As it is known, the heart is the organ that pumps blood in our body. Two separate pumps, right and left, connected and working in harmony with each other, consist of two chambers. There are atria and ventricles on the right and left. The mechanisms that control the passage of blood from the atrium to the ventricle and from the ventricle to the arteries are heart valves. On the right side, there is a three-leaflet tricuspid valve between the auricle and ventricle, and on the left side, there is a two-leaflet mitral valve between the left ventricle and the left atrium. There are semilunar valves consisting of 3 small leaflets, two of which go to the arteries, that is, the part leading to the pulmonary artery from the right side and the main aortic artery from the left side. There are 4 separate heart valves in total. It is more widely known because the valves that are most frequently affected by diseases and require treatment are the aortic and mitral valves.
Why do heart valves deteriorate?
These valves are naturally made of fibrous tissue inside the heart and are flexible. In other words, it is movable. It allows unidirectional movement of blood in the process of pumping it into the circulation. It has a structure that prevents blood from flowing backwards and fully allows forward passage.
These valve structures and their functions can deteriorate or become diseased for three main reasons:
The first is congenital, embryo development. It may be due to an error in the period when the heart valve does not close sufficiently or develops in a way that creates a stenosis that cannot create sufficient opening. These are diseases that occur in babies and children.
The second main group occurs in the form of wear, deterioration, rupture and leakage of the heart valves due to serious microbial diseases in childhood or later in adulthood. After the microbial disease is overcome, stenosis may occur with the development of fibrous tissue and calcification during the healing process and the functions of the valves may become abnormal.
The third main group is the one we see in older ages, usually between the ages of 60-70. These are disorders in the form of leakage or stenosis, calcification or ruptures, which are characterized by wear and tear over the years.
Basically, we can classify them into these 3 main groups. But apart from microbial diseases There are also other diseases that we encounter less frequently, such as rheumatic diseases, which we see more in adulthood, that is, the malfunction of these valves due to some disorders of the immune system, or the dysfunction of the valves due to the development of some cancer or cancer-like tumors in the valve. Deterioration of the muscle tissue that supports the valve leaflets or changes in the geometry of the ventricle in connection with myocardial infarction may also impair valve functions.
What kind of symptoms does the deterioration of the heart valve cause?
We generally categorize heart valve disorders into two main groups: stenosis or retrograde leakage. In these cases, the heart, which has to work harder to provide the required amount of blood due to overload, will gradually grow and expand. Higher than normal working speed and load may also lead to thickening of the heart muscles and rhythm disorders.
It can usually cause symptoms such as shortness of breath, palpitations and rhythm disorders. In more advanced stages, symptoms such as edema in the legs or severe shortness of breath, inability to breathe properly even in bed, and lack of oxygen, which occur in other advanced stages of heart failure, may occur.
Heart. How is valve disease detected?
Apart from these symptoms, the physician's examination will include listening to the heart with a stethoscope during the general heart-related examination - that is, listening to whether there is any abnormality in the sounds created by the blood passing through the valves - and whether there is any stenosis or leakage in the valves. Most of the time it is understandable. But today, apart from this rough physical examination, more advanced examination methods are;
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ULTRASONOGRAPHY (Echocardiography and Doppler Ultrasound)
Ultrasonography, i.e. These are examinations performed on the heart using sound waves, without any external intervention (such as a needle, etc.). With echocardiography and Doppler ultrasound examination, which are subgroups of ultrasonography, it is easy to understand whether there is leakage or stenosis in the valves. Enlargements and thickenings in the heart cavities are evaluated, and accordingly, it is determined whether the disease or disorder requires any treatment. The decision is made.
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ANGIOGRAPHY
Although the most valuable diagnostic tool in examining the heart valves is echocardiography, today tomographic angiography or classical angiography With these methods, other features of the heart, the condition of the vessels, whether the coronary vessels are open or not, and the presence of other disorders are evaluated. It is also possible to perform other examinations regarding the functions of the heart with MR angiography.
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ECG (Electrocardiography)
Apart from echocardiography, it is also the most basic One of the examinations is electrocardiography, in which we detect the conduction system of the heart and conduction abnormalities. Briefly, there is an examination method called ECG, which evaluates whether electrical activity and heartbeats are regular.
Are all of these examinations needed?
