Category Archives: Diseases Of Heart Valves
Infective Endocarditis (Acute and Subacute Bacterial Endocarditis)
Infective endocarditis is an infection of the endocardium or the inner lining of the heart, often involving the heart valves.
- Infective endocarditis is the bacterial infection of the heart valves resulting from bacteria that have entered the blood stream from some other sites of infection in the body.
- Acute bacterial endocarditis appears suddenly with symptoms such as high fever, severe fatigue, and rapid heart rate and it quickly damages the heart valves.
- Low grade fever, fast heart rate, marked loss of body weight, and lowered RBC count are symptoms of sub-acute endocarditis. Fatigue and sweating may also be present.
- Heart valve defects and injuries can be diagnosed by echocardiography.
- People who have pre-existing heart valve abnormalities or those who have artificial valves should take antibiotics as a precautionary measure prior to surgery or dental procedures to prevent possible infections that may result in endocarditis.
- Intravenous administration of antibiotics in large doses helps overcome the infection, but the existing damage of the heart valves may need to be surgically corrected.
Infective endocarditis is more prevalent in people above sixty, and in that age group, it affects men eight times more than women. In the general population too, the incidence of this disease in men is twice as that in women.
Endocardium is the inner lining of the heart and though infective endocarditis is a disease due to an infection of the endocardium, it is not always restricted to it. Endocarditis often involves the heart valves and the muscles and blood vessels of the heart too. Infective endocarditis occurs in an acute form as well as a subacute form. Acute infective endocarditis appears suddenly, starting with a high fever, and deteriorates quickly into a life threatening condition whereas the subacute infective endocarditis progresses slowly and steadily over weeks and months, often accompanied by a low grade persistent fever.
Blood is usually free of microorganisms such as bacteria, but due to some injury or infection elsewhere in the body, sometimes bacteria and even some fungi may enter the blood stream. These microorganisms have a tendency to settle on the heart valves and cause infection of the endocardium or the inner lining of the heart. Defective valves and those which are damaged due to some reason, as well as artificial valves are usually more prone to infection, especially subacute bacterial endocarditis. However, aggressive strains of bacteria, when present in large numbers do not spare even healthy valves.
Birth defects, especially abnormal connections that allow leakage of blood across the various chambers of the heart predispose children to infective endocarditis. In older people, damage to the valves resulting from aging or heart disease and calcium deposit formation in the aortic valve or in the mitral valve, are risk factors that increase susceptibility to endocarditis. Rheumatic fever in childhood, when not treated with antibiotics, often precipitates permanent valve damage which in turn becomes susceptible to infections later on.
Dirty needles, syringes, or drug solutions often used by drug abusers may introduce bacteria directly into the blood stream; hence, such people are at a very high risk of contracting endocarditis. Another high risk category is people with artificial valves, especially for a year following the valve replacement surgery. The risk factor varies according to the type of valve implanted; higher risk associated with a mechanical valve compared to a valve of animal origin and an implanted aortic valve compared to a mitral valve.
Causes
When bacteria are introduced into the blood through a cut in the skin or inside the mouth, or through minor infections such as gum disease or gingivitis, the body’s defense mechanism usually destroys them. But, if the bacteria get caught in the heart valves, especially when the valves are defective or damaged, or when artificial valves have replaced them, they colonize the valves, resulting in an infection of the valve which spreads to the lining of the heart (endocardium), resulting in infective endocarditis. Surgical procedures and some dental procedures may introduce bacteria into the blood stream. It may happen during open-heart surgery or when an artificial valve is fitted, but that is rare due to the precautions taken prior to and during such surgery.
When the immune response of the body is compromised, the risk increases, so does, when a large number of bacteria enter the blood stream. A severe infection of the blood called sepsis, which is life threatening in itself, can cause endocarditis even in people who have normal healthy heart valves because of the sheer number of bacteria circulating in the blood.
Infective endocarditis mostly affects the mitral valve and the aortic valve, except when infection results from unhygienic injection of illicit drugs and the use of intravenous lines for very long periods, in which cases the tricuspid valve between the right atrium and the right ventricle is usually affected.
Symptoms and complications
Acute bacterial endocarditis often makes a sudden appearance with a fever in the high range (38.9° to 40°C or 102° to 104°F). Other symptoms include fatigue and a fast heart rate, severe damage to the heart valves.
