Heart Valve Treatment
Medical Therapy
There are four major classes of heart failure according to the New York Heart Association:
- Class I: The patient has no limitations with activity
- Class II: The patient has slight limitations with activity
- Class III: The patient has severe limitations with activity
- Class IV: The patient has symptoms even at rest and discomfort with any activity
Medical therapy is useful for milder forms of valve disease, but it must be remembered that it is sometimes difficult to treat a mechanical problem with a medicine. Your doctor may recommend medicines to make the heart stronger or to lower the blood pressure, which can make it easier for the heart to pump blood out of the heart.
Surgical Therapy
We have come a long, long way in the surgical treatment of valvular heart disease. In 1968, if you had your heart valve replaced, you had a 42% chance of dying. Depending on the age and condition of the patient, the risk of dying with valve surgery today is often less than 2%. The results of surgery are better today, with better artificial valves and the ability to repair many valves. These good results with surgery often depend on getting to the problem early, before the valve is terribly damaged, before the heart is weakened, and before the patient is very ill. In addition, with some severe valve diseases, there is the small risk of sudden death without warning.
Indications
For almost all valve problems, surgery is indicated if the patient has Class III symptoms. As surgery has become safer and the results better, most patients with Class II symptoms should be considered for surgery. And in this day and time, for many patients that have severe valve disease, surgery is recommended for patients with Class I status or no symptoms at all.
Early Surgery
As mentioned above, the surgeon's ability to provide a safe and effective operation is partially determined by the condition of the patient, the heart, and the valve. This is leading more cardiologists and surgeons to consider operating early in the disease course. This is especially true of mitral regurgitation, if the doctors believe that there is a high likelihood that the valve can be repaired. These concepts are discussed under the headings for each valve disease separately. A good reference for this is the ACC/AHA 2006 Guidelines for the Management of Patients with Valvular Heart Disease
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