Valvular Heart Diseases

Valvular heart diseases are a group of conditions that involve abnormalities of one or more of the heart valves, affecting their ability to regulate blood flow through the heart leading to a range of serious health issues.  

Valvular heart disease is treated in Cuba with a broad range of therapy and interventions aimed at improving and managing heart health, such as medication, advanced surgical procedures, and lifestyle changes. 

Types of Valvular Heart Disease 

The heart has four valves: the aortic, mitral, pulmonary, and tricuspid valves.  Valvular heart diseases occur when one or more of these valves become damaged. Valvular heart diseases can be broken down into two categories: 

Valvular Heart Stenosis:  

Stenosis refers to the narrowing of heart valves, impeding blood flow and oxygen supply forcing the heart to work harder to pump blood.  

• Aortic Stenosis: Narrowing of the aortic valve, which can lead to reduced blood flow from the heart to the body. 

• Mitral Stenosis: Narrowing of the mitral valve, which can impede blood flow from the left atrium to the left ventricle. 

• Pulmonary Stenosis: Narrowing of the pulmonary valve, which can restrict blood flow from the right ventricle to the lungs. 

• Tricuspid Stenosis: Narrowing of the tricuspid valve, which can hinder blood flow from the right atrium to the right ventricle. 

Valvular Regurgitation:  

Regurgitation, also known as valvular insufficiency or valvular incompetence, occurs when the heart’s valves fail to close tightly, allowing blood to leak backward (flows back to the valves) instead of moving forward as it should. 

• Aortic Regurgitation: Leakage of blood backward through the aortic valve, causing blood to flow back into the left ventricle. 

• Mitral Regurgitation: Leakage of blood backward through the mitral valve, causing blood to flow back into the left atrium. 

• Pulmonary Regurgitation: Leakage of blood backward through the pulmonary valve, allowing blood to flow back into the right ventricle. 

• Tricuspid Regurgitation: Leakage of blood backward through the tricuspid valve, causing blood to flow back into the right atrium. 

Mixed Valve Disease:  

This occurs when a single valve has both stenosis and regurgitation, causing a combination of restricted blood flow and leakage. 

Multiple Valve Disease:  

This occurs when multiple valves are affected, either through stenosis, regurgitation, or both, resulting in complex hemodynamic changes (alterations in blood flow and pressure) that require comprehensive management. 

Causes 

 Valvular heart disease can be the result from various factors, including: 

• Congenital Heart Defects: Structural abnormalities present at birth. 
• Rheumatic Fever: An inflammatory disease that as a complication of untreated strep throat or scarlet fever 
• Infective Endocarditis: Infection of the inner lining of the heart and valves. 
• Degenerative Changes: Age-related wear and tear on the valves. 
• Other Conditions: Such as high blood pressure, heart attack, and connective tissue diseases. 

Symptoms 

• Shortness of breath, especially during exertion or when lying down 
• Fatigue and weakness 
• Swelling in the ankles, feet, or abdomen 
• Chest pain or discomfort 
• Palpitations or irregular heartbeats 
• Dizziness or fainting 
• Rapid weight gain due to fluid retention 

Diagnosis 

• Echocardiogram: Uses ultrasound waves to create detailed images of the heart valves and chambers. 
• Electrocardiogram (ECG): Records the electrical activity of the heart to detect irregularities. 
• Chest X-ray: Provides images of the heart, lungs, and blood vessels. 
• Cardiac MRI: Offers detailed images of the heart’s structure and function. 
• Cardiac Catheterization: Involves inserting a catheter into a heart artery to measure pressures and evaluate blood flow. 

Treatment 

Treatment of valvular heart diseases in Cuba depends on the specific type and severity of the condition and may include a combination of medications, lifestyle changes, and surgical procedures. 

• Medications: To manage symptoms and reduce the risk of complications.

• Lifestyle Changes: Including a heart-healthy diet, regular exercise, and smoking cessation. 

• Surgical Procedures: 

• • Valve Repair: This procedure is aimed at correcting dysfunction in one of the heart’s valves to restore its proper function and improve blood flow. Techniques can include: 
    • Annuloplasty, where the valve’s ring is tightened or reinforced 
    • Valvuloplasty, which uses a balloon to open a narrowed valve 
    • Leaflet repair, which involves reshaping or fixing the valve leaflets to ensure they close properly.  
  • Valve repair can effectively alleviate symptoms, improve quality of life, and reduce the need for long-term anticoagulation therapy, often making it a viable option for patients with specific types of valvular heart disease. 

• • This approach is often preferred over valve replacement because it preserves the patient’s natural valve and maintains its original anatomy. 

• • Valve Replacement: This procedure is carried out to treat severe valvular heart diseases when repair is not feasible and involves removing the damaged valve and replacing it with either a mechanical valve, made from durable materials, or a biological valve, derived from animal tissue or donated human valves.