth, which become problematic much later in life.

Fortunately with advancements in technology and cardiac surgery the management of heart valve disease is better as we know more about the valves, their function and how to repair them.
As I have already mentioned there are a lot of  recent advancements in the treatment of heart valve disease. The first step for treatment is to do an echocardiography, to know which valve is affected and secondly, how severe the heart valve dysfunction is. The majority of patients are managed well on medicines.

The surgical  option is for the critical valve stenosis or severe valvular regurgitations. About 30 to 40% of patients diagnosed with rheumatic heart disease will eventually require heart valve repair or replacement. This amounts to one or two patients in a population of approximately 1,000 people. When you visit the heart surgeon, he will tell you if the valve disease is severe enough to require open heart surgery. Once it is confirmed that you require open heart surgery, you will know whether your own valve can be repaired or you need to replace it.

There are two categories of heart valves available viz tissue valve and metallic valve.   So depending on a lot of factors we take the decision on which valve is best suited for you. Each valve comes with its benefits and risks. Discuss it thoroughly with your doctor before choosing the valve.

Recently  minimal invasive cardiac surgery gives options to choose from for replacement of your heart valve. Here we can perform these operations through smaller incisions with rapid recovery and return to work. Recent developments in transcatheter valves has made heart valve implantation from small vessels from your leg. At this stage this procedure (what we call TAVR) is restricted to highly selected patients.
The precautions for  heart valve surgery are routine that we take for any bypass surgical patients. It takes six to eight weeks to fully recover from surgery. You should not bend, lift weights of more than six kgs and do breathing and walking exercises.

Apart from this you will be on blood thinners. You should not miss a single dose of the blood thinner medications so as to avoid blood clot formation secondary to the prosthetic heart valve.

Again there are a few dietary restrictions if you are taking blood thinners. Certain green and leafy vegetables should be avoided. Your doctor will tell you in detail about this particularly if your heart valve is  replaced with a mechanical valve.

We should avoid strenuous muscular work, driving and so on. All these precautions differ from patient to patient and valve to valve. We must take due precautions so that the body gets adjusted to the valve and vice versa.
Dr Bipeenchandra Bhamre is a Cardio-Thoracic Surgeon with Sir H N Reliance Foundation Hospital and Research Centre

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