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Heart disease pathology: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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In any heart valve, stenosis or insufficiency that causes hemodynamic changes may occur long before the onset of any symptoms. Most often, stenosis or insufficiency is detected in one valve, but multiple valve lesions are possible.
Treatment depends on the severity of the disease. Usually it includes catheterization valvuloplasty (for example, percutaneous balloon commissurotomy, valvulotomy) or surgical correction (eg, surgical commissurotomy, plastic or valve replacement). Two types of valve prostheses are used: bioprosthetic (pig) and mechanical (metal).
Traditionally, mechanical valves have been installed by patients younger than 65 years and older patients with a large expected life expectancy, as bioprosthetic valves function for no more than 10-12 years. Patients with mechanical valves need lifelong administration of anticoagulant drugs with maintenance of MHO within 2.5-3.5 (to prevent thromboembolism) and antibiotics before certain medical or dental procedures (to prevent endocarditis). Prosthetic valves that do not require anticoagulant therapy have been implanted in patients older than 65 years, younger patients with a presumed lifespan of less than 10 years, and with some valve lesions in the right heart. However, new bioprosthetic valves can serve longer than valves of the first generation; so at present the selection of patients for the implantation of certain valves must be reviewed.
If a woman of childbearing age who is planning to have a baby in the future needs to replace the valve, the doctor must correlate the risk of teratogenic action of warfarin (appointed for life after the implantation of mechanical valves) with the risk of accelerated degradation of the bioprosthetic valves. These risks can be reduced by prescribing sodium heparin instead of warfarin in the first 12 weeks and the last 2 weeks of pregnancy, or by frequent echocardiographic studies.
Almost all patients with the pathology of the heart valves are also shown to prevent endocarditis.
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