When the valvular disease assumes a serious form (Grade 3 or 4), it becomes necessary to repair it mechanically. In case of mild or moderate disease, a person can remain healthy with lifestyle changes and medicines only in majority of the cases.
Mechanical treatment is of three types:
- Balloon Valvuloplasty : For the valve which has become too narrow without significant leakage, a balloon is passed through the thigh and taken up to valve. Based on patient’s height, weight and size of the valve, it is inflated with high pressure. As a result the valve gets dilated.
This procedure is comparatively safer as it is done under local anaesthesia and without cutting open the chest. The point of greatest satisfaction is we preserve the valve endowed by nature. It has not become possible for mankind to manufacture an equally good and functional valve as one made by God !
- Surgical valve Repair : When the valve is not diseased to very severe extent, it can be preserved by repairing only. In order to take this decision, it is necessary to do echocardiography by passing and endoscope through the food pipe (TransEsophageal Echocardiography).
This is a very challenging surgery for the surgeon. Only specially trained surgeons can perform such surgeries. If the surgeon is not happy with the quality of valve repair, he may proceed for valve replacement.
- Surgical valve Replacement : If the valve is completely destroyed, it is removed and an artificial valve is fitted in its place. This requires an open heart surgery.
Artificial valves are of two types :
- Artificial Metal valve (Mechanical Prosthesis) :
Advantage : This is valve is quite durable. It remains active for 15- 30 years.
Disadvantage : It is necessary to keep blood thin for the entire life. A medicine like warfarin or Acitrom needs to be taken daily and one has to go for a blood test (PT INR) at a regular interval to know the thinness of blood. Unfortunately, the results of this test vary from time to time and above mentioned drugs have serious interactions with many other drugs and food. If the blood becomes too thin, there is a risk of severe hemorrhage. And if the blood is not adequately thin, it leads to serious consequences due to clotting of blood on this valve : impaired valve function, paralysis, blood clot in hand or leg, sudden shortness of breath or even death.
- Valve Made of Animal Tissue (Bioprosthesis) : The valve created from an animal tissue is fixed by taking stitches on a ring platform and fitted inside the body of a patient. Biggest advantage of this valve is no requirement of blood thinning medicines. The life of this valve is slightly less, approximately 8-15 years.
Several factors such as, age of the patient, preparedness of the patient to take blood thinning medicines and to undergo periodic blood test to assess its effectiveness, risk of haemorrhage due to this drug, the patient’s heart rhythm, etc. are considered while selecting the type of prosthesis valve.
A patient with valvular disease should not get frightened or depressed. A long and good quality life is possible with the help of medicines and if required, percutaneous or surgical interventions.