Patent valve in cardiac surgery – Causes, symptoms and treatment options for this common heart condition.

A leaky heart valve, also called regurgitation or valvular insufficiency, is a condition in which one or more of the heart’s valves do not close properly. This causes blood to reflux, causing the heart to pump ineffectively. Valve leaks can occur in any of the four heart valves: the mitral valve, tricuspid valve, aortic valve, or pulmonary valve. Although some cases of valve leak may not cause major health problems, severe regurgitation can lead to serious complications, such as heart failure or arrhythmias.

Several factors can contribute to the development of a patent valve. A common cause is age-related degeneration, in which the valve tissues become stiff and thicken over time, affecting its ability to close tightly. Other causes include congenital heart defects, infective endocarditis (bacterial infection of the heart valves), rheumatic heart disease, and diseases that dilate or enlarge the heart, such as high blood pressure or cardiomyopathy.

Key points:

• Heart valve failure, also known as valvular regurgitation, occurs when the heart valves do not close properly, causing blood to back up.
• This condition can be caused by age-related degeneration, congenital heart defects, infective endocarditis, rheumatic heart disease, and heart conditions that stretch or enlarge the heart.
• Common symptoms of a leaky valve may include fatigue, difficulty breathing, swollen ankles, and a fast or irregular heartbeat.

The Importance of Heart Valve Function

There are four main heart valves: the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Each valve is strategically placed to facilitate proper flow of blood through the heart. The mitral valve and tricuspid valve are located between the atria and ventricles, while the aortic valve and pulmonary valve are located at the exit points of the ventricles. These valves open and close synchronously, ensuring that blood flows in only one direction and preventing any backflow that could cause ineffectiveness or complications.

The function of the heart valves is vital to maintaining adequate cardiac output and preventing the development of conditions such as heart failure or arrhythmias.

• Cardiac expenditure: The function of heart valves directly affects cardiac spending, which is the amount of blood pumped by the heart in a minute. If the valves do not open and close correctly, the heart can have difficulty pumping the blood effectively, which reduces cardiac output. This can cause symptoms such as fatigue, difficulty breathing and fluid accumulation.
• Reflux prevention: The role of heart valves in reflux prevention is crucial. When the valves close correctly, they prevent blood from going back to the cavities you just left. Without this mechanism, blood could accumulate or flow in the wrong direction, increasing the workload of the heart and compromising its general function.
• Pressure maintenance: the opening and closure of the heart valves contribute to maintain optimal blood pressure in the heart and in the rest of the body. The effective functioning of the valves guarantees the maintenance of the pressure gradient, which allows blood to flow smoothly without the heart and blood vessels suffering excessive tension or resistance.

Understanding the importance of the function of heart valves is crucial to diagnose and treat various cardiovascular conditions. Periodic reviews and proper treatment of any valvular anomaly can help prevent serious complications and improve the general health of the heart.

Understanding the causes of a leaky heart valve

There are several factors that can contribute to the development of a permeable heart valve. A common cause is ag e-related degeneration, in which valve tissues weaken and stop closing tightly. This is especially frequent in older adults, since the wear of heart valves over time can cause degeneration. Other causes can be previous cardiac interventions, infections such as endocarditis, certain congenital heart defects and underlying diseases such as rheumatic fever or connective tissue disorders.

Ag e-related degeneration is one of the main causes of permeable heart valves, especially in the elderly population. The valves become less flexible and lose their ability to form a hermetic seal, allowing the blood to flow again to the camera from which it has just left.

• Degeneration related to age
• Previous cardiac surgery
• Infections such as endocarditis
• Congenital heart defects
• Underlying diseases

It is important to note that not all cases of valve regurgitation cause symptoms. Some people can live with a patent heart valve without experiencing any noticeable effects. However, when symptoms do occur, they may include fatigue, shortness of breath, irregular heartbeat, chest pain, and swelling of the feet or ankles. If left untreated, a patent heart valve can lead to complications such as heart failure, arrhythmias, and even stroke.

1. Age-related degeneration weakens the tissues of the heart valves, impairing their ability to close tightly and causing valve regurgitation.
2. Previous cardiac interventions can disrupt the normal function of the valves and cause leaks.
3. Infections, such as endocarditis, can damage the heart valves and cause regurgitation.
4. Congenital heart defects can be associated with abnormal valve structures or functions, causing valve leaks.
5. Underlying medical conditions, such as rheumatic fever or connective tissue disorders, can affect the valvular structures and contribute to valvular regurgitation.

Diagnosing a Leaky Heart Valve

Accurately diagnosing a patent heart valve involves a thorough evaluation of the patient’s medical history, a physical examination, and the use of diagnostic tests. During the medical history assessment, the healthcare professional will collect information about the patient’s symptoms, medical history, and family history of heart disease. This information helps identify possible risk factors and determine the need for further diagnostic investigations.

Important information:

• A patent heart valve can be caused by a variety of factors, including age-related degeneration, heart disease, and congenital anomalies.
• The physical examination may reveal abnormal heart sounds, such as a murmur, which may indicate the presence of valve abnormalities.
• Diagnostic tests commonly used to diagnose a patent heart valve include echocardiography, electrocardiogram (ECG), and cardiac catheterization.

