Valves of the heart
To better understand how valvular heart disease affects the heart, a review of basic heart anatomy and valve function follows. The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles.
While there are many causes of valvular heart disease (including rheumatic fever, congenital heart disease, cardiac dilation, and age-related calcification of the valves), whatever the cause, heart valve problems are generally manifested in one of two ways. Either the valve openings become too narrow and blood has a difficult time crossing the valves (i.e., stenosis), or the valves become incompetent, allowing blood to leak across the valves when they are supposed to be closed (i.e., regurgitation).
There are valves between each of the heart's pumping chambers : -
Tricuspid valve - located between the right atrium and the right ventricle
Pulmonary (or pulmonic) valve - located between the right ventricle and the pulmonary artery
Mitral valve - located between the left atrium and the left ventricle
Aortic valve - located between the left ventricle and the aorta
Valvular stenosis causes “damming up” of the blood behind the valve. This damming up of blood leads to increased pressure in the cardiac chambers behind the valve.
Valvular regurgitation allows blood to wash backwards across the valve when the valve should be closed. This extra volume of blood produced by this backwash causes dilation of the cardiac chambers receiving the extra blood.
Both increased pressures and increased blood volume in any of the cardiac chambers can eventually produce permanent weakening of the cardiac muscle, and can ultimately lead to heart failure. Either stenosis or regurgitation in a cardiac valve causes turbulence of blood flow, and that turbulence is detected as a “heart murmur” when the doctor listens to the heart with a stethoscope. Generally, heart valve problems can be readily diagnosed by performing an echocardiogram.
The tricuspid valve :-
The tricuspid valve separates the right atrium from the right ventricle. When the tricuspid valve develops stenosis, increased pressure in the right atrium leads to high pressure in the veins throughout the body, causing edema (swelling) of the liver, abdomen and legs. When tricuspid regurgitation occurs, both the right atrium and right ventricle tend to dilate, reducing the efficiency of both these cardiac chambers.
The pulmonic valve :-
The pulmonic valve separates the right ventricle from the pulmonary artery. With pulmonic stenosis there is increased pressure in the right ventricle. With pulmonic regurgitation there is volume overload of the right ventricle. Either way, the right ventricle can ultimately fail.
The mitral valve :-
The mitral valve separates the left atrium from the left ventricle. Mitral stenosis causes damming up of blood in the left atrium, and ultimately in the lungs. Mitral regurgitation causes dilation of both the left atrium and left ventricle, and can lead to failure of both cardiac chambers. Mitral valve prolapse (MVP) is a common condition that results in one of the leaflets of the mitral valve flopping backwards into the atrium during the contraction of the left ventricle. MVP often involves at least mild regurgitation. Click here for a discussion of MVP.
The aortic valve :-
The aortic valve separates the left ventricle from the aorta. Aortic stenosis causes increased pressure in the left ventricle. (Click here for a complete discussion of aortic stenosis.) Aortic regurgitation causes dilation of the left ventricle. Both of these aortic valve problems can lead to heart failure
Reasons for the Procedure :
Valvuloplasty is performed in certain situations in order to open a heart valve that has become stiff as a result of disease or the aging process. Not all conditions in which a heart valve becomes stiff are treatable with valvuloplasty. There may be other reasons for your physician to recommend a valvuloplasty.
Risks of the Procedure :
Possible risks associated with valvuloplasty include, but are not limited to, the following : -
Bleeding at the catheter insertion site
Blood clot or damage to the blood vessel at the insertion site
Infection at the catheter insertion site
Cardiac dysrhythmias/arrhythmias (abnormal heart rhythms)
Rupture of the valve, requiring open-heart surgery
After the Procedure :
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
Bed rest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bed rest may be of shorter duration. In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bed rest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
At home :
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the injection site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your physician.
If your physician used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin at the injection site. This is normal. The knot should gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions. You may be advised not to participate in any strenuous activities. Your physician will instruct you about when you can return to work and resume normal activities.
Balloon Mitral, Aortic and Pulmonary Valvuloplasty :-
Balloon valvuloplasty or percutaneous balloon valvuloplasty, is a surgical procedure used to open a narrowed heart valve and is at times referred to as balloon enlargement of a narrowed heart valve.
There are four valves in the heart - aortic valve, pulmonary valve, mitral valve and tricuspid valve - each at the exit of one of the heart's four chambers. These valves open and close to regulate the blood flow from one chamber to the next and are vital to the efficient functioning of the heart and circulatory system. Balloon valvuloplasty is used primarily to treat pulmonary, mitral and aortic valves when narrowing is present and medical treatment has not corrected or relieved the related problems.
Valvuloplasty is recommended for those patients whose symptoms continue to progress even after medication has been administered for a period of time.
Depending on the severity of the stenosis, surgery is needed to correct the defect. Another option may be a balloon valvuloplasty if the narrowing involves valve alone. This procedure is done by the cardiologist.
This can sometimes lead to enlargement of the right ventricle. Depending on the severity of the pulmonary stenosis, open heart surgery may be indicated to correct the defect. Another option is balloon valvuloplasty. This procedure is done in the cardiac catheterization lab
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