The two main aortic valve diseases are aortic stenosis and aortic regurgitation. Aortic valves can become thick and narrowed (stenotic), causing them not to open fully, or curled at the edges and leaky (aortic valve regurgitation or insufficiency), resulting in a backflow of blood into the left ventricle.
[ Aortic Stenosis ]
Symptoms of Aortic Stenosis
Aortic stenosis may not produce immediate symptoms or signs. The first sign is usually an abnormal heart sound, or heart murmur, which may develop months or even decades before other signs and symptoms. Aortic stenosis ranges from mild to severe.
As the valve narrows, more signs and symptoms develop and can include : -
Chest pain (angina) or tightness
Feeling faint or fainting with physical exertion (exercise)
Dizziness
Fatigue, especially during times of increased activity
Shortness of breath, especially with physical exertion
Heart palpitations - sensations of a rapid, fluttering heartbeat
Swollen ankles and feet
Causes of Aortic Stenosis
Aortic valve stenosis obstructs the way blood normally flows through the heart. Causes may be : -
Calcium buildup on the valve : - With age, heart valves may accumulate deposits of calcium (aortic valve calcification). In some people - particularly those with a bicuspid aortic valve - calcium deposits result in stiffening of the valve leaflets. This stiffening narrows the aortic valve.
Rheumatic fever : - Rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue can narrow the aortic valve and lead to aortic stenosis.
Congenital heart defect : - Rarely, some babies are born with an already narrowed aortic valve. Others are born with an aortic valve that has only two flaps (leaflets) - not three. Known as a bicuspid aortic valve, this deformity may not cause problems until adulthood, when the valve may begin to narrow or leak and may need to be repair or replacement.
[ Normal Hear Valve ]
[ Bicuspid valve ]
Symptoms of Aortic Regurgitation
[ Aortic Regurgitation ]
In most cases, aortic regurgitation develops gradually over decades. The heart compensates for the problem. No signs or symptoms may appear for many years. Most people are unaware they have this condition.
However, as aortic regurgitation progresses, signs and symptoms usually appear and may include : -
Fatigue and weakness, especially during physical exertion
Shortness of breath, especially with physical exertion or when lying down
Chest pain, discomfort or tightness, often increasing during physical exertion
Fainting
Rapid or irregular pulse
Fluttering heart beat
Swollen ankles and feet
Aortic valve regurgitation that occurs suddenly is a medical emergency that requires in-hospital treatment by one or more specialists.
Causes of Aortic Regurgitation
Any condition that damages the aortic valve can cause regurgitation. Causes of aortic regurgitation may be : -
Rheumatic fever : - Rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue can narrow the aortic valve and lead to aortic stenosis.
Deterioration of the valve with age : - The aortic valve opens and shuts tens of thousands of times a day, every day of a person's life. Aortic regurgitation may result from age-related wear and tear on the valve.
Endocarditis : - The aortic valve may be damaged by endocarditis - an infection inside the heart that can involve the heart valves.
Congenital heart defect : - Some infants are born with an aortic valve that has one leaflet (unicuspid valve) or two leaflets (bicuspid valve) rather than the normal three leaflets. This puts the child at risk of developing aortic regurgitation at some point in their life.
Other, rarer conditions can damage the aortic valve and lead to aortic regurgitation, including : -
Marfan syndrome, a disease of connective tissue
Ankylosing spondylitis, a spine disorder
Reactive arthritis, a rare form of arthritis affecting the eyes and joints
Syphilis, a sexually transmitted disease
Damage to the aorta near the aortic valve, such as damage from trauma to the chest or a tear in the aorta, can cause regurgitation
Diagnosis of Aortic Valve Disease
At We Care partner hospitals, diagnosis begins with a complete physical examination by a medical team that specializes in heart care. Patients will be asked about their general health, including signs and symptoms, and a history of heart disease in their family.
Various tests can help diagnose the type of heart valve problem, the possible cause of a heart valve defect, determine how serious the problem is and whether the aortic valve needs to be surgically repaired or replaced.
Diagnostic tests may include : -
Chest X-ray
An X-ray image of the chest allows the physician to study the size and shape of the heart and determine whether the heart's left ventricle (lower left chamber) is enlarged - a possible sign of a damaged aortic valve. A chest X-ray can also reveal calcium deposits on the aortic valve. In addition, a chest X-ray helps the physician check the condition of the lungs. Aortic stenosis may lead to blood and fluid backing up in the lungs, which causes congestion visible on an X-ray.
Electrocardiogram (ECG)
An ECG can provide clues about whether the heart's left ventricle is thickened or enlarged, which can occur with aortic stenosis.
Echocardiogram (Doppler Echocardiogram)
This test uses sound waves to produce images of the patient's heart.
Transesophageal Echocardiogram
Similar to a "regular" echocardiogram, this test uses a tiny transducer (sound device) on a tube inserted down the esophagus (part of the digestive tract that runs from the throat to the stomach).
Exercise Tests (Stress Test)
Different types of exercise tests help measure the patient's tolerance for activity and check the heart's response to physical exertion.