Subacute bacterial endocarditis which usually has milder symptoms such as a low-grade fever (99° to 101° F [37.2° to 38.3°C]), anemia, weight loss and fatigue, may often remain undiagnosed for several months till the steadily progressing disease causes a block in the arteries or damage to heart valves, which when detected and investigated brings the endocarditis into light.
When blood clots and bacteria accumulate on the valves, they are called vegetations. And when they get disengaged from the site of infection and travel in the blood stream (emboli), they may clog the arteries. A block in the artery supplying the heart muscle can precipitate a heart attack and if an artery supplying the brain is blocked, stroke can result. Emboli can settle in other places and cause infection wherever they settle, usually forming abscesses filled with pus, especially around the valves. Infected heart valves may develop perforations that result in leakage and regurgitation of blood in a short period, affecting the function of the heart. Infections that spread to arteries make the artery walls weak and cause them to rupture, which can be very dangerous, and even fatal, if it happens near the heart or in the brain. Septic shock also may develop, resulting in failure of vital organs like the kidney and liver.
Very small clots (emboli) may travel to various parts of the body and may appear as freckles or red spots in the white part of the eyes and on the skin or as red streaks under the fingernails. Emboli that are larger result in stomach pain, numbness and pain in the limbs or blood in urine. They can also cause stroke or heart attack, if a major artery supplying blood to the brain or heart gets blocked. Enlargement of spleen is a common occurrence. Painful nodules appearing under the skin, pain in the joints, pallor, chills and confusion are also symptoms associated with sub acute bacterial endocarditis.
Whether acute or sub acute, infective endocarditis of an artificial heart valve is more complicated, as the infection, often spreading into the tissue around the valve may loosen the valve. Also, disruption in the electrical conduction system of the heart may result in very slow heartbeat, which may cause fainting and even death.
Diagnosis
Since symptoms of infective endocarditis are not usually specific to that disease, diagnosis can be made only through detailed investigations. When doctors come across fever without any identifiable cause, in a patient having a defective or damaged heart valve or an artificial valve, endocarditis is suspected especially if the patient has also undergone any dental or surgical procedure recently. Since infective endocarditis is a dangerous disease with serious consequences, the patient is immediately hospitalized for further investigations and treatment.
A newly developed heart murmur or a change in the old murmur pattern may point to endocarditis, but echocardiography and blood cultures are the tests employed to make an accurate diagnosis. Echocardiography, which can project images of the heart, can detect accumulations (vegetations) at the heart valves as well as the damage caused to the heart.
If echocardiography done with the probe placed on the patient’s chest (transthoracic echocardiography) is not clear enough, a transesophageal echocardiography may be performed with the ultrasound probe introduced into the esophagus which is situated right behind the heart. This invasive procedure may be costly, but an accurate result may be obtained.
Several blood samples are taken and cultured to identify not only the particular type of bacteria causing the infection but also the most effective antibiotic to fight it. But sometimes, difficulties are encountered in culturing bacteria from the blood samples. If previous antibiotic therapy, which has not been successful in wiping out the infection, has reduced the bacterial count in the blood significantly, it may be very difficult to detect or culture bacteria from blood samples. There are a few disorders such as a tumor in the heart that may display symptoms of endocarditis, making diagnosis difficult.
Prognosis
Prolonged treatment with high doses of antibiotics may be necessary for surviving an episode of infective endocarditis. The outcome usually depends on the age of the patient, the type of infection and its duration and whether the person has an artificial valve implanted. Without treatment, prognosis is poor as infective endocarditis is fatal.
Prevention
When people with congenital heart defects or heart valve defects and those fitted with artificial heart valves undergo dental or surgical procedures, the medical practitioners concerned should be informed of these risk factors so that antibiotics may be given prior to the procedure as a precautionary measure against infective endocarditis. Even though antibiotics given as a precaution may not be very effective in preventing endocarditis and a minor surgical procedure may not pose a high risk of developing the disease, antibiotics are always justified considering the dangerous nature of endocarditis.
Treatment
Intravenous administration of high doses of antibiotics for prolonged periods (usually 2 to 8 weeks) is the first line of treatment, which is started in the hospital immediately on diagnosis, but later on, can be shifted to the patient’s home under the supervision of qualified medical personnel.
Following an episode of infective endocarditis, often corrective measures involving heart surgery may be necessary due to the following reasons:
- Accumulation of bacteria and blood clots (vegetations) should be removed.
- When antibiotics are not successful in getting rid of abscesses, they have to be drained surgically.
