A little more than one in ten people, after the age of 75, can have a disease of one or more valves of the heart. and after the age of 65 the risks increase, according to international research estimates.
In some cases, especially if the picture is not particularly serious, disturbances may not occur, even if blood circulation is not optimal. In others you may have different symptoms, from palpitations to breathlessness and loss of consciousness. Or even pains that can make you think of a heart attack. Then the specialist discovers that a valve does not “normally allow blood to pass through it when it is pushed (in this case we speak of stenosis) or / and does not close perfectly at the right time, allowing blood to regurgitate backwards. (insufficiency).
In all cases the picture must be identified and then treated, case by case, always remembering that sometimes in the same valve there can be insufficiency and stenosis and that these pathologies can occur in several valves at the same time.
But how should we behave? To give an answer, the guidelines of the European Society of Cardiology (Esc) andEuropean Association for Cardio-Thoracic Surgery (Eacts), published on European Heart Journal.
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According to the new guidelines, the first fundamental step is to undergo a cardiological examination. Clinical examination, according to the guidelines, is a fundamental factor in identifying the suspicion of a valvular pathology. Then we move on to finer diagnostic tests, favoring tests that are not invasive starting from echocardiography and then deepening with other tests, on the advice of the carers.
On the treatment front, the key factor is to rely on centers that have a high volume of treatments and that can address the situation by identifying times and methods of treatment thanks to a specialized unit (Heart Team) which includes clinical and interventional cardiologists, cardiac surgeons, imaging specialists, cardiovascular anesthetists and nurses. It is fundamental, case by case, to always keep in mind the clinical picture and the anatomical situation together, as well as the patient’s preference.
Heart door
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This leads to the cure. According to the ESC communication, interventions (percutaneous or surgical) are indicated in symptomatic patients if there is an expected benefit.
Decision making in asymptomatic patients must weigh the risk of surgery against the expected natural history of the disease: when rapid progression of symptoms is expected, intervention may be justified if procedural risk is low. In elderly patients, decisions should consider the estimated impact of treatment on life expectancy and quality of life. In short: the patient also plays an important role in choosing the approach.
According to the president of the Eacts task force, Friedhelm Beyersdorf dell’University of Freiburg, “Patients and their families should be carefully informed and assisted in their choices. Symptom relief alone may justify intervention if it is a priority for the patient. However, treatment is considered useless when it is not expected to prolong life or relieve symptoms “.
Finally, on the choice of intervention modalities, the guidelines recall that greater experience and procedural safety have led to greater indications towards early surgery in asymptomatic patients with aortic stenosis, aortic insufficiency or mitral insufficiency. The guidelines emphasize the need for more comprehensive evaluation and early surgery in tricuspid regurgitation to avoid irreversible heart damage.
Regarding percutaneous techniques, good outcomes in high-risk or inoperable patients with aortic stenosis and mitral regurgitation have led to an increase in indications, as long as futility is avoided.
The guidelines also report that the encouraging preliminary experience with transcatheter tricuspid valve interventions suggests a potential role for inoperable patients, but this needs to be confirmed by further evaluation.
Valves of the heart, when surgery can be avoided
The guidelines just presented focus on the aortic, mitral and tricuspid valves. To understand their role and functioning, it is necessary to remember the anatomy of the heart. Between the atria and the ventricles and at the point where the blood is pushed from the ventricles into the blood vessels there are valves, which have the task of regulating the flow of blood and preventing it from traveling backwards.
In perfect synchronism, without us noticing it, these valves normally open when the blood must pass, allowing it to flow smoothly and close immediately afterwards, avoiding the formation of blood backflows in an anti-anatomical sense.
The tricuspid and pulmonary are found in the right heart, the mitral and aortic in the left. Tricuspid and mitral are located between the atria and ventricles, while the pulmonary and aortic regulate the flow of blood from the heart to the vessels.
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