Acquired heart defects – what it is and methods of treatment

Author arrhythmia

2019-04-28

There are four heart valves in the heart that regulate blood flow, opening and closing in turn. With acquired heart defects, one or more valves cease to function properly, that is, they do not fully open or close. As a result, the blood flow is disturbed, and the heart begins to work less efficiently.

Acquired heart defects (PPS) almost always occur due to inflammatory heart diseases lasting for a long time. This affects the mucous membrane of the heart and the heart muscle. PPPs are quite rare in Central Europe, although they are quite common in the peripheral countries of the Mediterranean (North Africa, Turkey, etc.).

Acquired heart defects are primarily the result of rheumatism, streptococcal inflammatory disease of the joints, in which the heart may be involved in the form of endocarditis and myocarditis. As a result, the heart valves are deformed, and the aortic and mitral valves are particularly often affected, as a result of which they can calcify.

Rheumatism-related heart valve defects at a later age often require replacement with an artificial sash as a correction.Viral myocarditis can lead to permanent overstrain of the left ventricle, including weakness during pumping. There is a so-called dilated cardiomyopathy, which may require long-term drug therapy. In severe cases, at a later stage, a heart transplant is performed.

Video: What is valvular heart disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy

Heart Disease: Common Characteristics

All heart diseases relating to the valve apparatus can be divided into three groups:

  1. Congenital heart defects - in these disorders, the heart did not undergo intrauterine development in such a form that it could do its job well.
  2. Arrhythmia - the so-called cardiac arrhythmias are disorders of cardiac conduction. It can also lead to poor pumping function or even dangerous additional (extraordinary) contractions of the heart.
  3. Acquired heart defects - they are essentially the result of previously transferred infections that affected the heart muscle.Violation can cause heart valves to stop closing properly or heart arrhythmias can occur.

Heart defects can also occur at middle and young age. In children and adolescents, they usually do not matter much, but in the long run they lead to serious changes and acquired heart defects.

Manifestations of heart disease

Newborns with heart disease often show signs of the disease:

  • Weakness.
  • Feeling unwell.
  • Dehydration.
  • Blue skin (cyanosis) and mucous membranes.
  • Anxiety.
  • Heart murmurs.
  • Severe breathing when joining heart failure.

Heart diseases often cause heart palpitations, dizziness and even loss of consciousness in children and adults.

Acquired heart defects usually lead to a sudden loss of working capacity, the presence of weakness, palpitations or tachycardia. Additionally, nausea and vomiting in previously healthy people can be determined, especially after an infection.

Diagnosis of heart disease

The first is electrocardiography (ECG), which can confirm the signs of cardiac abnormalities, as well as indicate organic changes in the heart muscle. If cardiac irregularities are not clearly expressed, an ECG is recorded over a full day or an ECG recording is performed during exercise, for example, when cycling or running on a track.

A painless way to visualize various changes in the heart is ultrasound diagnosis (echocardiography). With its help, violations of the activity of the valve apparatus, functional disorders and other changes are determined.

Cardiac catheterization is performed in extreme cases, since this technique is invasive and is sometimes accompanied by complications, which, in the context of PPS, can especially worsen the patient's condition.

Echocardiography of the two main anatomical types of mitral regurgitation (often found acquired heart disease). A is an example of reclining the posterior cusp floating in the left atrium, with the anterior cusp completely normal. B - an example of functional mitral regurgitation. LA = left atrium. LV = left ventricle.

Life with valve defect

Valvular heart disease usually progresses slowly. In some cases, the defect remains stable for many years, and in other cases the condition of patients with an affected heart valve suddenly deteriorates. Therefore, it is important to closely monitor the existing complaints and - if a defect in the heart valve is detected - regularly undergo annual screening with a cardiologist. If new complaints have arisen or old ones have become more troubling, you should not wait for the next intake, but consult a doctor.

It is important to know that patients with a defect in the heart valve who are at high risk of inflammation of the inner lining of the heart (endocarditis, especially after replacing the heart valve), should take antibiotics after tooth extraction and other operations performed in the mouth to prevent serious complications.

Video: Ventricular Septal Defect (VSD) Surgical Repair - Pediatric Heart Surgery

Treatment of Acquired Heart Diseases

Heart valve disease can be eliminated only in one way - by operation. However, depending on the nature and stage of the disease, medications are often used to alleviate the symptoms, as well as to eliminate concomitant diseases, such as atrial fibrillation. Sometimes medications help reduce the risk of further complications.