- Leaking or damaged heart valves should be repaired.
- In case of irreparable damage to the valves, they have to be replaced with artificial valves.
- Congenital septal defects (abnormal connections between the chambers of the heart) should be corrected.
When the infection involves artificial valves, antibiotics are not sufficient to clear it due to certain reasons. Since antibiotics had definitely been an integral part of treatment during valve replacement surgery, any bacteria that survived it could be a resistant type. Also, artificial materials do not respond to antibiotic treatment as human tissue does, necessitating surgical intervention.
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Pulmonary Valve Stenosis
Pulmonary valve stenosis, otherwise known as pulmonary or pulmonic stenosis, is a valve defect resulting in reduced flow in the pulmonary artery that carries deoxygenated blood from the heart to the lungs. This is generally a congenital condition characterized by a constricted pulmonary valve opening which regulates the blood flow.
Mild forms of this condition often go undetected in childhood due to lack of apparent symptoms, but a pronounced heart murmur in children often indicates severe pulmonary valve stenosis which requires surgical intervention.
In adults, angina or chest pain, shortness of breath, and bouts of fainting on exertion may point to a hitherto undiagnosed valve defect. When detected in adults, it can be often corrected through balloon valvuloplasty, an alternate option to valve replacement. A catheter is guided into the pulmonary valve and the three cusps that control it are separated by inflating the balloon at the tip of the catheter. Recently the pulmonary valve can be replaced using cardiac Cath.
Watch This Video about Pulmonary Stenosis:
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Aortic Valve Regurgitation Or Incompetence
Aortic valve regurgitation occurs during left ventricular relaxation when the diseased valve cannot hold blood from leaking back to the left ventricle.
In normal hearts, during left ventricular relaxation blood flows back from the left atrium to the left ventricle via the mitral valve. But with aortic incompetence, blood leaks through the aortic valve resulting in an increase in the blood volume and pressure in the left ventricle. To adapt itself to this higher volume of blood, the left ventricle gradually enlarges and its wall becomes thickened (hypertrophied). Sometimes the heart fails to adapt completely to the new situation, resulting in failure of the heart pump and lung congestion (fluid accumulation).
Causes of Aortic Valve regurgitation
In developing countries where antibiotics are not properly used, still rheumatic fever and syphilis are the most common causes. Both diseases are now rare in USA and Europe.
In developed countries, causes are different namely aortic dissection, degeneration of the aortic valve due to a defect in the binding (connective) tissues as well as aortic aneurysm and infection of the valve tissue with bacteria.
Birth defect is another cause of aortic valve regurgitation, where the valve is formed of 3 leaflets (cusps) instead of 2. This occurs in around 1% of newborns.
Symptoms and methods of Diagnosis
In early cases where the disease is still mild, the symptoms are usually absent. As the disease progress in severity and heart failure develops, the patient will start to experience easy fatigue and shortness of breath with exertion as well as when lying flat in bed. Chest pain is another symptom which occur in 4 % of patients and can be explained by the fact that thickened (hypertrophied) muscle needs more blood.
During examination , your doctor will notice a special pulse characteristic of Aortic valve regurgitation . This pulse is known by physicians as water hammer pulse. When listening to your heart with a stethoscope, a characteristic heart murmur is heard. When suspecting aortic regurgitation, your doctor will order further tests such as ECG and more importantly an echocardiogram. Echocardiogram will show the diseased valve, the heart function as well as other valves of the heart. if you are a male in the 40′s or a female in the 50′s , coronary angiography will be ordered if surgery is decided to be the solution to your problem.
Treatment Of Aortic valve Regurgitation
If you are diagnosed with the disease, you will receive antibiotic before some dental and surgical procedures, to avoid infection of the damaged valve leaflets.
In mild aortic regurgitation, treatment will be focused in preventing and treating heart failure symptoms using diuretics , ACE inhibitors and digoxin. Follow up with echocardiography is essential to monitor the severity of the regurgitation and the heart size and function.
In severe cases, surgery will be the only option and is carried out to replace the damaged valve with either a tissue or mechanical valve. Mechanical valves will require life long therapy with an oral anticoagulant (blood thinner)
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What is Aortic Stenosis
What is Aortic stenosis ? Simply, it is just a narrowing of the opening of the aortic valve. As a result, blood exiting the left ventricle will face a resistance to its flow through this narrowed valve.