Treatment options for a leaky heart valve

1. Medical treatment: In some cases, mild or moderate valve leaks can be treated with medications. These medications are intended to control symptoms associated with the condition, such as diuretics to reduce fluid buildup and blood pressure medications to help the heart pump more efficiently. However, it is important to note that medical treatment alone cannot solve the underlying valve problem and is often used as a temporary solution or as a way to prepare patients for surgery.

Note: Medical treatment is often recommended for patients who are not appropriate candidates for surgery due to age, comorbidities, or other factors that may increase surgical risks.

2. Surgical repair: Surgical repair is one of the most common treatment options for a patent heart valve. During this procedure, the surgeon corrects the defective valve by tightening the valve opening or repairing damaged leaflets. The surgical repair technique may vary depending on the specific valve affected, and may involve the use of annuloplasty rings or patches to support and reinforce the valve structure. The goal of surgical repair is to restore proper function of the valve and prevent blood leaks.

1. Advantages of surgical valve repair
• Preserves native valve tissue
• Lower risk of infection
• Possible long-term durability
2. Risks of surgical valve repair:
• Risks of general anesthesia
• Infection
• Hemorrhage
• Recovery time

Surgical Repair for a Leaky Heart Valve

When it comes to surgical repair of a patent heart valve, there are several techniques and procedures available, depending on the severity and location of the valve patency. One of the most common procedures is valve repair, the objective of which is to repair the defective valve and restore its normal operation. This method is preferable to valve replacement whenever possible, as it preserves the patient’s own tissue and avoids the need for long-term anticoagulant treatment.

Note: Surgical repair of a patent heart valve should be carefully studied by a team of experienced cardiac surgeons and cardiologists. The decision to proceed with surgery will depend on the patient’s individual circumstances, including the severity of symptoms, the underlying cause of the valve leak, and the patient’s overall health.

• Valvular repair techniques: There are different techniques to repair a permeable heart valve, such as the annulpastia, which consists of remodeling and tightening the valvular ring, and the repair of the valves or cords, which deals with the anomalies of the valves or the tendons thatThey hold them. The objective of these techniques is to restore the correct functioning of the valve and avoid new regurgitations.
• Valvular replacement options: In cases where repair is not feasible or is very likely to be successful, it may be necessary to replace the valve. For this, mechanical or biological prosthetic valves can be used. Mechanical valves are made of lasting materials and are long duration; However, they require prolonged anticoagulant treatment. Biological valves, on the other hand, come from animal or human donors and do not usually require life anticoagulation.

Important: The choice between valve repair or replacement is based on various factors, such as patient’s age, their general health status, their lifestyle and the characteristics of valvular dysfunction. An exhaustive evaluation by the health team is essential to determine the most appropriate surgical approach for each individual case.

Recovery and Rehabilitation after Heart Valve Surgery

1. Physical activity:

• The regular practice of physical activity is crucial to promote cardiovascular health and recover strength after a heart valve intervention.
• Specific exercise programs for each patient, which include aerobic exercises such as walking or riding a bicycle, can adapt to individual needs and gradually increase their intensity as healing progresses.
• It is important that patients follow the orientations of their health team and gradually increase their level of activity while monitoring any sign of fatigue or discomfort.

2. Medication and monitoring:

1. After the intervention of the heart valve, patients will be prescribed a medication guideline aimed at preventing infections, controlling pain and facilitating the healing process.
2. Compliance with prescribed medication and assistance to periodic monitoring appointments with the surgical equipment are essential to supervise progress, address any concern and make the necessary adjustments in the treatment plan.
3. The medical team will provide detailed instructions on the dosing of medication, possible side effects and lifestyle modifications that may be necessary.

Important: Patients should strictly follow the medication program and keep the medical team informed of any change in symptoms or in the general state of health.

Long-term Outlook and Follow-up Care for a Leaky Valve

Lon g-term perspectives:

1. Valves repaired or replaced usually provide a significant improvement of cardiac function and symptoms.
2. The success of the intervention depends on several factors, such as the severity of the valvular escape, the general health state of the patient and the fulfillment of the postoperative recommendations.
3. With adequate care, most patients may experience a significant reduction in symptoms, such as fatigue, difficulty breathing and exercise intolerance.
4. Surgical correction can also minimize the risk of complications associated with a permeable valve, such as heart failure, arrhythmias and damage to other heart structures.

Note: The lon g-term forecast may vary depending on the concrete valve in question, the degree of valvular escape and if the patient suffers from an underlying heart disease.

Monitoring care:

• Periodic monitoring appointments with a cardiologist are crucial to supervise the function of the replaced or replaced valve and guarantee the general health of the patient.
• During these visits, the cardiologist will perform physical explorations, request diagnostic tests (such as echocardiograms) and evaluate the patient’s symptoms and quality of life.
• It is possible that medications, such as anticoagulants and beta blockers, are prescribed to control symptoms and prevent complications.
• A healthy lifestyle, which includes a balanced diet, regular exercise and avoiding tobacco and excessive alcohol consumption, is essential for lon g-term heart health.

Note: Compliance with monitoring care and periodic monitoring is essential to detect any possible dysfunction or complication of the valve and initiate rapid intervention.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont