Patient Information Sheet Valvular Heart Disease
Valvular heart diseaseCENTRE CARDIO-THORACIQUE DE MONACOPatient information sheetValvularheart diseaseCharacteristics, diagnosis, and treatment1Valvular heart disease or valvulopathyThis refers to all disorders affecting the heart valves.Heart valves are flexible structures which separatethe four chambers of the heart. There are twovalves on the left side of the heart (mitral andaortic) and two valves on its right side (tricuspidand pulmonary). These have the unique role ofpreventing blood from flowing backwards (by actingas «non-return valves»).Sometimes one or more of these valves do notfunction properly. They can be affected by two typesof condition: narrowing (or stenosis): where the opening is toosmall and slows the flow of blood; leakage (or insufficiency): incomplete closure ofthe valve causing leaks and back-flow of blood.These two lesions can affect the same opening,thus constituting valvular heart disease.Pulmonaryvalve (open)Mitral valve(closed)Tricuspid valve(closed)Aortic valve(open)The most frequent valvulopathiesTo date, the most frequently encounteredvalvulopathies in adults are aortic valve stenosisand mitral valve insufficiency.Other valvulopathies include aortic insufficiency,tricuspid insufficiency and mitral valve stenosis.Pathologies affecting the pulmonary valve are rare.
Valvular heart diseaseWhat are the causes?The causes differ depending on the type of valveaffected: age-related degeneration (aortic stenosis, mitralinsufficiency, aortic insufficiency); congenital abnormalities (i.e. from birth); Rheumatic heart disease or RHD (mitral stenosis,tricuspid stenosis), birth deformations; infections or inflammations (i.e. endocarditis) caninvolve all heart valves; diseases which affect the heart muscle (caused byinfarction or heart failure for example) may lead toabnormal valve function.How does a valvulopathy progress?Left untreated, a valvulopathy will lead to dilationof the atria and/or ventricles as a consequence ofthe increase in heart workload. Symptoms includeshortness of breath due to increased lung pressure(pulmonary oedema), light-headedness, fainting,palpitations, episodes of heart failure.2How is a valvulopathy diagnosed? Signs: shortness of breath, initially upon exertionand subsequently at rest, angina or loss ofconsciousness (aortic stenosis), palpitations,pulmonary oedema, heart failure. Auscultation: detection of stenosis orregurgitation murmur, irregular heartbeat.Sometimes, the absence of symptoms is notinconsistent with the severity of the disease. A cardiac echocardiogram provides anaccurate diagnosis. It is either performed witha probe positioned on the thorax (transthoracicultrasound) or introduced through the oesophagus,under local anaesthesia (transoesophagealultrasound)Cardiac ultrasound :identifies whether the valvulopathy is due to,stenosis or insufficiency,- measures the valve surface,- estimates the extent of the insufficiency,- determines the impact of the valvulopathy on thecapacity of the heart muscle to contract and theability of the chambers to dilate.The criteria to determine whether surgery isappropriate or not are extremely specific and arebased on well-defined measurements.Once the indication for surgery has beenestablished, the assessment will becompleted: by coronary angiographyCarried out as part of the preoperative assessment ofa valvulopathy, coronary angiography is an invasiveexamination enabling,visualisation of all the coronaryarteries, detection of areas of narrowing caused byatheroma plaque and if necessary, a decision to bemade regarding the need for therapeutic action.The examination takes place in a specifically equippedradiology room, and necessitates the injection of acontrast agent, which is opaque to X-rays, and makesit possible to visualise all the coronary arteries.As with any invasive procedure, coronaryangiography comprises some risks, albeit verylow, of which the patient should be aware: allergic complications; complications atthe needle puncturesite. heart and vascularcomplications.
