HEART VALVE & AORTIC VALVE

 Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide in developing nations. Nearly more than 2.5 lakh death happening in India per year due to Heart Valve Disease.

 

Q. What is Heart Valve or Aortic Valve?

Ans. The heart has four chambers – two upper chambers called the left and right atriums, and two lower chambers called the left and right ventricles. Within these four chambers are four valves that control the flow of blood through the heart by opening and closing: the aortic, mitral, pulmonary and tricuspid valves. When you heart beats and pumps blood through these valves, the valves contract or squeeze.

 

Q. What is aortic stenosis?

Ans. Aortic Stenosis is a progressive condition caused by a narrowing of the aortic valve, which prevents normal blood flow. Because the condition will get worse with time, doctors will measure it as mild, moderate, or severe (depending on how damaged the valve is).

 

Q. What causes aortic stenosis?

Ans. There are four main causes of aortic stenosis calcium build-up on the valve leaflets; birth defects that may impact the structure of the arotic valve, rheumatic fever which can cause scar tissue to form in the heart & radiation therapy.

 

Q. What is severe aortic stenosis?

Ans. If aortic stenosis goes untreated, it will progress to the severe stages of the disease. Severe aortic stenosis means the aortic valve has a severe build-up of calcium and has a difficult time opening and closing. Your heart may need to work harder to pump blood throughout your body.

Q. What is severe symptomatic aortic stenosis?

Ans. Once aortic stenosis progresses to the severe stages, symptoms such as shortness of breath, chest pain, fatigue, or lightheadedness may occur. It is important to tell your doctor right away if you experience symptoms or if your symptoms worsen.

 

Q. What are the symptoms of severe aortic stenosis?

Ans. Symptoms of severe aortic stenosis include shortness of breath, chest pain, fatiguue, lightheadedness, rapid or irregular heartbeat, swollen ankles/feet or difficulty exercising. These symptoms may indicate your aortic stenosis has progressed to a life-threatening point.

Q. How serious is severe aortic stenosis (also known as severe aortic valve stenosis)?

Ans. Approximately 50 percent of people who develop severe aortic stenosis symptoms will die within an average of two years if they do not have their aortic valve replaced. If you have been diagnosed with severe aortic stenosis and have symptoms, talk to your doctor right away about your treatment options.

 

Diagnosis and Treament of Aortic Stenosis

 

Q. How is aortic stenosis diagnosed?

Ans. Your doctor will perform a few tests to determine if you have aortic stenosis. This is primarily done by listening to the sounds of your heart with a stethoscope. Diagnosis may also be done through a test called echocardiogram, which uses ultrasound waves to obtain images of the heart chambers and valves.

 

Q. What are the treatment options for aortic stenosis?

Ans. Depending on how far your aortic stenosis has progressed, your doctor may prescribe medication to help control your symptoms. However, it’s important to know the only effective way to treat aortic stenosis is by replacing your valve. This can be done through transcatheter aortic valve replacement (TAVR) or open-heart surgery.

 

 

 About Transcatheter Aortic Valve Replacement (TAVR)

 

Q. What is TAVR (Transcatheter Aortic Valve Replacement)?

Ans. TAVR (also known as transcatheter aortic valve implantation or TAVI for short) is a less invasive procedure for replacing a diseased aortic valve. During the procedure, your TAVR Doctor will use a catheter to implant a new valve within your diseased valve. TAVR can be performed through multiple approaches; however, the most common is through a small puncture in the leg.

 

Q. What are the different approaches used to perform TAVR?

Ans. TAVR can be performed in different ways depending on each individual’s anatomy.

  • The Tranfermoral approach is the most common approach and is through an incision in the leg.

  • The subclavian approach is through an incision near the shoulder.

  • The transapical approach is through an incision in thr chest between the ribs.

  • The transaortic approach is through an incision in the upper chest.

 

 Q. How could I benefit from a transcatheter valve replacement?

Ans. With the less invasive TAVR procedure, people may return to daily activities sooner than with open heart surgery. People who undergo TAVR report improved qaulity of life following the procedure. Other TAVR benefits include: short hospital stay, relief of symptoms (sometimes immediately), improved heart function, and reduced pain and anxiety.

 

Q. How long is the TAVR procedure?

Ans. Depending on your health and the procedural approach recommended by your doctor, the average TAVR procedure lasts approximately 1.5 hours. In comparison, the average open heart surgery lasts approximately 4 hours.

 

Q. How long does a transcatheter heart valve last?

Ans. How long your transcatheter heart valve will last depends on many factors and will vary per person. However, regular follow-ups will help your doctor know how your valve is working.

 

Q. What is TAVI, and is it different from TAVR?

Ans. TAVI stands for transcatheter aortic valllve implantation. The procedure ans its approaches are the same as TAVR. Your doctor may use the terms interchangeably when discussing your treatment options.

 

Q. How long have TAVR procedure been performed?

Ans. TAVR has been commercially available inEurope since 2007 and in the United States since 2011 and in India since 2012.

 

Q. Are there different types of transcatheter heart valves and can I ask for a specific valve?

Ans. Transcatheter heart valves are made by different manufactures. You can check which valves are used and available at your hospital. Although you can ask for a specific valve, your TAVR Doctor will recommend the best valve for you.

 

TAVR Evaluation

 

Q. How do I know if TAVR is right for me?

Ans. TAVR used to only be available for people who were too weak to undergo open heart surgery. But now, the procedure is available to more people depending on their risk for open heart surgery. It is also an option for people who previously had their aortic valve replaced. You need to consult an interventional cardiologist at a TAVR Hospital to determine if TAVR is an option for you. You can call us on 022-27666627 & 9619028808 for queries

 

Q. What tests will my doctor perform to determine if TAVR is right for me?

Ans. Your Doctor may use one or more of these tests to determine if TAVR is the best option for you.