In order to pump this blood through the stenotic valve, the left ventricle has to work harder resulting in thickening of its muscular wall. This thickened left ventricular muscle will require more oxygen, and hence more blood, to perform its function normally. Sometimes, during exercise, the coronary arteries are not able to deliver sufficient amounts o blood to this thickened ventricle and the patient can experience pain in the chest, fainting and in rare occasions sudden death may occur. As the disease progresses, the left ventricle will become weakened and heart failure occurs.
Causes Of Aortic Valve Stenosis
In developed countries Such as United states, the main cause is degeneration of the valve leaflets with aging resulting in calcium deposition and scarring of the valve leaflets or cusps. The condition usually starts around the 60′s, yet the patients may remain without symptoms till the 70′s. In developing countries, rheumatic fever is the main cause of aortic valve stenosis and i most cases others valves of the heart are also affected especially the mitral valve.
Symptoms And Diagnosis
Most common is chest pain which is usually noticed during exercise. Patients who developed heart failure usually suffer from easy fatigue and shortness of breath.
Aortic stenosis can occur due to a birth defect. In this case the valve may be composed of 2 cusps or leaflets instead of 3. Some children may develop severe symptoms in infancy while most of them experience problems in adulthood. As the child grows, the valve opening remains narrow and the left ventricle struggle to pump the blood. With time calcium deposits inside the valve which become very thickened and more narrowed.
In severe cases of aortic stenosis , sudden drop of blood pressure can result in fainting. fainting attack due to aortic stenosis are rarely preceded by lightheadedness.
Diagnosis of aortic stenosis is done through a physical examination . The doctor listen to a characteristic murmur with a stethoscope. The murmur can also be heard on the left side of the neck. Electrocardiography(ECG) is usually ordered to detect and pulse abnormalities and left ventricular wall thickness. The most important test to be done is an echocardiography. This test uses ultrasound waves and gives a detailed picture of the heart, its valves and chambers. The aortic valve area is measured as well as the pressure across the valve. The heart function is also evaluated.
Treatment of Aortic stenosis
Adult Patients with aortic stenosis require routine follow up visits to evaluate the progress of narrowing and the heart function. Decision to replace the valve surgically is based on the area of the valve as well as the patient symptoms. Patients with chest pain and shortness of breath may require earlier surgical intervention.
Before proceeding with surgery, heart failure should be treated using diuretics. Valve replacement is performed using a tissue valve or mechanical valve. Mechanical valves will require long-life therapy with anticoagulants such as coumadin. Antibiotics will be prescribed for patients with artificial valves before certain dental and surgical procedures to protect the valve from bacterial infection.
Children with aortic stenosis are treated either surgically or using balloon valvuloplasty. Balloon widening of the valve is performed using a catheter that is introduced through the groin area and advanced to the heart until it reaches the aortic valve. The balloon is then inflated to widen the valve.
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Mitral Valve Stenosis
Mitral valve stenosis is a disease characterized by narrowing of the opening of the mitral valve . since the mitral valve is the gate of blood flow from the left atrium to the left ventricle, this narrowing will increase the resistance to the blood flowing through the valve.
As a result of this resistance, blood will accumulate in the left atrium increasing its pressure and left atrial enlargement will occur. With time, the left atrium becomes larger and irregularity in the heart rhythm will occur (atrial fibrillation). The left atrium ability to pump blood will be lost and blood accumulates more in the left atrium resulting in increase pressure in the pulmonary veins draining the blood from the lungs. Fluid will accumulate in the lungs resulting lung congestion and a decrease in the level of oxygen in blood.
Causes of mitral valve stenosis
Rheumatic fever is the number one cause of Mitral valve stenosis. This is a disease of childhood that follows improperly treated streptococcal throat infection or scarlet fever. Rheumatic fever is common in developing countries and can rarely be seen in USA and Europe due to wide spread use of proper antibiotics to treat streptococcal infections. the disease is prevalent in children and teenager of developing countries and it can be seen in old population in USA. Rheumatic fever can affect any valve of the heart , but the mitral valve is the most commonly affected.
in few cases some infants can be born with congenital mitral stenosis and they will mostly need surgery early in their life.
sometime mitral valve stenosis can be caused by benign tumor of the left atrium called myxoma. This tumor can grow big in size and sometimes protrude in the mitral valve orifice leading to its narrowing.