Valvular heart diseaseAs an indication, a study on a large series of patients,published in a medical journaldetermined a risk of death of 0.8/1000, a prevalenceof neurological disturbances (including paralysis) of0.6/1000 and a frequency of myocardial infarctionof 0.3/1000. Other, less severe complications havebeen reported with frequencies of less than 1%. by cardiac magnetic resonance imagingThis imaging method has been in operation at theCardio-Thoracic Centre of Monaco since 2002, andprovide an accurate analysis of the cardiac muscleto detect fibrosis or evidence of a previous infarction.Refer to the “coronary artery diseases” information sheetfor more details. in some cases, by coronary CT-scanIn young patients, coronary arteries can bevisualised with ,butonly if the coronaryarteries are strictlynormal.Thescanalsoenablesustovisualise the shape and size of the aorta as it exitsthe heart, in cases of associated aortic valve damage(aortic aneurysm).Refer to the “MRI” information sheet for more details.Refer to the “CT-scan” information sheet for more details.3What are the current treatment options for valvulopathies?Depending on the extent of valve degradation, theimpact on the heart muscle and the signs aftermedical treatment, a more invasive treatment optionmay be necessary: surgery (to repair or replace the valve), or, in some cases percutaneous treatments (mitralvalvuloplasty, Transcatheter Aortic Valve Implantationor TAVI).Surgery remains the standard treatment forvalvular heart disease.1 - Surgical treatmentIf surgery is feasible, it may include: valve repair (of the mitral, tricuspid and in somecases the aortic valve); or the replacement of the valve either with amechanical or a tissue-based prosthesis.
Valvular heart diseaseValve repairValve repair is the preferred treatment option formitral insufficiency, whenever feasible. Mitral valvuloplasty can be used to treat mitralinsufficiency: it repairs valve anomalies whilstpreserving the native valve (i.e. plastic surgery insidethe heart). It can correct abnormalities of the papillarymuscle, the leaflet, the annulus and is alwaysaccompanied by the placement of a prosthetic ring tocorrect deformation of the mitral orifice. Commissurotomy (incision at the base of theFused commissures) this repair is performedexclusively to correct mitral stenosis resulting fromrheumatic heart disease (RHD), when the valveis flexible, heart rate regular (sinus rhythm), andpreferentially in children or women of childbearingage. Repair of the tricuspid valve to correct functionaltricuspid insufficiency caused by dilation of theright ventricle. In some cases of isolated tricuspid insufficiencywhere the repair surgery is a genuine plastic surgeryprocedure to enlarge one of the valves. Finally, the aortic valve, in the context of ananeurysm in the ascending aorta, can in some casesalso be repaired.Valve replacementProsthetic valves can be fitted to the aortic, mitraland more rarely tricuspid apertures. It is possibleto replace two or even three heart valves.Treatment option and valve choice (mechanical ortissue-based) are dependent on a number of criteriaand decided upon in consultation with the patient: patient’s age, the presence or absence of an irregular heartbeatrequiring anticoagulation therapy the feasibility and risks associated with long-termvitamin K antagonist based anticoagulation therapy, the condition of the heart muscle, the patient’s lifestyle.Mechanical valves are made of pyrolytic carbon withtwo discs that swivel on an axis.They have the advantage of being durable, butdisadvantage of requiring an anticoagulationtreatment for life, with the associated risks ofhaemorrhage when treatment is too effective, or ofthromboembolism (formation of a clot) when it isineffective.Tissue-based or bio-prosthetic valves consist of aDacron coated framework, which either holds inplace a pig’s aortic valve or a valve made from calfpericardium. A ring lined with silicone padding allowsthe bio-prosthetic valve to be fitted to the patient’svalvular annulus.The main advantage of bio-prosthetic valves isthat they do not require long-term anticoagulationtherapy, in the absence of total cardiac arrhythmia.These valves do howeverdeteriorate over timeand need to be replaced,on average, every fifteenyears.Bio-prosthetic valves arefavoured in individualsaged 60 to 65 or older, inBio-prostheticwomen wishing to conceiveand in particular in cases where a contraindicationexists or effective and correctly monitored long-termanticoagulation treatment is not feasible.However, they can be fitted to individuals under 50,who are active, with a heart in good condition andwho refuse long-termanticoagulation treatment,but who agree to thehigh likelihood of repeatsurgery within 15 years ofthe first operation.Bio-prostheticvalvesdegrade more slowly inBio-prosthetic Magna-Easeolder patients.Carpentier Edwards
