Valvular heart disease treatment options. Heart valve problems in patients with symptoms and without symptoms. When treatment of valvular heart disease is not necessary? When is surgery needed for mitral valve prolapse?
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Dr. Anton Titov, MD. Valvular heart disease treatment options. Understand your heart valve treatment options. Video interview with top expert in cardiology. Second opinion ensures that valvular heart disease diagnosis is correct and complete. Second opinion also helps to choose the best treatment strategy for aortic stenosis or mitral regurgitation. Seek second opinion on valvular heart disease and be confident that your treatment is the best. Treatment options for heart valve disease are mostly surgical if there are any symptoms. Sometimes there is any sign of stress on the heart. Then heart valve disease treatment is heart valve replacement or heart valve repair. Dr. Anton Titov, MD. How Is Heart Valve Disease Treated? Sometimes valvular heart disease is symptomatic. Then it is treated by heart surgery. Medical Second Opinion. Dr. Anton Titov, MD. Hello from Boston! Today Medical Second Opinion, who is Professor of Medicine at Harvard Medical School. Dr. Adler received his MD at Weill Medical College of Cornell University. He did his residency in internal medicine and fellowship in cardiovascular medicine. Dr. Dale Adler, MD clinical and research interests are in cardiovascular disease, specifically complex coronary artery disease, diabetic heart disease and its prevention, and valvular heart disease. Dr. Dale Adler, MD also has extensive experience in managing healthcare organizations and integrating hospital networks. Dr. Adler, thank you and welcome! – Thank you very much for having me. Medical Second Opinion: Let’s start with valvular heart disease. My mother had mitral valve repair at Brigham and Women’s Hospital several years ago. So I learned a lot about mitral valve repair surgery from a patient perspective. Process of treating valvular heart disease is intricate. Valvular heart disease treatment has to be perfectly timed and choreographed. Only then treatment cures the patient with mitral valve prolapse. But not everyone needs the surgery immediately. Medical Second Opinion. What is the role for medical treatment in valvular heart disease? How to prepare a patient for valvular heart disease surgery? How to treat the patient after surgical operation for valvular heart disease? Medical Second Opinion. You are asking a very interesting question in the entire realm of cardiology. Dr. Dale Adler, MD. Let’s talk about mitral valve prolapse repair. 2.5% of males and 6.5% of females in the United States have mitral valve prolapse. A study was done many years ago to listen to the heart of young patients. 15% of all young patients entering college had mitral valve click (mitral valve murmur). So 15% of all patients have mitral valve click. But only 6.5% of all women and 2.5% of all men have real mitral valve prolapse. Dr. Anton Titov’s note. Mitral valve prolapse symptoms are more rare than mitral valve murmur. In real life 90% of all patients who have mitral valve click will do perfectly fine throughout their life span. Only 10% percent of patients with mitral valve murmur will need attention to their mitral valve. So it is a becoming a progressively smaller number of patients who need medical attention to their heart valve. Dr. Dale Adler, MD. We see patients and take a good listen to their heart. Some of them have mitral regurgitation. So we do an echocardiogram We study their heart valves, including mitral valve. Some patients have a classic mitral valve prolapse. The leaflets of mitral valve are thickened. Some leaflets of mitral valve prolapse. Mitral valve leaflets open perfectly well. Leaflets move from exactly where they should be and open up nicely. Then it’s time for mitral valve leaflets to close. But one or both of the leaflets will move backwards into the top chamber the heart on the left side. This backward movement of mitral valve leaflet will cause a leak. Dr. Dale Adler, MD. Most patients with mitral valve prolapse will not need any medical help for a long period of time. But we are always interested in a group of patients who have symptoms of mitral valve prolapse. Mitral valve prolapse symptoms are shortness of breath. Patients with mitral valve prolapse have fatigue and struggle on exertion. We are interested to help this group of patients with mitral valve prolapse symptoms. Dr. Dale Adler, MD. Sometimes mitral valve prolapse causes enlargement of heart chambers because the leak is very severe. Enlargement of heart chambers in mitral valve prolapse sometimes increases pressure in the lungs. Patients with mitral valve prolapse also stretch the top chamber their heart on the left. It is left atrium of the heart. This can lead to cardiac rhythm disturbances. It is atrial fibrillation arrhythmia. So we are interested in this group of patients. Medical Second Opinion. Dr. Anton Titov, MD. How can you prevent mitral valve prolapse consequences? Are there medical solutions to treat valvular heart disease? Is it possible to treat mitral valve prolapse without surgery? This is the most important lesson that we have learned over many years. Mitral valve prolapse causes the leaflets to prolapse more with time. Dr. Dale Adler, MD. Mitral valve leaflets are having a harder time keeping the blood moving forward. The chambers of the heart are starting to stretch. Mitral valve prolapse worsens and time goes by. In this situation it is a mistake to try to use medicines to treat patients with mitral valve prolapse. We could use medicine, but it is not a good decision. We could use diuretics. We can make the heart a little smaller. We can use “ace inhibitors” and “unloading” medicines. These medicines are afterload reduction medicines. We can make it a little easier for the heart to pump the blood forward. These medications might help a patient to feel better. But the patients feel better temporarily. The underlying process of mitral valve prolapse and stretching of the heart is still continuing. Heart function is getting worse. Research studies showed nicely that medical treatment of bad valvular heart disease does not help the patients. Eventually patients get worse and worse. Medical Second Opinion: In mitral valve prolapse the heart has a mechanical problem. Dr. Dale Adler, MD. Clinical examination and echocardiography may confirm that mechanical problem of the heart is getting worse. Mitral valve prolapse causes stretching of heart chambers and increase in pulmonary artery pressure. For those patients the best treatment of valvular heart disease is to first treat the mechanical problem. Mitral valve prolapse treatment by surgical operation is better. Only after surgical operation treats valvular heart disease, then doctors should give support to the heart by medications. Medical Second Opinion. This is correct. There is one caveat. There is one area to be careful about. There might be a patient with very severe mitral regurgitation. But this patient feels very well. Their heart is not stretching. It is always very difficult to decide to correct severe mitral vale prolapse in a patient. Sometimes patient does not show any symptoms of mitral valve prolapse. The patient might feel fine. Their heart chambers might not be enlarging. Their pulmonary artery pressures are good. Pressures within their heart chambers are good. Should we treat this patient by surgical operation? There is a lot of discussion in the United States about the best way to approach such patients. Doctors who write clinical guidelines say that surgical repair of severe mitral valve prolapse should be considered. It should be done even if the patient feels fine. Surgical treatment of valvular heart disease can be considered even if the heart is not stretching. Sometimes surgeons are very sure that they can repair the mitral valve. Surgeons can do surgical operation very safely. Then it’s OK for surgeons to consider surgery for mitral valve prolapse. Dr. Dale Adler, MD. That’s what some doctors say. I think we just have to be very cautious with that approach. So to all what you said I would just add the following. In addition to the presence of severe mechanical problem of the heart something else could show that the heart is struggling. There could be signs that the heart is integrating the problems in a wrong way. In that situation you must use the mechanical solution. You do a surgical operation to repair mitral valve prolapse. Do not try to use medications to treat valvular heart disease in those situations. Dr. Anton Titov, MD. Valvular heart disease treatment options: surgery or medical therapy? Video interview with top expert in cardiology. Who does best with medical therapy.