Q1. What are the heart valves? What are their functions?
There are four valves in the heart. They let blood flow through when open, and prevent blood from flowing backward when closed. Heart valves are very important. The heart cannot pump blood effectively to the whole body when they are impaired.
Q2. What is heart valve disease? What are the causes?
Heart valve disease is a common type of structural heart diseases. It often involves valve stenosis, characterised by valves thickening and failing to open fully. Valve regurgitation is another condition, where the valves fail to close properly, resulting in blood flowing backwards. These two conditions are the most common forms of heart valve disease.
Q3. What are the symptoms of heart valve problems?
When there are problems with heart valves, be it stenosis or regurgitation, the common symptoms include swollen feet, shortness of breath, frequent lightheadedness, poorer exercise ability, and chest tightness during walking or physical exertion. These symptoms are similar to those of common coronary heart diseases.
Q4. How is heart valve disease diagnosed?
Diagnosis starts with a simple step – your doctor will first listen to your heart with a stethoscope. Heart valve disease is indicated by a whooshing sound or heart murmur. Further investigations such as echocardiogram are performed to confirm the diagnosis.
Q5. What are the treatments for heart valve disease? What will happen if treatment is delayed?
Prompt treatment is required if the valve problem is severe. Surgery is typically necessary as the disease involves structural problems, while medications are primarily prescribed for symptom relief. Common surgical procedures include conventional open-chest surgery, which involves breastbone incision and stopped-heart techniques. The surgeon opens the heart to replace or repair the affected valves. The second type of surgery is catheter-based surgery, which, instead of open-chest surgery, uses catheters to repair or replace the valves. If the valves are left untreated or treatment is delayed, it may severely affect the heart, making it less capable to pump blood, or increasing the risk of congestive heart failure, even death.
Q6. What types of patients are suitable for catheter-based surgery?
Each patient will be examined by a heart-team of cardiologists, cardiac surgeons and other medical professionals. Factors such as age, medical history, location of the affected valve, and other structural issues will be taken into account to determine whether open-chest surgery or catheter-based surgery is more suitable. For example, catheter-based surgery is considered the preferred option for patients aged over 70, with aortic valve stenosis and deemed structurally suitable after basic examination, including heart ultrasound (echocardiogram) and CT scan. For younger patients at 40 and with aortic valve stenosis, even if they are deemed suitable for catheter-based surgery, doctors may recommend open-chest surgery as the preferred choice.
The treatment decision involves multiple factors and will be explained in detail to patients by doctors.
Q7. What is the postoperative care?
It takes time to recover after open-chest surgery or catheter-based surgery. Remember to follow your doctor’s instructions regarding rehabilitation, e.g. doing exercises. Medications, such as anticoagulants or anti-platelet agent, may be prescribed after heart valve replacement. It is also important to maintain good oral hygiene, as research suggests that poor oral hygiene can increase the risk of heart valve infection (endocarditis). Your doctor may therefore recommend regular dental cleanings, usually once or twice a year. Before seeing a dentist, you should inform your doctor for prescription of antibiotics to prevent infection in case of dental procedure. All of these are important after open-chest or catheter-based heart valve surgery.
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