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Summer 2011 - Heart Valve Conditions Know No Age

Valve conditions are not just issues of the elderly. There are a variety of heartrelated birth defects that can result in heart valve issues later in life.

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Valves & Valve Problems

The heart’s four valves – pulmonary, tricuspid, mitral and aortic – open and close to regulate blood flow into, out of and through the chambers of the heart. Blood flow can be interrupted when valve conditions such as stenosis, insufficiency and mitral valve prolapse are present.

Stenosis – When one or more valves do not completely open, blood flow into the next chamber or artery is reduced.

Insufficiency (incompetence, regurgitation) – One or more valves do not properly close, allowing blood to leak into the previous chamber.

Mitral valve prolapse – The faulty mitral valve does not close properly or closes unevenly. Because of the uneven closure, the valve may “bulge” (prolapsed) and may allow blood to leak back into the upper chamber (atrium).

When these issues result from birth defects, symptoms can occur in teenagers and people in their 20s, 30s, 40s and 50s.

Symptoms: Sometimes You Have ’em, Sometimes You Don’t

Shortness of breath, fatigue and heart palpitations are the most common symptoms of a valve condition. Less common symptoms include losing consciousness and chest pain. Some heart valve patients experience no symptoms at all. Or, they simply don’t realize they are having symptoms because they come on slowly.

When Should I Go to the Doctor?

Always listen to your body. No matter what your age, if doing your normal activities leaves you short of breath or just feeling not quite right, see your doctor just to make sure all is fine.

The most important symptom for an adult to watch for is a change in the way you feel when going about your normal activities. That maybe short of breath after usual 30-minute run. It’s a subtle change or unusual feeling when are doing everyday usual things that signals it’s time to go see your doctor.

Diagnosing Heart Valve Problems

A pediatrician or primary care physician will likely be the first person to suspect a valve condition. When valves are not working properly and cause interruptions in blood flow, a sound called a heart murmur is often produced. Further testing is required to determine the type of valve problem and the extent of damage. Heart murmurs can also indicate heart conditions other than valve problems – another reason testing is important.

Physicians can diagnose about 98 percent of valve disorders with echocardiograms. Echocardiography, also known as cardiac ultrasound, uses standard ultrasound technology to produce 2- and 3-dimmensional images of the heart. Cardiologists at WakeMed will use advanced technology such as transesophageal echocardiography (TEE) to diagnose the harder-to-see valve disorders – those that are blocked by the chest wall. This test requires a patient to be sedated. A small fl exible tube with an ultrasound at the end is advanced through the patient’s food pipe (esophagus), ultrasound waves are beamed out from the tube and images of the heart are recorded.

What Treatment Is Right for the Younger Valve Patient

The primary treatment for valve problems is surgery. There are also procedural intervention options (to replace the valve without surgery) for select patients. The need and timing for procedural or surgical intervention depends on the person’s severity of symptoms and severity of the valve problem itself.

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Today, heart valves (depending on those involved and the severeart ity of problem) can be repaired or replaced. When a heart valve must be replaced, heart surgeons can use a biological valve or a mechanical valve.

Age and lifestyle are important considerations for all patients facing heart valve surgery. Physicians like to do valve repairs as much as we can, but often replacement is necessary.

Dr. Chaudhry explains that biological (made from pig, cow or human tissue) and mechanical (made of manufactured materials) valves each have benefits and drawbacks.

A mechanical heart valve can last a lifetime. However, the patient will also need to take blood-thinning medication (such as warfarin) for a lifetime. Patients who have mechanical valves run a greater risk of developing blood clots and stroke. Blood thinners significantly decrease this risk. Valve dysfunction is also prevented with the use of blood-thinning medication.

Patients who have biological valves do not need to take warfarin, but they may face another valve surgery in several years. Biological valves can last about 15 years and then must be replaced, which means another surgery.

Unless other health conditions point us in a clear direction, the choice of which type of valve to choose is ultimately up to the patient. Physicians can help them make the choice by looking at their lifestyles and experiences of other patients in their same age group.

A medically directed cardiac rehabilitation program, like the one available at WakeMed Healthworks, can patients return to their normal activity level through monitored exercise.

After valve surgery, patients also need to follow up with their cardiologist. Approximately four to six weeks after surgery, cardiologists perform an echo to establish a patient’s baseline heart and valve function. If everything is normal and there are no other problems, a repeat echo usually isn’t necessary for another three years. Patients who receive biological valves should have echocardiograms more frequently once they hit the five-year post-surgery mark to monitor the valve’s viability.

No matter what your age, if doing your normal activities leaves you short of breath or just feeling not quite right, see your doctor just to make sure all is fine.