Heart Valve Repair: Treating Heart Valve Disease for Long-term Quality of Life
The heart is the most remarkable human organ, composed of specialized muscles, heart valves, and an electrical system that functions automatically 24/7. It is one of the first organs to develop in the womb and continues to operate faithfully until our final breath. Over a typical lifespan of 70 years, the heart will pump blood to nourish bodily organs more than 2.6 billion times!!!
A remarkable synergy defines the heart, with each component harmoniously supporting the others. If the defect is not too severe, the heart continues to function because its interconnected parts can compensate for one another effectively.
“The extraordinary synergy of the heart presents a profound challenge for cardiac surgeons. I have devoted myself to thoroughly understanding complex functions and mechanisms of each component, striving to repair and restore this intricate harmony and enable the heart to perform at its best once again.”
Dr Taweesak Chotivatanapong, a renowned cardiothoracic surgeon at the Cardiology Center, MedPark Hospital, delves into the marvels of the heart and offers insights on “heart valve repair,” a treatment option for heart valve regurgitation. Discover more in this article.
Heart Valve Regurgitation: The Silent Threat That Could Lead to Heart Failure
Heart valve regurgitation is a silent condition that significantly heightens the risk of sudden cardiac death, often without any warning signs. In its early stages, the symptoms of heart valve regurgitation may appear less severe than other heart conditions. However, the startling reality is that many individuals are oblivious to the condition, subjecting their hearts to prolonged strain and fatigue.
The human heart has four valves: the mitral, aortic, tricuspid, and pulmonary. Each valve ensures that blood flows in a forward direction from the upper to lower heart chambers and from the lower heart chambers to their outflow tracts, effectively preventing any backflow. Remarkably, they are designed with protective mechanisms that allow the heart to adapt and maintain optimal function, even if one valve is compromised.
If the chordae tendineae of the mitral valve ruptures, the ability of the heart to pump blood efficiently to bodily organs becomes compromised. Under normal circumstances, the heart pumps 5 liters of blood per minute. However, if 2 liters of blood regurgitate backward, the heart can only propel 3 liters per minute. Despite this, the body may not show noticeable symptoms because the heart compensates by increasing its pumping force to restore the lost volume, maintaining a total output of 5 liters per minute. As a result, the heart must work harder, exerting the force needed to pump 7 liters per minute of blood to compensate for the leakage and maintain adequate circulation.
“In the past, when awareness of heart disease was limited, most patients with valve regurgitation sought medical attention only after their condition had progressed to stage 3 or 4. It was uncommon for individuals to visit a doctor without experiencing noticeable symptoms. Today, however, greater awareness and the adoption of regular annual checkups have made it possible to detect and address heart valve regurgitation before symptoms manifest.”
“Without regular health checkups, patients may remain unaware of valve regurgitation. Over time, the constant strain from the leaking valve forces the heart to work harder, eventually leading to signs of heart muscle fatigue. As the condition progresses and the heart struggles to pump adequate blood to the body, it can progress to severe valve regurgitation. These are especially critical in cases involving the mitral valve, which must withstand the greatest pressure and force during contractions. Significant damage to this valve can ultimately result in heart failure,” explained Dr. Taweesak.
Heart Valve Repair: Less Daunting Than You Think
Heart valve regurgitation in the elderly often causes concern for patients and their families, raising questions about the best ways to restore a good quality of life. In fact, the complexity of heart valve repair depends on various factors, including the underlying condition, pathology, and the age of a patient. Each of these factors involves intricate details that can vary significantly from one patient to another.
“Most elderly patients come with age-related conditions. The complexity and challenges lie in the fact that, in addition to valve regurgitation, they may also suffer from chronic diseases such as kidney disease, diabetes, or hypertension. These require the doctor to carefully and meticulously lay out the treatment plan. Surgery in younger patients offers better tolerance and quicker recovery than in older individuals.”
The doctor described the degree of severity, which varies from mild to extremely severe. Symptoms progress from being entirely asymptomatic, allowing individuals to live their daily lives as usual, to fatigue with strenuous physical exertion. As the condition worsens, even minimal exertion causes fatigue, eventually leading to shortness of breath, difficulty breathing, inability to lie flat, and swelling in the legs and feet while at rest. This stage is critically severe and poses a heightened mortality risk. Besides valve replacement, valve repair is another viable option to manage this condition effectively.
The heart has four valves. The success of surgical repair can vary. Early detection of mitral and tricuspid valve issues and prompt medical attention significantly increase the likelihood of successful repair, so long as the valve damage is minimal, and the overall health of the patient has not deteriorated.
“The aortic valve repair has a lower success rate, so doctors typically recommend valve replacement. The type of replacement heart valve material chosen depends on appropriateness to the patient, such as using tissue derived from own tissues, other living organisms, or mechanical valves made of metal. The heart surgeon makes the call on the final choice.”
Besides employing autologous tissue and mechanical heart valves, current medical innovations have advanced to using heart valve tissue from organ donors or livestock, such as porcine or bovine tissues. These provide alternatives to artificial heart valves for treating valvular regurgitation, offering promising results and gaining increasing attention in the medical realm.
For using porcine (pig) or bovine (cow) pericardial tissue in treating valvular regurgitation, valve defects, or valve damage from infection, the tissue must come from specially raised medical-grade livestock only to ensure the tissue pieces meet medical quality standards. Thailand imports these tissues from abroad. Before gaining approval for human use, they must go through multiple procedures to meet standards and receive certifications from the US Food and Drug Administration (FDA), European authorities, and the Thai Food and Drug Administration.
Caring for your heart health: No symptoms do not imply the absence of disease.
“Do not overwork your heart to the point of fatigue.” Dr. Taweesak stressed the importance of annual checkups. These routine examinations are essential for staying proactive about our health and preventing diseases.
“I always remind my patients that the absence of symptoms does not mean the absence of disease. Some people fear that an annual checkup might reveal unexpected diseases. However, I tell them not to be afraid of knowing they have lurking underlying diseases. It is far more concerning not to know that you are sick. Early diagnosis and prompt treatment significantly increase the likelihood of full recovery.”
Discovering early-stage heart valve regurgitation through a health checkup means we catch it before showing physical symptoms when the heart is not yet stressed to the point of fatigue and failure. The chances of returning to normalcy are much higher than waiting until the heart becomes overworked and shows signs or symptoms of disease, calling for intervention.
“Patients and their families often ask the same questions: 'Is the surgery dangerous?' Some are very anxious, fearing they may not wake up from the surgery, become disabled, or even pass away. I assure them that worrying is okay, but they must remain calm. I always tell my patients, 'If you fight, I will fight alongside you.' If you are not sure, talk to another doctor. Speak with several doctors if necessary until you are confident enough to take the plunge.”
While a 100% success rate in repairing the damaged valves is beyond reach, the doctor answers inquiries about his confidence with a firm voice and resolute gaze,
“I am confident.”
