Heart valve disease may be seen at birth or it may develop later in life
This depends on the type of valve involved and the severity of its involvement. The recent advances in heart surgery and the consideration of surgery in the elderly have increased the chances of survival in these patients. After the successful surgery, the quality of life in most individuals is the same as in a general population of age-matched subjects. Even in elderly patients with other coexisting diseases, the surgery offers increased chances of survival.
The chances of survival in an untreated heart valve disease are poor.
- Aortic stenosis (AS): Patients with severe AS develop symptoms in 3 to 5 years. Around 75% of patients with unoperated aortic stenosis may die 3 years after the onset of symptoms. The long-term survival following surgical valve replacement in patients over 65 years of age is excellent and up to the first 8 years is comparable to the matched general population.
- Aortic regurgitation (AR): Most patients of AR will be symptomatic and require valve replacement surgery within 2 to 3 years of developing breathlessness and symptoms of heart failure. Valve replacement surgery gives an excellent improvement in individuals suffering from severe symptoms. A Swedish study has proven that these individuals have a life expectancy of only 2 years lesser than the healthy population of the same age. In the operated individuals younger than 50 years, survival chance is even higher.
- Mitral valve prolapse (ballooning): This condition needs only medical management. The age-adjusted survival rate in patients with mitral valve prolapse is similar to patients without mitral valve prolapse.
- Mitral stenosis: In North America, mitral stenosis is a slowly progressive disease, with 20 to 40 years passing between the initial infection and the onset of clinical symptoms. In developing countries, it progresses much more rapidly and may lead to symptoms in children less than 5 years of age. Around 80% of patients with mild symptoms live for at least 10 years after diagnosis. In 60% of these patients, the disease may not progress at all.
However, their survival chances worsen if the breathlessness becomes more frequent and develops while performing daily activities like cooking and bathing. If severe pulmonary hypertension has developed due to increased heart load, the mean survival time is less than 3 years. The timely surgery and replacement of the mitral valve offer a significant survival benefit in these persons, especially those younger than 50 years.
- Mitral regurgitation: Properly timed surgery gives patients with mitral regurgitation a postoperative survival rate similar to that of the general population.
- Tricuspid regurgitation (TR): This condition is better managed medically. 1-year survival rates were 92, 90, 79, and 64% inpatient groups with no, mild, moderate, or severe untreated TR, respectively.
- Pulmonic stenosis: This condition is mostly seen in children. It is usually associated with a benign clinical course, and excellent treatment options are available for severe cases. Thus, there is a high rate of survival into adulthood. 96% were free of operation at a 10-year follow-up. Severe pulmonic stenosis most often presents in childhood and may need valve replacement but has an excellent prognosis.
It must be remembered that survival in the patients of the valvular disease depends on timely diagnosis, management, and follow-up. The timing of surgical intervention often correlates with the outcome of these patients. Regular follow up and medications are imperative to reduce long-term morbidity and mortality.
What are heart valve diseases?
The heart has two upper (atria) and two lower chambers (ventricles). There are certain structures, called valves, present in the heart to regulate the flow of blood into, within, and out of the heart. These valves are flaps present at specific junctions in the heart. They help maintain the flow of blood in the heart in one direction. In valvular heart disease, the heart valve may become narrow (valve stenosis) or weak (valve regurgitation). Both stenoses as well as regurgitation increases the load on the heart.
Heart valve disease may be seen at birth or it may develop later in life due to age-related changes in the heart. Valvular heart disease (VHD) comprises a number of heart conditions that account for 10% to 20% of all cardiac surgical procedures in the United States.
The valvular heart diseases include:
- Mitral stenosis
- Mitral regurgitation
- Tricuspid regurgitation
- Mitral prolapse
- Aortic stenosis
- Aortic regurgitation
- Pulmonic stenosis
The valvular heart disease may also result from infections like rheumatic fever, which may be seen in childhood cancer survivors, who had chest radiation, or after a heart attack.
Mild valvular heart disease often goes unnoticed. The severe valvular disease may cause the heart to develop abnormal rhythm (fibrillation), heart failure, stroke, develop a blood clot, and death.
The symptoms of valvular heart disease are breathlessness, dry cough, swelling over the legs and ankles, chest discomfort, etc.