  • Chest X-ray: a type of imaging to view images of the organs and structures inside your chest. You will be placed between a metal plate and the x-ray machine. The x-ray technician will take several images of your chest in a variety of positions. This may take up to 30 minutes to perform.

  • Transthoracic Echochardiogram (TTE): This diagnostic test (also know as an echo) uses ultrasound to obtain 3D images of the heart. While you are lying on a tablet, a probe will be placed on your chest wall and will use sound waves to provide detailed pictures of your heart. This usually takes 30-60 minutes.

  • Magnetic Resonance Imaging (MRI): A diagnostic test that uses magnetic and radio waves to take detailed pictures of your heart. You will be asked to lie down on a bed that moves into a large tube. You won’t feel anything but will hear a noise as the images are acquired. You will be asked to lie very still for duration of test. This usually takes 30-90 minutes.

  • Pulmonary Fuction Test (PFT): A group of tests, using special breathing equipment that will measure how well your lungs are moving oxygen to the blood. These can take 60-120 minutes.

  • Computerized Tomography (CT) scan: An imaging test that uses x-rays to obtain detailed pictures of your heart and blood vessels. You will be injected with contrast dye through an IV. You will be asked to lie down on a bed that passes through a donut-shaped x-ray scanner to take clear images of your heart. This takes up to 60 minutes.

  • Angiogram (Cardiac Cath): An imaging test that uses x-ray and dye to see how blood flows through your arteries and veins. You will lie on your back on an x-ray table. A small incision will be made and a small tube, called a catheter, will be inserted either in your groin or near your elbow. Dye will be injected into the vessel to make the area show clearly on the x-ray pictures. This takes up to 60 minutes.

  • Transesophageal echocardiogram: A test that obtains detailed pictures of your heart by inserting a probe down the esophagus (throat). While lying on a table, a technician will spray your throat with medicine to numb and supress your gag reflex. A thin flexible tube will be guided down your throat. The probe will send and receive sound waves which will become pictures on a video screen. This may take up to 60 minutes.

 

Q. How can I get evaluated for TAVR?

Ans. To see if the TAVR procedure is right for you, you need to seek out expert care from a specialized heart doctor called an interventional cardiologist at a TAVR Hosiptal. Only a TAVR Hospital can evaluate you for both TAVR and open heart surgery to determine what the best treatment option is for you.

 

Q. What is a Heart Team?

Ans. You may have heard the team Heart Team while researching your aortic stenosis treatment options. A Heart Team is a specialized care team that includes interventional cardiologists, cardiothoracic surgeons, imaging specialists, anesthseiologists, cardiac cath lab staff, and a cardiologist. Together, the specialized Heart Team will conduct a comprehensive evaluation to determine whether the TAVR procedure is appropriate for you.

 

Recovery from TAVR

 

Q. What should I expect directly after my TAVR procedure?

Ans. Typically following a TAVR procedure. You may be taken to the intensive care unit (ICU) for a little while or moved directly to a recovery room. Your doctor will update your caregiver or loved ones on how you are doing.

 

Q. What does life after TAVR look like?

Ans. Research has shown that patients that undergo the less invasive TAVR procedure have improved health within 30 days of their procedure. To optimize your recovery, your doctor will give you specific instructions, which may include a special diet, exercise and medication therapy. It is important to carefully follow you doctors’ directions, especially if the blood-thinning drugs are prescribed.

 

Q. Who should not receive TAVR?

Ans. Not everyone with severe aortic stenosis is a candidate for the TAVR Procedure . TAVR is not appropriate for:

  • Patients whose aortic valve is not calcified.

  • Patients whose aortic valve has only onr or two leaflets (usually due to a birth defect)

  • Patients who have a blood clot or an abnormal growth.

  • Patients who have an infection in the heart or infection elsewhere.

  • Patients who already have a prosthetic (manmade) valve or repair device implanted in any of their four heart valves.

  • Patients who have aortic stenosis along with aortic regurgitation (when the valve does not fully close and allows blood to leak backward through the valve)

  • Patients who have severe disease in the mitral valve.

  • Patients whose aortic valve is either too small or too big.

  • Patients who have severe disease in their vessels leading to the heart, have small vessels, or have vessels with many bends that would not allow passage of the products necessary to perform the procedure.

  • Patients who have thick aortic leaflets that is very close to the arteries that supply the heart with blood.

  • Patients who have severe problems with bleeding or blood clotting.

  • Patients who have a condition in which the heart muscle becomes thick.

  • Patients who cannot take aspirin, heparin, ticlopidine (Ticlid) or clopidogrel (Plavix), or have sensitivity to contrast medium (fluid used to see your internal structures during the procedure)

  • Patients who can have open-heart surgery.

 

Q. What are the risks of undergoing TAVR?

Ans. Risks associated with TAVR include atroke, in which blood suddenly stops flowing to the brain, major vascular complications such as a tear or hole in the blood vessels or in the heart, which would require additional operations to correct, and blood loss. Within the first 30 days after the TAVR procedure, the short-term risks include infection, irregular heartbeat, difficulty excercising, pain at the incision, problems with breathing, and high or low blood pressure. Reduced heart function and bruising are also risks.

 

Q. Follw-up Care

Ans. You should continue to have regular visits with your cardiologist and primary care doctor to ensure that your valve is performing properly and also that your symptoms are improving. If you experience any symptoms, such as shortness of breath or fatigue, please contact you doctor right away.

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