Valvular heart disease

Aortic Stenosis

Other names: : AS, ‘narrowed’ aortic valve

Basic overview

Aortic stenosis is a progressive condition characterised by thickening and reduced mobility of the aortic cusps, eventually leading to marked restriction of blood flow from the left ventricle to the aorta.

Most people have 3 aortic cusps, but there are several variations in this, the most common being a ‘bicuspid’ aortic valve which affects about 1% of the population – this results in only 2 cusps, and accelerated valve dysfunction, which can be in the form of narrowing (stenosis) or a leaf (regurgitation)

Symptoms

Progressive exertional breathlessness is the most common symptom. In advanced cases patients can experience chest tightness, exertional syncope (black outs with exercise) and heart failure

Treatment

  • This is a ‘mechanical’ problem, that in most cases requires a ‘mechanical’ solution. Medications such as diuretics can be used to alleviate some symptoms, but once symptoms develop prompt decision making as to the appropriateness of valve intervention is critical.
  • Valve intervention can be either via a surgical replacement (sternotomy – i.e. open heart surgery) or a transcatheter replacement (usually via the femoral artery). Your cardiologist will help decide what is the best and most suitable option for you.

Aortic Regurgitation

Other names: AR, ‘leaking aortic’ valve

Basic overview

The aortic valve functions as a ‘one-way’ valve allowing blood to be ejected from the left ventricle to the aorta. Aortic regurgitation is the backwards ‘leak’ of blood from the aorta into the left ventricle.

Commonly, a small amount (trivial) of aortic regurgitation can be detected via echocardiography. However, with advancing age, hypertension or other conditions (such as valve infection) – the degree of aortic regurgitation can range from mild to severe

Symptoms

Progressive exertional breathlessness is the most common symptom. When the heart is unable to cope with amount of aortic regurgitation, or if it occurs very quickly patients may experience ankle swelling and breathlessness when laying flat (orthopnoea).

Treatment

  • Like aortic stenosis, severe regurgitation is a ‘mechanical’ problem, that in most cases requires a ‘mechanical’ solution.
  • Mild or moderate degrees of regurgitation don’t generally require intervention. Instead, medications to reduce blood pressure are often used to slow the progression.
  • Severe regurgitation requires valve replacement surgery if the patient is considered ‘fit’ enough. Generally speaking, transcatheter aortic valve replacement is not indicated / suitable in pure aortic regurgitation due the absence of calcium to anchor the device.

Mitral Stenosis

Other names: : MS, narrowed mitral valve

Basic overview

The mitral valve consists of a large anterior leaflet and a smaller posterior leaflet. It allows the passage of blood from the left atrium to the left ventricle.

Mitral stenosis is a condition that leads to progressive thickening and restriction of the mitral leaflets that make it more difficult for blood to flow into the left ventricle. The two most common causes of mitral stenosis are rheumatic heart disease (long-term consequence of childhood rheumatic fever), and mitral annular calcification (usually seen in older patients, advanced kidney disease – particularly if on dialysis).

As the condition worsens, the pressure in the left atrium becomes higher to ‘force’ the blood into the left ventricle. Eventually, this puts strain on the blood vessels in the lung circulation and right-side of the heart.

Symptoms

Exertional breathlessness is the most common symptom

Later in the course of disease patients may develop arrhythmias (atrial fibrillation) which significantly increase the risk of stroke.

Treatment

  • Invasive treatment for mitral stenosis is required when it becomes severe (either at rest or with exercise).
  • Depending on the appearance of the mitral valve and age of the patient, some people may be offered a balloon valvuloplasty.
  • Many patients will require a valve replacement, particularly is there is a lot of ‘calcium’ in the leaflets / supporting structures

Mitral Regurgitation

Other names: MR leaky mitral valve, mitral valve prolapse, floppy mitral valve, MVP

Basic overview

The mitral valve consists of a large anterior leaflet and a smaller posterior leaflet. It allows the passage of blood from the left atrium to the left ventricle, and prevents ‘backwards’ flow during ventricular contraction, so that blood is only permitted to flow into the aorta.

Mitral regurgitation is where blood travels ‘backwards’ from the left ventricle to the left atrium during ventricular contraction – this reduces the amount of blood pumped into the aorta.

As this condition worsens, the left atrium becomes larger to accommodate the ‘extra’ blood and this in turn places increased strain on the vessels in the lung (causing breathlessness).

If severe and untreated, this can lead to heart failure.

Symptoms

Exertional breathlessness is the most common symptom

Later in the course of disease patients may develop arrhythmias (atrial fibrillation) which significantly increase the risk of stroke

Treatment

  • Invasive treatment for mitral regurgitation is generally required when it becomes severe and associated with symptoms or heart muscle impairment (even in the absence of symptoms).
  • Depending on the appearance of the mitral valve, it may be possible to repair the leaflets, or a valve replacement (tissue or mechanical) may be required in more complex abnormalities

Tricuspid Stenosis

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Tricuspid regurgitation

Coming Soon

Pulmonary stenosis

Coming Soon

Pulmonary regurgitation

Coming Soon

Our Locations

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Cardiology Tasmania has 3 specialist centres located in Howrah, Derwent Park and Huonville. As well as our fixed locations, our cardiology specialists and consultants travel to regional and remote areas to ensure all patients have access to cardiology services regardless of where they live.

Call Us:
(03) 6245 8999
Howrah
Outreach Medical Group Building 250 Clarence Street, Howrah

Services Provided

  • Consultations
  • Transthoracic echocardiograms
  • Stress echocardiograms
  • Holter monitors
  • ECGs

Derwent Park

Northcare Health Centre, 254 Main Road, Derwent Park, TAS

Services Provided

  • Consultations
  • Transthoracic echocardiograms
  • Holter monitors
Huonville
Huon Valley Health Centre, 85 Main Road, Huonville, TAS

Services Provided

  • Consultations
  • Transthoracic echocardiograms

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