Valvular heart diseaseBefore the procedureOn admission, you will provide your doctors andnurses with all the medical documentation relating toyour condition (X-rays, electrocardiogram, stress testand laboratory test results.).A full laboratory test will be carried out and ourhealthcare team will explain the preoperativepreparation protocol to be followed, (showersand oral care), to prevent infection. Body hair willbe carefully removed from the incision area beforedisinfection.What does the operation entail?It is performed under general anaesthesia.Several techniques and access routes can be useddepending on the patient’s pathology and state ofhealth:Most frequently, an incision is made in the middle ofthe sternum (sternotomy) or a mini sternotomy (aorticvalve).Finally, endoscopic minimally invasive surgery: thisis a method whereby an incision is made to inserttrocars in order to facilitate viewing, aspiration andthe passage of instruments.These various techniques are carried out underextracorporeal circulation making it possible to isolatethe heart and facilitates cardiac surgery in a “dry”operative field. During the operation, the heart muscleis protected by local and systemic hypothermia andstopped by cardioplegia.The surgical procedure lasts several hours,depending on the complexity of the case.Your stay in the intensive care unitFollowingsurgery,patients are admittedto the intensive careunit, for approximately48 hours.Assisted breathing byway of a ventilatoris maintained for the first few hours and then graduallyremoved, by withdrawing the tube from the trachea.Medications are prescribed to relieve pain andintravenous fluids are administered to maintainhydration.Temporary drainage tubes (chest drains) are left inplace for a few days, to divert serous fluids and bloodfrom the wound. A small percentage of patients mayrequire a blood transfusion.Eating can generally be resumed the day after theoperation.Returning to your roomMost patients will obtain consent from the medicalstaff to get up and stroll around 48 hours post-surgery.Regular physiotherapy sessions will help youregain functional autonomy and recover respiratoryfunctions. Patients are continuously monitored byECG (telemetry).What are the risks of heart valva surgery ?Heart valve surgery is a procedure which, like all othersurgical procedures, is associatedwith an inherent risk of morbidity/mortality, which istaken into account by the medical team (cardiologist,surgeon and anaesthetist) and very much dependson the patient’s heart condition and general state ofhealth. Such complications may be of an intra- or perioperative nature.Some complications, such as heart rhythm disorders(arrhythmia, bradycardia) may require the fitting ofa pace-maker; other, less frequent complicationsinclude post-operative infections (less than 2% in theCardio-Thoracic Centre of Monaco’s experience) orneurological complications (less than 1.5%).These risks, about which the patient and their familyare advised, are specific to each patientand every pathology. These risks are however,significantly lower than the risks involved in lettingthe disease run its natural course, resulting in surgeryneeding to be proposed.
Valvular heart diseaseWhat happens once you have beendischarged ?Long term follow up of patients fitted withvalve prosthesesUpon discharge, you will either return home or mostoften be admitted to a specialised rehabilitationcentre, depending on your condition and/or yourpersonal preference.Generally speaking, physical recovery is fast. Drivingand sexual activity can be resumed within 4 weeks.In most cases, replacement of the damaged valveleads to significant improvement, in particularreduced or eradicated breathlessness upon exertion.The main limiting factor to resuming normal activitiesis the healing of the sternum. Like any bone fracture,this can take between 6 and 12 weeks to consolidate.Any activity likely to put pressure on the chest duringthis period of time is prohibited.Returning to workThis depends on the speed of your recovery andthe physical and stressful nature of your profession.Your surgeon and referring cardiologist will help youdetermine when you will be fit to enough to return towork.Do you need to follow a rehabilitationprogram ?Acardiacrehabilitationprogram can help monitorprogress and expedite theresumption of a normal activelife. General guidance and,recommendations will be givento you regarding beneficiallifestyle changes : diet, weightloss and level of physical exercise or sports activityto attain.During this period, you will be taught about youranticoagulation treatment and how to live with aprosthesis.Depending on the condition of your heart and youroverall health, the cardiologist and surgeon will helpyou implement this rehabilitation program.Regular check-ups are crucial, by: your general practitioner, your cardiologist, your dental surgeon. Your GP should be consulted every two tothree months to check: auscultation of your prosthetic valve, the absence of anaemia, the absence of an infected site, the effectiveness of the anticoagulation treatment. Your cardiologist should be consulted everysix months to complete your GP’s assessment withan electrocardiogram and echocardiogram. Shoulda potential prosthesis dysfunction be suspected,further tests may be required (cardiac MRI,echocardiography ). You should get your teeth checked every sixmonths, as a matter of routine, and ensure thatantibiotic treatments are prescribed for any dentalcare associated with an increased risk of infection.Mention your anticoagulation treatment to your dentalsurgeon.