Symptoms and Diagnosis
In early cases of mild mitral valve stenosis, the patient may not encounter any symptoms. as the disease progresses and become more severe, patients will develop irregular heart beats and heart failure. Easy fatigue and shortness of breath are common symptoms during this stage. With time shortness of breath can be experienced even at rest or when lying flat on bed. Coughing of blood (hemoptysis) is not uncommon and patients should seek immediate medical help if they develop it. Some patients may develop a characteristic mitral facies in which their cheeks look red-flushed.
During physical examination, you doctor will hear a characteristic heart murmur as the blood tries to flow through the narrowed mitral valve. An echocardiogram is usually ordered to confirm the diagnosis and to give a detailed image of the heart and all the valves.
Treatment of Mitral valve stenosis
As I always say, best treatment is prevention. The most important is the prevention of rheumatic fever by properly treating streptococcal infections with antibiotic for at least one week.
Early cases of mitral stenosis will require diuretics or water pills to decrease congestion of the lungs and the symptoms of heart failure. Heart rhythm controlling drugs, such as digoxin, or calcium channel blockers, will be prescribed to treat atrial fibrillation. Anticoagulants or blood thinners will also be used to prevent development of blood clots inside irregularly beating atrium.
As the disease progresses, valve repair or replacement will be the only solution. If the valve is not so hardly calcified, it can be dilated using a balloon tipped catheter, in a procedure called balloon valvuloplasty. The procedure is done in the Cath. Lab. under local Anesthesia . When the mitral valve is severely damaged, it is usually replaced with a mechanical or tissue valve. Anticoagulants will be prescribed after valve replacement.
Patients with mitral valve stenosis or those whose valves are replaced will require antibiotics before some dental and surgical procedures.
Watch These Videos About Mitral valve Stenosis:
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Mitral Valve Prolapse Syndrome
Mitral valve prolapse or sometimes called mitral valve prolapse syndrome is a connective tissue disorder affecting the leaflets of the mitral valve. As a result the cusps of the mitral valve bulge into the left atrium during left ventricular contraction resulting in regurgitation of blood into the atrium.
About 4 % of the population have Mitral valve prolapse syndrome. The weak connective (binding) tissue of the valve leaflets will result in redundancy of the valve leading to blood leakage into the left atrium. The condition is considered serious if blood regurgitation becomes severe, or if the valve is infected or if the chordae (Thin Ropes) that hold the valve is ruptured.
Symptoms and diagnosis of Mitral valve Prolapse
Affected patients rarely complain of any symptoms but some of them may experience rapid heart beats, chest pain, palpitations, easy fatigue, and migraine. Diagnosis is usually accidental during a routine physical examination. Doctors usually hear a clicking sound when they listen to the heart with a stethoscope. If the condition is associated with severe regurgitation, a characteristic heart murmur is heard. Doctors usually order an echocardiogram to confirm the diagnosis and asses the degree and severity of regurgitation if present.
Treatment:
Most of the patients will not require treatment. If there are rapid heart beats, a medication called beta-blocker is prescribed to control the rate of the heart and bring it back to normal. If there is associated mitral regurgitation, diuretics may be added to treatment. Antibiotics will be advised as a prophylaxis before some dental and surgical procedures to decrease the risk of infective endocarditis.
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Mitral valve insufficiency (Mitral valve incompetence)
Mitral valve insufficiency or a leaking mitral valve occurs during left ventricular contraction. When the left ventricle contracts blood is supposed to move in one direction through the aortic valve to the aorta. However, when the mitral valve is leaking, blood will flow backward to the left atrium during ventricular contraction. As a result the blood volume and the pressure inside the left atrium increases which in turn leads to increased pressure in the pulmonary veins ( Their Function is to bring blood from the lungs to the heart). As a result of this incompetence, the left atrium will gradually enlarge to become able to hold the excess amount of leaking blood. An enlarged atrium is potentially harmful. The atrium will start to lose its ability to beat regularly and its rhythm is disturbed resulting in atrial fibrillation. As a result of this irregular beating, blood circulation is affected inside the atrium and blood clots may form. A fresh blood clot can move down to the ventricle and eventually pumped to the body organs such as the brain leading to stroke.
When mitral valve insufficiency become severe, fluid will start accumulating in the lungs (lung congestion). Also the amount of blood pumped to the body is reduced and with time the left ventricular muscle is weakened. The net result will be development of heart failure.
