Heart Valve Problems?

What are valvulopathies?

In the interior of the heart there are structures that are the cardiac valves, their mission is to open and close. They function as gates that allow, and at the same time force, the blood to always follow in the same direction through the cardiac circuit. Any disease of these valves are the valvulopathies and although there are four valves inside the heart, there are really two: the mitral valve and the aortic valve which most frequently get sick.

What are their causes?

It depends on the valve affected. If it is the mitral valve, the most frequent disease is degenerative or alteration of the valve tissue itself. In these cases the valve ages earlier and can break and today it is the most frequent valve disease in the world. A second frequent cause is ischemic heart disease, patients with myocardial infarction that can affect the function of this valve. Over time, the aortic valve degenerates, becomes damaged and mild or more than mild valvulopathies appear, which after the age of 80 years may appear in a significant percentage of the population, but which often do not cause symptoms and no treatment is required. However, 2% of the general population is born with an abnormal aortic valve, the so-called bicuspid aortic valve. This valve works very well for many years, but because it is abnormal it ages earlier and there are patients in their 50s and 60s who are born with this aortic valve, who have to be operated on at this age because they have severe valve disease.

Do they always have to be treated?

No, valvulopathies are long-standing diseases that take years to show symptoms. In the meantime they have gone from mild, to moderate or severe, but the heart accommodates. This accommodation can become a problem because it involves changes that can end up being irreversible, so it is very important to operate on the patient at the right time to obtain the best results. And what is the best time to operate on a patient? Well, there are international guidelines for action, of consensus among experts, that allow us to decide this moment. Basically, it will depend firstly on whether the valve is frankly deteriorated, has severe valve disease, and secondly, whether the patient has symptoms related to this valve or whether the adaptive changes of the heart begin to be worrying.

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How can they be treated?

Treatment is primarily surgical. There are 2 types of surgeries possible, reparative and prosthetic, and in both cases the results will be very good as long as the patient undergoes surgery at the right time. In reparative surgery what we are going to do is to maintain the patient’s own valve. This, in mitral valve disease, has been shown to offer important advantages over prosthetic surgery. In prosthetic surgery we are going to remove the diseased valve and implant a prosthesis. Prostheses, nowadays, are very well tested and really have an optimal performance, therefore, although it is a more basic surgery, the results are excellent. The choice of one type of surgery or another will depend on the valve affected, the type of disease and, above all, the surgeon’s experience.