Valvular heart diseaseInform your healthprofessionals about youranti-coagulation treatment !Anticoagulation treatmentAnticoagulation treatment consists of a vitamin Kantagonist (Sintrom , Previscan , Coumadin ): It is systematic and for life in patients fitted withmechanical valves; it is also taken for the first three months, followingplacement of a valve bio-prosthesis or mitralvalvuloplasty; in the event of arrhythmia, the treatment will onlybe discontinued once the arrhythmia has beentreated.In cases of mechanical valve replacements,anticoagulation treatment should not beinterrupted under any circumstances. It is monitored by measuring INR (InternationalNormalised Ratio) and maintained: between 2 and 3 in cases of arrhythmia, tissuevalve replacements or valvuloplasty, between 3 and 4 for a mechanical mitral valve.Initially, INR is checked every 8 days, then every 15days at the beginning of treatment, and subsequentlyevery month, if the treatment appears to be stable.If INR results are unstable, more frequent tests arenecessary. Similarly, if the vitamin K antagonist doseis adjusted a repeat test is required a few days later.The dosage schedule and the test results arerecorded in a diary to monitor the effectiveness ofthe anticoagulation therapy. Overdosing may cause signs of haemorrhage:prolonged bleeding after shaving or after brushingyour teeth or if you bruise easily. A repeat bloodtest is necessary to determine if the current doseof medication should potentially be reduced. Some medications should not be takenconcomitantly, as they increase the potency ofanticoagulation drugs (e.g. tetracyclines, aspirin,anti-inflammatories); while others may decrease it(barbiturates). No intramuscular injection should beadministered to a patient on anticoagulationtherapy. Some foods can affect your anticoagulationtreatment. In practice: do not consume more than one portion of foodsrich in vitamin K per day (tomatoes, lettuce,spinach, cabbage, broccoli, ); avoid alcohol.Prevention of infectious endocarditisInfectious endocarditis is a potentialcomplication which occurs when bacteriacolonise the prosthetic valve.This may produce a fever (not necessarily a veryhigh temperature) which is sustained over anextended period of time. This type of complicationshould always be taken very seriously, as itcan lead to heart valve deterioration.A previous dental infection is often the precursorof this type of infection.To minimise the danger of infectious endocarditis: be aware of and inform your physician ifyouhave any episode of fever; treat all types of infections appropriately,however small: tooth, lung, rhino pharyngeal,urinary tract or skin infections; take preventive antibiotic treatmentsubsequent to any invasive procedure,specifically any dental procedure, which isat risk of infection. Inform your dentist aboutyour heart disease; be rigorous about your oral hygiene andmaintain your teeth in perfect condition.Valve protheses are notentirely perfect and requireregular check-ups, mostoftenpermanentandappropriate anticoagulationtreatment as well as a rangeof measures to owever facilitate the resumption of a normal lifeand completely normal socio-professional activities,for patients who undergo surgery in time before thecardiac muscle has incurred irreversible damage.