The affected valve is repaired or replaced with an artificial valve. The operation must be done in a timely manner so that during the procedure, irreversible damage to the heart is avoided and the patient’s life expectancy is increased.

Today, as a rule, a person after heart surgery starts working much earlier than several years ago. In some cases, even if the patient is determined to have a small discomfort, his activity can be complete.

Nevertheless, a marked increase in the left ventricle or a decrease in the work of the heart, to some extent, is no longer amenable to recovery. Then the operation on the heart valve can only prevent the deterioration of the disease. In any case, a successful valve operation can reduce or eliminate discomfort and increase longevity.

Surgical risk and age limits

Surgical risk increases with age, so the worst predictions are given to elderly patients. This is especially true for those procedures during which, in addition to the heart valve, surgery is performed on the coronary arteries. Nevertheless, there are no exact contraindications in the form of age restrictions.

Not the date of birth, but the biological age (physical and mental vitality) of a person, are crucial in the outcome of the operation.

If an elderly patient is limited in his daily life with a heart defect, he must decide with the doctor whether he can withstand surgery and agrees with an increased surgical risk in order to improve his performance and quality of life by replacing the valve.

After a closed surgery, recovery is usually slower than an open surgery. The rehabilitation of the heart muscle usually takes months or even years. In addition, before the operation, the physical state of the myocardium is most often unsatisfactory, which also affects the speed of recovery. Therefore, after surgery, it is first recommended to start training with a low load and gradually increase it.

It is important to know that the more limited physical performance was before the operation, the slower the patient recovers after surgery.

Modern features allow you to install artificial heart valves through special catheters. This procedure is faster and easier than open surgery, and, therefore, can be recommended for patients who can not stand the usual surgical intervention.

Life after surgery

After the operative procedure, it is necessary to undergo regular examinations: more often immediately after the operation, and then after three or six months, after a year and then at annual intervals. If there are recent cardiac symptoms, a timely examination should be carried out as soon as possible.

A transesophageal echocardiography, or an inside echocardiography, in which an ultrasound of the heart is carried out not outside, but through the esophagus. Should be carried out with the appearance of new symptoms or fears of complications.

Patients with a mechanical heart valve should constantly take anticoagulant drugs. In the case of a biological heart valve replacement, the rules of anticoagulant therapy are followed for three months.

Additionally, patients who have had a bacterial infection with a fever or repeated surgery should also take antibiotics.This will help them avoid endocarditis and myocarditis. In this case, the patient should never forget that he had an operation on a heart valve.

A healthy lifestyle is important for everyone without exception, but this is especially true for patients with acquired heart defects. For this reason it is important:

  • Do not smoke.
  • Eat right.
  • Maintain a normal weight.
  • Move regularly.

Additionally, you may need to treat comorbidities that could lead to heart disease.

Well dosed exercise strengthens the heart muscle

The use of an artificial heart valve cannot fully restore the initial physical performance, but many patients become more stable after surgery than during illness. Repairing a damaged heart valve often leads to an improvement in heart function. That is why it is necessary to go in for sports with restored sashes, and not competitive sports, because otherwise the heart starts to work too hard.

Endurance classes, such as jogging, jogging, cycling, hiking or swimming, are best suited for postoperative patients. In contrast, sports with a high risk of falling or injury, such as skiing, especially during anticoagulant treatment, is problematic.

As a rule, regular exercise increases a person’s ability to perform daily work. They also improve well-being, but at a suitable pace for the patient and without stress.

Options for surgical treatment of acquired heart defects

Modern surgical capabilities allow to eliminate acquired heart defects in two ways - reconstructive surgery and replacement of the heart valve.

Reconstructive surgery

In the so-called reconstructive surgery, the surgeon tries to restore (reconstruct) the anatomical structure of the damaged valve. This option is used only for minor heart disease.

If the valves are severely distorted by scars or they are deformed, then such a correction is practically impossible. Most often, reconstructive surgery is used for mitral valve insufficiency.

Heart valve replacement

Severe heart disease almost always means that the damaged heart valve is removed and replaced with a prosthesis.Depending on the situation, different variants of artificial replacement can be used.

Mechanical valves made from ultra-modern plastics are very reliable and have an almost unlimited service life. They are particularly well suited to young patients. When using exogenous material, there is a risk that small blood clots (thrombi) will accumulate on the valve, which are then carried to the bloodstream. They can clog arterial blood vessels.In order to avoid this so-called embolism, patients after surgery should take anticoagulant medications (anticoagulants) throughout life.

