Updated advice for people with heart valve disease

The heart’s four valves open and shut in a carefully timed sequence to move blood through and out of the heart to the body. But as people age, these one-way valves may narrow and stiffen — a problem known as stenosis — which partially limits blood flow. Heart valves can also leak, allowing blood to flow backward; that’s called regurgitation.

About one in 10 adults ages 65 and older has moderate to severe heart valve disease. Without timely diagnosis and treatment (see “Monitoring heart valve disease”), valve problems can worsen, causing serious and sometimes fatal consequences. The good news: More people who need a new heart valve can get one without major surgery.

“No one wants to have heart surgery, so people who need a valve replacement are very interested to find out if they qualify for a transcatheter valve implant,” says Dr. Patrick O’Gara, professor of medicine at Harvard Medical School. Most valve replacements are in people with stenosis of the aortic valve. In 2011, when the less invasive procedure — known as transcatheter aortic valve replacement, or TAVR — was first approved (see illustration), it was limited to older people who were considered too ill for surgery.

Monitoring heart valve diseaseMost heart valve problems are discovered when a physician hears an abnormal sound (called a murmur) while listening to the heart through a stethoscope. An ultrasound of the heart (echocardiogram) can reveal any leaky or thick, stiffened valves.If you have a mild heart valve problem without any symptoms, you may simply need to monitor the condition with your doctor. Unfortunately, there are no drug therapies that can help prevent the progression of valve disease. But it’s important for people to take any other heart drugs their doctor prescribes to prevent other complications that might worsen their valve problem. They should also stay alert for symptoms of the two most common valve problems.Symptoms of aortic stenosisShortness of breathChest pain or tightness with activityDizziness, lightheadednessSymptoms of mitral regurgitationShortness of breath after activity or when lying downFatigueA rapid, fluttering heartbeatSwollen ankles or feet

Who can consider TAVR?

Today, many people ages 65 and older who meet certain criteria can have TAVR, says Dr. O’Gara, who co-authored recently updated valve replacement guidelines in the Journal of the American College of Cardiology. People younger than 65 are still advised to have surgical replacement because the longer-term consequences of TAVR haven’t been studied much in that age group.

Understandably, people prefer TAVR because it doesn’t require general anesthesia and has an easier, shorter recovery. But TAVR isn’t feasible or safe for people with certain anatomical issues, says Dr. O’Gara. For example, narrowed arteries outside the heart (peripheral artery disease) can make it difficult to thread the catheter up through the body to the heart. A buildup of calcium deposits in or below the valve also makes TAVR riskier, because the procedure can disrupt the surrounding tissues or dislodge flecks of calcium into the circulation, potentially triggering a stroke. And in some people, the valve delivered by TAVR may obstruct some of the arteries that feed the heart.

Transcatheter aortic valve replacement (TAVR)In a TAVR procedure, a valve made of cow or pig tissue is crimped onto the tip of a thin, flexible tube (catheter). The doctor threads the catheter (A) from the top of the thigh up to the opening between the heart and the aorta (B). Once it reaches the diseased aortic valve, the new valve is deployed (using either a balloon or a self-expanding device), which then anchors to the old valve (C).Illustration by Scott Leighton

Bicuspid valve challenges

Most people have aortic valves with three flaps (known as leaflets). But between 1% and 2% of people are born with bicuspid valves, which have only two leaflets. This defect, which is three to four times more common in men than women, may run in families and leaves people more prone to aortic valve degeneration. They usually develop symptoms of aortic stenosis about 10 years earlier than people with a three-leaflet valve who develop age-related stenosis.

The anatomy of a bicuspid valve can make TAVR more challenging, and many people with this defect also have an aneurysm (swelling due to a weakened vessel wall) in the aorta near the heart. As a result, most people with bicuspid valves need surgery instead of TAVR. Most people with severe leakage of the aortic valve also require surgery.

Mitral valve repair

About 1% to 2% of the population develop a condition known as mitral valve prolapse, which causes leaking or regurgitation. Most cases are mild, but some become severe and require surgical repair. Other people develop mitral regurgitation because of an enlarged left ventricle, which can occur after a heart attack or in response to longstanding atrial fibrillation or heart failure. The annulus (the fibrous ring of tissue supporting the leaflets) stretches out, preventing the leaflets from closing tightly.

For most people with severe mitral regurgitation due to prolapse, surgical repair remains the standard treatment. The surgeon adds a new ring to shore up the annulus but keeps the person’s original valve. But for people with prolapse and severe leakage who are too weak or frail to undergo surgery, a transcatheter approach may be an option. Instead of delivering a new valve, the technique uses a device that pulls the edges of the leaflets together. The first of these devices, MitraClip, was initially approved only for people with prolapse but was approved more recently for certain people with heart failure and mitral regurgitation. A similar device is expected to be approved within the year.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

Recommended contacts for prayer request and Bible study

www.agapetemplesda.com

www.adventistontario.org

https://www.hopechannel.com/au/learn/courses

breathoflife.tv/

https://3abn.org/all-streams/3abn.html

http://www.nadadventist.org/article/15/contact-us

https://www.adventist.org/en/utility/contact/

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