Cardiac Catheterization
A thin tube (catheter) is inserted in a blood vessel in the patient's arm or groin and threaded up to the heart. The catheter is used to deliver dye into the heart chambers and heart blood vessels. The dye, appearing on X-ray images as it moves through the heart, gives physicians detailed information about the heart and heart valves.
This test helps show blockage in arteries to the heart that can coexist with aortic stenosis and may need surgical treatment at the same time as the aortic stenosis.
Computed tomography (CT)
A CT scan uses a series of X-rays to create a detailed image.
Magnetic Resonance Imaging (MRI)
An MRI uses powerful magnets and radio waves to create a detailed image.
Positron Emission Tomography (PET)
A PET scan involves injecting the body with a small amount of radioactive glucose (tracer), which can be tracked by a special camera (positron) to provide detailed images.
Treatment of Aortic Valve Disease in india
Patients with heart valve disease are at increased risk for getting bacterial endocarditis, an infection of the lining of the heart and its valves, which can progress rapidly and be fatal. They must take antibiotics prior to any dental and surgical procedures that might introduce bacteria into the bloodstream.
Regular follow-up by healthcare providers is important. Actively observing the stability or the progression of aortic valve disease is important so that the right treatment can be started at the right time. Valves need to be repaired or replaced before irreversible damage occurs.
Monitoring
If tests reveal a mild to moderate condition and there are no symptoms, the physician will suggest scheduled checkups to carefully monitor the valve so medications can be prescribed or surgery done at the appropriate time.
Medications
People with heart valve disease are at increased risk for getting bacterial endocarditis, an infection of the lining of the heart and its valves, which can progress rapidly and be fatal. They must take antibiotics prior to any dental and surgical procedures that potentially could introduce bacteria into the bloodstream.
Surgery for Aortic Valve Disease in India
If valve damage becomes more severe and medications do not control the symptoms, surgery to repair or replace the valve becomes necessary. Aortic valves are usually replaced rather than repaired. However, because of advances in technology, equipment and surgical techniques, some aortic valves, especially ones with normal or near normal leaflets, can be repaired. Heart surgeons at We Care India agree that whenever possible a heart valve should be repaired instead of replaced. Heart valve repair leaves patients with their own normally functioning tissue, which is resistant to infection and does not require blood-thinning medication.
A damaged aortic valve that cannot be repaired can be surgically replaced in three ways : -
aortic valve replacement with a mechanical valve or tissue bioprosthesis.
aortic valve replacement with a preserved human valve.
the Ross procedure, a surgery in which the aortic valve is removed and replaced by a patient's pulmonary valve. (The pulmonary valve is then replaced with a preserved human pulmonary valve.)
Heart Valve Repair Surgery in India
Heart specialists and surgeons at We Care India agree that whenever possible a heart valve should be repaired instead of replaced. Heart valve repair leaves patients with their normally functioning tissue, which resists infection and does not require a lifetime of blood-thinning medication. Patients who have valve repair generally have a longer life expectancy
Part of a prolapsing mitral valve is removed to allow the valve to fully close and stop leaking.
Valve repair may be performed to separate fused valve leaflets, sew torn leaflets or reshape parts of the valve. However, repair is not possible for severely damaged valves such as those affected by calcium deposits or rheumatic disease.
Cardiovascular surgeons at We Care India have pioneered, studied and taught cutting-edge valve repair techniques since the beginning of cardiac surgery. In some cases, they can now offer the same proven techniques through smaller, incisions using minimally invasive Aortic Valve surgery.
Heart Valve Replacement Surgery in India
Heart valves that are severely damaged must be replaced. Valve replacement is most often used to treat aortic valves and badly damaged mitral valves, but it can be used to treat any valve disease that is life threatening.
Two kinds of replacement valves are available : -
Mechanical valves
Mechanical valves are made of synthetic materials. They are reliable, and last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines (anticoagulants).
Biological valves
Biological valves are made of animal or human tissue.Biological valves are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft / Ross procedure).
Patients with biological valves usually do not need to take blood-thinning medication. These valves are not as durable as mechanical valves, however, and they may need to be replaced. Biological valves are used most often in elderly patients.
Minimally Invasive Aortic Valve Surgery in India
Minimally invasive surgery allows surgeons at We Care India to perform aortic valve surgery through smaller incisions than traditional heart valve surgery. Other minimally invasive valve surgery techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery.
The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Other possible benefits may include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital (3 to 5 days) and decreased recovery time.
Valve surgeries, including valve repairs and valve replacements, are the most common minimally invasive cardiac procedures. The surgical team will carefully compare the advantages and disadvantages of minimally invasive valve surgery versus traditional valve surgery. Your surgeon will review the results of your diagnostic tests before your surgery to determine if you are a candidate for any of these minimally invasive techniques.
The list of of world class heart hospitals in India is as follows : -
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Patient Storys
Successful heart surgery at We Care India partner hospital allows Robert Clarke to live a normal life despite a rare genetic disorder We Care india helped Robert find best super specialised surgeon for his rare conditions.