Valvular heart disease2 - Specific casesPercutaneous mitral valvuloplastyIn cases of mitral stenosis following acute rheumaticheart disease (RHD) in young patients, with aflexible valve and withregular sinus rhythmsa percutaneous mitralvalvuloplastycansometimespostponesurgery for severalyears.Conditionstreatedwiththisapproach must fulfilMitral valve dilatationveryspecificandlimited criteria.Treatment of certain mitral regurgitationsusing a percutaneous approach with theMitraclip system in high risk surgical orinoperable patients.This technique is designed for patients unable toundergo mitral valve surgery, which is the standardtreatment, who suffer from severe mitral valveleakage (grades 3 and 4). It involves the placementof a clip introduced through the femoral vein, whichapproximates the mitral valve leaflets so that thedefect closure can be reduced.In order to validate its indication and feasibility,a preoperative assessment is carried out. Thisincludes a transoesophageal echocardiogramduring which various anatomical measurementsof the heart are recorded. This may be completedby a thoracoabdominal CT scan and a coronaryangiography.The procedure is carried out under generalanaesthesia in a hybrid operating theatre inthe presence of interventional cardiologists, ananaesthetist, the heart surgeon, and a sonographer,who guides the cardiologists throughout theprocedure.Once the clip has been positioned, residual leakageis assessed by ultrasound. If necessary, conventionalsurgery may be carried out at any time without theneed to move the patient.Transcatheter aortic valve implantation(TAVI)This technique is an alternative for patients at highsurgical risk or inoperable, suffering from severeaortic stenosis. These patients are often elderly orhave already undergone surgery.Preliminary tests are carried out before the procedure,including an electrocardiogram, a chest x-ray, anda CT coronary angiogram, the aim of which is toascertain the feasibility of this technique, as wellas determine the bestapproach and the sizeof valve to be implanted.Thisalternativetovalve surgery enablesus to replace thedamaged valve with abio-prosthesisundersedation or generalThe Edwards-Sapien 3 valveanaesthesia.Two techniques are possible: by cardiac catheterisation, during which the valveis inserted into the heart through the femoral artery, or through trans-apical access via a minimalincision underneath the left breast at the level of theapical tip of the heart.The procedure is performed in what is known as a“hybrid” angiography room/operating theatre where,if necessary, conventional surgery can be carried outat any moment with no need to move the patient.For more information, refer to the “Implantation of apercutaneous artificial aortic valve” information sheet.Setting up the clipReferencesFrench Society of CardiologyFrench Federation of Cardiology CENTRE CARDIO-THORACIQUE DE MONACO - july 2019
Valvular heart disease Valvular heart disease Characteristics, diagnosis, and treatment This refers to all disorders affecting the heart valves. Heart valves are flexible structures which separate the four chambers of the heart. There are two valves on the left side of the heart (mitra
ESC - Management of Valvular Heart Disease - Guidelines slide-set Author: European Society of Cardiology, Alec vahanian, Bernard Iung Subject: Management of Valvular Heart Disease Keywords: Valvular Heart Disease , guideline slide set, european society of cardiology,presentation, Created Date: 8/3/2014 1:40:45 PM
Valvular heart disease & Atrial fibrillation! Valvular heart disease has been associated with a 1.8- and 3.4-fold increased risk for AF in men and women valvular heart disease cause atrial myopathy increase susceptibility to AF increase LA pressure alter wall stress JAMA. 2004; 291(14):1720-9 Circ Res. 2014; 114(9): 1453-68
Valvular Heart Disease in Pregnancy No Financial Disclosures Objecves Discuss common valvular heart condiHons in . (2010). "Contraception in women with congenital heart disease." Am J Cardiol 106(9): 1317-1321. Kovacs, A. H., et al. (2008). "Pregnancy and contraception in congenital heart disease: what women are not told." J Am Coll .
Valvular AF AF in the presence of mechanical prosthetic heart valve or moderate to severe rheumatic mitral valve disease. Non-valvular AF All other AFs are non-valvular NICE definition Consider an intervention which will do more good than harm for most patients and be cost eff
Valvular Heart Disease General Principles . (i.e. dilated CM, ischemic heart disease) No. at Risk EF 60% 185 109 94 83 69 61 45 30 19 11 6 EF 60% 44 24 21 20 15 9 6 4 1 1 1 . Microsoft PowerPoint - Valvular Heart Disease 10.24.ppt [Read-Only] Author: Administrator
Valvular Heart Disease - 1 . Normal Heart Valves. VALVULAR HEART DISEASE Due to a chronic process (e.g. calcification or scarring) Abnormality: 1-valve cusps 2- supporting structures (e.g. mitral annulus, tendinous cords, papillary muscles) It can be either acute (e.g. chordal rupture )
of valvular heart disease. The format will involve cardiologists, cardiac surgeons, cardiac anesthesiologists, advanced care providers, and fellows in training presenting and discussing up to 10 cases that span the range of valvular heart disease. This course has been developed to meet the educational needs of cardiovascular specialists,
BAB 6 LEMBAGA JASA KEUANGAN DALAM PEREKONOMIAN INDONESIA KOMPETENSI INTI 3. Memahami, menerapkan, menganalisis pengetahuan faktual, konseptual, prosedural berdasarkan rasa ingin tahunya tentang ilmu pengetahuan, teknologi, seni, budaya, dan humaniora dengan wawasan kemanusiaan, kebangsaan, bakat dan minatnya untuk memecahkan masalah kenegaraan, dan peradaban terkait penyebab fenomena dan .