A single examination is usually sufficient. It isn't happening. First of all, after performing the examination, the necessary examinations are carried out according to the detected or suspected condition and a diagnosis is made. In most valve diseases, immediate intervention or treatment methods may not be required immediately and it is very important to provide treatment at the right time. Therefore, it may be necessary to check the patient at 3-month, 6-month or yearly intervals and to monitor the changes in the leakage or stenosis in the valves through ultrasonographic examination and to determine the correct intervention time. Sometimes this follow-up lasts for years.
Is the detection of the presence of heart valve disease the beginning of a follow-up process?
This follow-up period is extremely important in terms of applying the right treatment at the right time. Because early treatment attempts may cause the patient to have more than one unnecessary surgery or to be exposed to some unnecessary risks.
TREATMENT METHODS
Basically, Although there are some drug treatments to be applied during acute illness periods related to infectious diseases or the immune system; In cases of progressive insufficiency or stenosis, the valve is repaired or replaced with an artificial valve. This requires a surgical procedure. Heart surgeries are not simple but very detailed surgeries. It is of vital importance .
Which valves are used in heart valve replacement?
We have two basic alternatives: metal and biological valves. They are valves made of a very light metal, the inner ring of which is usually titanium, which prevents blood from flowing back. These valves are coated with carbon and have a special structure that prevents blood from clotting in that area when blood hits this surface. The damaged cover is replaced by stitching rings that allow it to be attached from the edge with stitches. It is manufactured ready-made in various diameters. It is placed correctly by selecting a diameter appropriate to the size of the patient's heart and the width of the valve ring. Apart from the metal cap, there are also biological caps. These are valves with a biological tissue structure obtained directly from various animals such as cattle or pigs.
How is it decided whether to install a metal or biological valve?
METAL COVERS
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Metal Covers have become increasingly better over the years and are manufactured to be very long-lasting. In other words, a metal valve fitted to a young patient can serve him throughout his life.
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However, in terms of its coagulation surface, it has a structure that can cause blood clotting compared to biological valves. For this reason, the patient needs to use blood thinners throughout his life after the valve is installed.
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Problems such as bleeding or clotting occur at a rate of up to 1-2% annually in metal valves. This increases to significant levels in increasing years, such as 10-20 years. The annual rate of 1% reaches 20% in total after 20 years, which means approximately one fifth of the patients who undergo surgery.
BIOLOGICAL VALVES
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The most important feature of biological valves is their low tendency to clot. There is no need to use blood thinners in the long term, except for the early few months in applied patients.
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Not using blood thinners in biological valves provides a serious difference in complications compared to metal valves.
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For this reason, biological valves should be used especially in young female patients, women who have not given birth and women who want to give birth. It is especially preferred in older patients or older patients, that is, patients over the age of 65-70 who do not have a long-term life expectancy and who have a higher risk of bleeding due to blood thinners.
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The restrictive feature of biological valves. is that their lifespan is short. Generally, we can talk about an average lifespan of 10-15 years. Wear gradually increases after 7-8 years and most of them have to be replaced after 15 years. Due to its limited lifespan, it requires a second surgery to install a new valve.
Heart valve repair is also possible…
If If there is no severe damage to the valves, repair methods such as repairing the leaflets of the valve without using any artificial material or by adding a small suture ring to support the valve, and if there is a broken chordal structure, adding a new chordale instead, are used. It may be possible to open the existing stenosis or, if there is insufficiency or leakage, to eliminate the leakage and make the valve resealable and flexible. Repair methods are frequently used, especially in mitral valve patients, that is, if there is blood leakage back from the left ventricle to the left atrium or if the blood flow from the atrium to the ventricle is restricted due to stenosis. A little more surgical technical experience and knowledge is required to use these surgical methods. A successful repair will provide benefits for at least 5 years, usually 8-10 years or even longer, and sometimes up to 15-20 years. This is preferred over artificial valve implantation and should be evaluated as a priority.
How is heart valve repair performed?
Basically, almost all repair techniques are performed by open heart surgery method. However, with the new methods developed in recent years, special prostheses and artificial valves with stents have begun to be developed, especially for the aortic valve, which is where the transition from the left ventricle to the main artery, that is, the aortic vein, is provided, by entering directly from the groin or by making a small hole in the rib cage without stopping the heart. People with extreme problems, such as kidney disease, lung disease, liver disease, which pose very serious risks, especially in terms of heart surgery.
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