Causes:
- Rheumatic fever: this is the most common cause in developing countries but rare in USA and Europe. Rheumatic fever is an illness that occurs in children in the age group of 5-15 years. The disease is caused by poorly treated throat infections caused by streptococcal bacteria.
- Myocardial infarction or Heart Attack: Most common cause in USA and Europe. A heart attack will destroy the papillary muscles which are responsible for the opening and closing function of the mitral valve.
- Myxomatous degeneration: it is a genetic disorder that affect the connective (binding) tissues of the mitral valve. The valve weakens with time and loses its ability to close properly.
Symptoms Of Mitral Valve Insufficiency:
In mild cases , the patient usually has no symptoms. As the disease progresses, the patient will start experiencing palpitations and shortness of breath with effort . When heart failure develops , cough , shortness of breath at rest, coughing blood and swelling of both legs will occur.
Diagnosis:
The first step of diagnosis is a thorough examination by the physician. With a stethoscope , the doctor will listen to your heart and an abnormal sound or a heart murmur characteristic of mitral incompetence is usually heard. To confirm the diagnosis, the doctor will order an echocardiogram which is simply an ultrasound of the heart. Echocardiogram will give a detailed picture of the heart and its valves. An electrocardiogram will be be ordered to check if the heart rhythm is still regular or not. Chest x-ray is another exam done to check the size of the heart and the condition of the lungs.
Treatment of Mitral Valve Insufficiency:
In mild cases routine follow up may be the only thing required to monitor the progress of the disease. Antibiotics may sometimes be prescribed before some dental and surgical procedures. Moderate mitral incompetence may be treated with some drugs such as angiotensin converting enzyme inhibitors, digoxin and diuretics. In case of sever mitral insufficiency, surgery will be the only solution. Decision to proceed to surgery will be based on the status of the left ventricle. Surgical intervention is a must before there is a permanent damage in the left ventricle.
Two Surgical options are available, either mitral valve repair or replacement. Valve repair should be the first priority when treating mitral valve insufficiency. A naturally repaired valve will function more properly than an artificial valve. Replacement will be done if the valve repair is difficult and the patient will have to take an anticoagulant for 3-6 month if a bioprosthesis ( pig tissue valve) is used and for life if a mechanical valve is used.
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Heart Valves Function and Malfunction
The heart valves are responsible for regulating blood flow between the four chambers of the heart. The upper chambers of the heart are termed the right and left atria. The lower chambers are named the right and left ventricle. The right ventricle has 2 valves . The inlet valve is called the tricuspid valve which moves the blood in one direction from the right atrium to the right ventricle. The outlet valve is named the pulmonary valve which moves the blood from the right ventricle to the pulmonary artery. The left ventricle has 2 valves . The inlet valve is called the mitral valve which moves the blood in one direction from the left atrium to the left ventricle. The outlet valve is named the aortic valve which moves the blood from the left ventricle to the aorta. Each of the four valves is composed of leaflets that is called by physicians cusps. These leaflets are responsible for the opening and closing of the valves.
When the heart valves get diseased, they are either narrowed (Valve Stenosis) or became incompetent (Valve insufficiency or leaking valve). Narrowed or leaking valves will sure interfere with the pumping function of the heart. Doctors identify valve problems when they listen to your heart with a stethoscope. One important test to confirm a valve problem is an echocardiogram.
A diseased heart valve can be repaired or replaced depending on the quality of the valve. Repair is usually performed with surgery, however, cardiac catheterization can be used efficiently in case of a narrowed mitral valve. Using a local anesthetic, a catheter is introduced through the upper thigh and threaded until it reaches the mitral valve. A balloon is then inflated to widen the valve orifice. This procedure is generally safe and your hospital stay is relatively short compared to surgery.
If your doctor decided that valve replacement is the answer to your valve problem, then an open heart surgery is indicated. Artificial Valves used to replace your own diseased valve are either mechanical or bioprosthetic. Bioprosthetic valves are made from pigs or cows heart valves. One of the advantages of mechanical valves is the durability since they can stay for longer duration, yet you have to take blood thinner for life. Blood thinners or anticoagulants will prevent blood clots from forming on the valve. Bioprosthetic valves have a shorter life and they tend to degenerate in 12 years, however you will only need to take anticoagulants for just 3-6 months after surgery. It is important to note that artificial valves have a high incidence of getting infected and antibiotics will be prescribed before some dental and surgical procedures. These antibiotics will prevent bacterial infections to spread to the newly replaced valve.