How Is Heart Valve Disease Managed?
Short of actual replacement of the heart valves, there are other remedies that are indicated, depending on the site and extent of the valvular disease and whether or not it is life-compromising or life-threatening. Because the results are not as consistent or successful as with surgical repair (commissurotomy) or replacement with prosthetic valves, they are usually reserved for patients deemed unsuitable surgical candidates.
For the specific valve disease, the following are appropriate.
- Aortic valve replacement for severe disease and decreased left ventricular fraction, via either bio prosthesis or mechanical valve
- Percutaneous balloon valvotomy, reserved for those who are poor surgical risks
- Transcatheter aortic valve implantation, also for poor surgical candidates
- Aortic valve replacement is the treatment of choice
- Aortic valve repair in some endocarditis patients
- Mitral valve repair, if possible, is the treatment of choice.
- Surgical repair (commissurotomy) is the preferred surgical treatment of choice.
- Depending on the morphology of the mitral valve, percutaneous balloon valvuloplasty may be a better choice for a patient.
- Medical management with diuretics when mild
- For severe disease, repair is preferable to replacement
- Replacement is via bioprosthesis, which is preferable to mechanical valves
Other conditions associated with valvular disease, such as heart failure, hypertension, or arrhythmias, call for treatment themselves (medical or surgical) in the therapeutic search for the best outcome.
Other surgical treatments for comorbidities can be considered at the time of definitive valvular treatment. Treatment for coronary artery disease or atherosclerosis, while often indicated, add additional invasive approaches that can increase the risk of in-hospital mortality. Consequently, all combined surgical procedures must pass muster with a very careful risk-vs-benefit appraisal.