Dr. Dale Adler, MD, a leading expert in cardiovascular disease, discusses valvular heart disease treatment options, focusing on mitral valve prolapse. He explains when surgery is necessary and when medical management might suffice. Dr. Adler emphasizes the importance of accurate diagnosis and the role of second opinions in ensuring optimal treatment strategies. He highlights that while many patients with mitral valve prolapse may not require immediate intervention, those with symptoms or significant heart changes often benefit from surgical repair. Dr. Adler also addresses the limitations of medical therapy in managing severe valvular heart disease.
More from Diagnostic Detectives Network
Comprehensive Treatment Approaches for Valvular Heart Disease
Jump To Section
- Understanding Valvular Heart Disease
- Symptoms and Diagnosis of Mitral Valve Prolapse
- When Surgical Intervention is Necessary
- Role of Medical Management in Valvular Heart Disease
- Importance of Second Opinions in Treatment Decisions
- Full Transcript
Understanding Valvular Heart Disease
Valvular heart disease involves dysfunction of one or more of the heart's valves, which can lead to significant health issues if untreated. Dr. Dale Adler, MD, explains that while some patients may not exhibit symptoms, others may experience severe complications requiring intervention. Accurate diagnosis is crucial for determining the appropriate treatment path.
Symptoms and Diagnosis of Mitral Valve Prolapse
Mitral valve prolapse is a condition where the valve leaflets bulge backward into the left atrium, potentially causing a leak. Dr. Adler notes that while many individuals with a mitral valve click remain asymptomatic, a subset may develop symptoms such as shortness of breath and fatigue. Echocardiograms are essential for assessing valve function and guiding treatment decisions.
When Surgical Intervention is Necessary
Surgery is often indicated for patients with symptomatic mitral valve prolapse or significant heart changes. Dr. Adler emphasizes that surgical repair is preferred when the heart's mechanical function is compromised, as medical therapy alone may not halt disease progression. He advises caution in asymptomatic patients, where surgery may still be considered based on specific clinical indicators.
Role of Medical Management in Valvular Heart Disease
Medical management, including diuretics and ACE inhibitors, can provide temporary relief for some patients. However, Dr. Adler cautions that these treatments do not address the underlying mechanical issues of mitral valve prolapse. Long-term reliance on medication may lead to worsening heart function, underscoring the need for timely surgical intervention when appropriate.
Importance of Second Opinions in Treatment Decisions
Dr. Anton Titov, MD, highlights the value of seeking a second opinion to confirm valvular heart disease diagnoses and treatment plans. A second opinion can provide reassurance and ensure that patients receive the most effective and personalized care. Dr. Adler supports this approach, particularly in complex cases where treatment decisions can significantly impact patient outcomes.
Full Transcript
Dr. Anton Titov, MD: Valvular heart disease treatment options. Understand your heart valve treatment options. A second opinion ensures that valvular heart disease diagnosis is correct and complete. It also helps to choose the best treatment strategy for aortic stenosis or mitral regurgitation. Seek a second opinion on valvular heart disease and be confident that your treatment is the best.
Dr. Anton Titov, MD: Treatment options for heart valve disease are mostly surgical if there are any symptoms or signs of stress on the heart. Then heart valve disease treatment is heart valve replacement or heart valve repair. Sometimes valvular heart disease is symptomatic, and it is treated by heart surgery.
Dr. Dale Adler, MD: 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. The process of treating valvular heart disease is intricate. It has to be perfectly timed and choreographed. Only then can treatment cure the patient with mitral valve prolapse. But not everyone needs the surgery immediately.
Dr. Dale Adler, MD: What is the role of 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? 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 a mitral valve click (mitral valve murmur). But only 6.5% of all women and 2.5% of all men have real mitral valve prolapse.
Dr. Dale Adler, MD: In real life, 90% of all patients who have a mitral valve click will do perfectly fine throughout their lifespan. Only 10% of patients with a mitral valve murmur will need attention to their mitral valve. So it is 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 the mitral valve. Some patients have a classic mitral valve prolapse. The leaflets of the mitral valve are thickened. Some leaflets of the mitral valve prolapse.
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. Symptoms include shortness of breath, fatigue, and struggle on exertion. We are interested in helping 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 of their heart on the left, the left atrium. This can lead to cardiac rhythm disturbances, such as atrial fibrillation arrhythmia.
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?
Dr. Dale Adler, MD: This is the most important lesson that we have learned over many years. Mitral valve prolapse causes the leaflets to prolapse more with time. The chambers of the heart are starting to stretch. Mitral valve prolapse worsens as time goes by. In this situation, it is a mistake to try to use medicines to treat patients with mitral valve prolapse.
Dr. Dale Adler, MD: 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 medications might help a patient to feel better temporarily. But the underlying process of mitral valve prolapse and stretching of the heart is still continuing. Heart function is getting worse.
Dr. Dale Adler, MD: Research studies showed nicely that medical treatment of bad valvular heart disease does not help the patients. Eventually, patients get worse and worse. In mitral valve prolapse, the heart has a mechanical problem. Clinical examination and echocardiography may confirm that the mechanical problem of the heart is getting worse.
Dr. Dale Adler, MD: 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.
Dr. Dale Adler, MD: There is one caveat. 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 valve prolapse in a patient who does not show any symptoms. 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.
Dr. Dale Adler, MD: 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.
Dr. Dale Adler, MD: 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. That's what some doctors say. I think we just have to be very cautious with that approach.
Dr. Dale Adler, MD: In addition to the presence of a 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.