Topic: Heart Valve Disease
Question: What are the treatments for Heart Valve Disease ?
Answer: Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can treat symptoms successfully and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
                
The goals of treating heart valve disease might include:
                
Medicines
                
Repairing or replacing faulty valves
                
Lifestyle changes to treat other related heart conditions
                
Medicines
                
In addition to heart-healthy lifestyle changes, your doctor may prescribe medicines to:
                
Lower high blood pressure or high blood cholesterol.
                
Prevent arrhythmias (irregular heartbeats).
                
Thin the blood and prevent clots (if you have a man-made replacement valve). Doctors also prescribe these medicines for mitral stenosis or other valve defects that raise the risk of blood clots.
                
Treat coronary heart disease. Medicines for coronary heart disease can reduce your hearts workload and relieve symptoms.
                
Treatheart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
                
Repairing or Replacing Heart Valves
                
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isnt causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
                
The decision to repair or replace heart valves depends on many factors, including:
                
The severity of your valve disease
                
Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease. Bypass surgery and valve surgery can be performed at the sametime.
                
Your age and general health
                
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they dont need to take blood-thinning medicines for the rest of their lives.
                
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
                
Repairing Heart Valves
                
Heart surgeons can repair heart valves by:
                
Adding tissue to patch holes or tears or to increase the support at the base of the valve
                
Removing or reshaping tissue so the valve can close tighter
                
Separating fused valve flaps
                
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients. Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure.
                
Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloonvalvotomy.
                
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube. Youre awake during the procedure, which usually requires an overnight stay in a hospital.
                
Balloon valvuloplasty relieves many symptoms of heart valve disease, but may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve. Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. For these people, balloon valvuloplasty often is preferred over surgical repair or replacement.
                
Balloon valvuloplasty doesnt work as well as surgery for adults who have aortic valve stenosis. Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.
                
Replacing Heart Valves
                
Sometimes heart valves cant be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.
                
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you wont need medicines to stop your body from rejecting the valve.
                
Man-made valves last longer than biological valves and usually dont have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15years or longer. Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of infective endocarditis.
                
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
                
If youre a woman of childbearing age or if youre athletic, you may prefer a biological valve so you dont have to take blood-thinning medicines. If youre elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
                
Ross Procedure
                
Doctors also can treat faulty aortic valves with the Ross procedure. During this surgery, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. Your pulmonary valve is then replaced with a pulmonary valve from a deceased humandonor.
                
This is more involved surgery than typical valve replacement, and it has a greater risk of complications. The Ross procedure may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isnt required. But in some patients, one or both valves fail to work well within a few years of the surgery. Researchers continue to study the use of this procedure.
                
Other Approaches for Repairing and Replacing Heart Valves
                
Some forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3 to 5 days, compared with a 5-day stay for traditional heart valve surgery.
                
New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter2to 4weeks versus 6to 8weeks for traditional surgery.
                
Transcatheter Valve Therapy
                
Interventional cardiologists perform procedures that involve threading clips or other devices to repair faulty heart valves using a catheter (tube) inserted through a large blood vessel. The clips or devices are used to reshape the valves and stop the backflow of blood. People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery.
                
Doctors also may use a catheter to replace faulty aortic valves. This procedure is called transcatheter aortic valve replacement (TAVR). For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. A deflated balloon with a folded replacement valve around it is at the end of the catheter.
                
Once the replacement valve is placed properly, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.
                
A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.
                
Lifestyle Changes to Treat Other Related Heart
                
To help treat heart conditions related to heart valve disease, your doctor may advise you to make heart-healthy lifestyle changes, such as:
                
Heart-healthy eating
                
Maintaining a healthy weight
                
Managing stress
                
Physical activity
                
Quitting smoking
                
Heart-Healthy Eating
                
Your doctor may recommend heart-healthy eating, which should include:
                
Fat-free or low-fat dairy products, such as skim milk
                
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
                
Fruits, such as apples, bananas, oranges, pears, and prunes
                
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
                
Vegetables, such as broccoli, cabbage, and carrots
                
Whole grains, such as oatmeal, brown rice, and corn tortillas
                
When following a heart-healthy diet, you should avoid eating:
                
A lot of red meat
                
Palm and coconut oils
                
Sugary foods and beverages
                
Two nutrients in your diet make blood cholesterol levels rise:
                
Saturated fatfound mostly in foods that come from animals
                
Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.
                
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
                
AvocadosNot all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are:
                
Corn, sunflower, and soybean oils
                
Nuts and seeds, such as walnuts
                
Olive, canola, peanut, safflower, and sesame oils
                
Peanut butter
                
Salmon and trout
                
Tofu
                
Sodium
                
You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
                
Dietary Approaches to Stop Hypertension
                
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
                
The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH.
                
Alcohol
                
Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weightgain.
                
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
                
12 ounces of beer
                
5 ounces of wine
                
1 ounces of liquor
                
Maintaining a Healthy Weight
                
Maintaining a healthy weight is important for overall health and can lower your risk for heart valve disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active.
                
Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes online BMI calculator or talk to your doctor. A BMI:
                
Below 18.5 is a sign that you are underweight.
                
Between 18.5 and 24.9 is in the normal range.
                
Between 25.0 and 29.9 is considered overweight.
                
Of 30.0 or higher is considered obese.
                
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
                
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk.
                
If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol.
                
Managing Stress
                
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
                
A stress management program
                
Meditation
                
Physical activity
                
Relaxation therapy
                
Talking things out with friends or family
                
Physical Activity
                
Regular physical activity can lower many heart valve disease risk factors.
                
Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week.
                
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
                
Read more about physical activity at:
                
Physical Activity and Your Heart
                
U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans
                
Quitting Smoking
                
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for atherosclerosis and other health problems. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
                
For more information about how to quit smoking, visit the Smoking and Your Heart Health Topic.
Source: NHLBI