Mechanical heart valve prostheses, unlike biological prostheses, cause soft clicks with each heartbeat. As a rule, patients quickly get used to it.

Another option is biological prostheses . For their manufacture take either the meninges or the pericardium of cattle, horses and pigs. These valves only work from 8 to 15 years. Therefore, biovalves are mainly recommended for elderly patients.

When using biological prostheses, anticoagulation is carried out only during the first three to six months after surgery. In the future, you can do without drugs because of the low risk of embolism.

Alternatively, there are human heart valves obtained from the heart of donor organs. They combine the advantages of biological prostheses with a long shelf life, but the main disadvantage is extremely low availability.

Various types of mechanical and biological heart valves.

Surgery for the treatment of acquired heart disease

Classic heart valve surgery is always performed under general anesthesia. First, the surgeon opens the chest, sawing the sternum. With the help of a special fluid (cardioplegic solution), the heart stops working. During the operation, the heart-lung machine oxygenates the blood and removes excess carbon dioxide from the body. This ensures the supply of blood, rich in oxygen, to all organs. To prevent the formation of dangerous blood clots when in contact with the machine, anticoagulant drugs are administered to the patient.

The surgeon opens the bloodless heart and removes the sore heart valve with a scalpel, making cuts at its base. A so-called flap ring is created. Then the surgeon sews the corresponding prosthesis into the heart muscle. After careful verification of the correct operation of the new valve, the surgeon turns off the heart-lung machine. Two drains are inserted into the wound area, then the chest is sutured again.

Another surgical method, minimally invasive, is used without incision of the sternum. At its performance also artificial blood circulation is not required. It is performed in some centers and is increasingly used.

Percutaneous devices used to treat mitral regurgitation.
A - transcutaneous clamp, which is introduced by venous and trans-septal access to the left atrium and through the mitral opening. The clamp is necessary for grabbing both sashes to further resuspend them. B - device for percutaneous coronary sinus inserted through the jugular vein into the coronary sinus.

Postoperative period

After a heart valve operation, patients are under observation in the intensive care unit for two to three days. Then they are transferred to the usual department.

Already in the intensive care unit, physiotherapy exercises begin that help the patient to get up quickly.

After removal of wound drainage, anticoagulant therapy begins, which lasts at least three months. The threads on the skin of the wound are removed after a week.

If there are no complications, patients usually leave the medical facility after two to three weeks. Drug consumption and follow-up examinations are discussed to ensure long-term prosthetic function. Basically, a hospital stay is accompanied by appropriate treatment.

Drugs prescribed after surgery

Every patient who has undergone surgery on a heart valve should take anticoagulant drugs for three to six months for double-leaf valves and a lifetime when installing artificial valves. A doctor checks blood clotting at regular intervals based on two blood counts. After that, the dosage of the medication is adjusted.

Lung bacterial and infectious components can be attached to the artificial valve and to the endocardium. For this reason, patients should take antibiotics for prophylactic purposes before and after each surgical procedure, for example, during dental treatment or tissue sampling.

It is important to remember that a patient with an artificial valve should notify every doctor prescribed by any treatment about his replacement.

Possible complications after surgery

The occurrence of complications depends, to a certain extent, on the severity of acquired heart disease and concomitant diseases. For example, existing heart failure increases the risk of postoperative pathologies. The following complications are the most common:

  • Early complications are wound infections, pericarditis, infection of the inner lining of the heart (endocarditis), arrhythmias, heart failure and bleeding.
  • Late complications are bleeding disorders (both thrombosis / embolism and bleeding through anticoagulant therapy), infection of the inner lining of the prosthetic heart (prosthetic endocarditis) and heart failure.

Despite the risks of complications, the operation is considered quite safe. The quality of life of most patients is greatly improved due to the artificial heart valve. Many again begin to lead mostly normal lives, play sports and work in their profession.

In some patients, pre-existing heart failure often subsides. The success of a heart valve operation largely depends on how badly the heart is affected.

Conclusion

Acquired heart defects are diseases of the valvular apparatus, and, like birth defects or arrhythmias, can lead to serious complications.

In some cases, PPS does not manifest in any way, and then specific treatment is not carried out. If the disease greatly violates the quality of life of the patient, then treatment is mandatory, most often surgery.

Depending on the indications and the age of the patient, the damaged valve can be reconstructed or replaced with an artificial valve. The operation takes place under general anesthesia and can be a minimally invasive intervention or is performed on an open heart. In the second case, the risks of complications are higher.

Video: Ventricular Septal Defect, Animation


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