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Private Cardiology

Improving your heart health

Dr Alamgir Kabir

MBBS BSc(Hons) FRCP PhD

Consultant Cardiologist

GMC No 4308173

email:[email protected]

Telephone 07518 082 240 outside the UK 00447518 082 240

My Blog

Blog

Mitral valve disease

Posted on October 22, 2013 at 3:38 PM Comments comments (480)
The mitral valve separates the left ventricle from the left atrium. It acts like all valves in the heart-- as a one way valve. This allows the blood to flow forward when the heart contracts and prevents leaking back into the left atrium as the heart relaxes between each contraction. The valve is composed of two leaflets which look, with the eye of faith, like the mitre the Pope wears-- hence the mitral valve.
The valve can become leaky (mitral regurgitation or MR) and this can cause the blood to leak into the left atrium. Patients can become more breathless as a result. In some patients it can cause the heart rhythm to become irregular. Breathlessness and palpitations are the main symptoms. Some patients can have mild to moderate degrees of leakiness of the valve and have no symptoms at all. The reasons for the leaking valve are several. The left ventricle can enlarge in conditions such as heart failure and this can lead to valve stretching and thus not closing tightly enough. The leaflets can become more floppy and prolapse back. In more dramatic cases the valve can become leaky after a heart attack or after an infection affecting the valve itself (endocarditis).
The valve can become narrowed (mitral stenosis or MS). This can be related to rhematic fever as a child. Some patients are born with a narrowed valve. Patients can present with breathlessness and palpitations. It can be undiagnosed for years and present when the heart is having to work harder, such as in pregnancy.
The treatment for a leaky valve if the degree is severe enough usually involves open heart  surgery. There are many patients with varying degrees of MR that simply need to be monitored for a period of time and can be managed well on medication for many years. In assessing the degree of leakiness a patient may require and angiogram which also focusses of the right heart pressures. They may also require a special type of echocardiogram called a transoesophageal echo. Recently there has been some cases of a mitral valve clip that can be used to reduce the leakiness which can be done via a procedure through an artery in the leg.
A narrowed valve may also require a surgical operation depending on the degree of narrowing. A balloon procedure that is performed from the leg is also possible in some patients.
With mitral valve disease monitoring of the valve with serial echocardiograms (ultrasounds of the heart) is important. The timing of heart surgery is important especially in mitral regurgitation.

Aortic valve disease

Posted on September 29, 2013 at 2:29 PM Comments comments (524)
The heart normally has four valves in it. They all act as one way valves--opening fully allowing the heart to push blood forward when the heart contracts and -- closing completely stopping the blood from leaking backwards when the heart relaxes.
 
The Aortic valve
This valve separates the left ventricle (the main pump chamber of the heart) from the aorta (the main blood vessel-- supplying blood to the rest of the body).
 
The aortic valve can become narrowed (aortic stenosis). This restricts the blood flow out of the heart. Patients may have- no symptoms, or chest pain, shortness of breath and even dizziness and collapse. An echocardiogram can usually distinguish the degree of narrowing. In some patients the degree of narrowing is monitored and it does not require any intervention such as a surgical valve replacement. However if the degree of narrowing becomes severe and the patient has symptoms then an operation on the heart valve may be deemed necessary.
 
The aortic valve can become leaky (aortic regurgitation or incompetence). This means that when the heart contracts only a portion of the blood goes forward. The rest leaks backwards. Patients may have no symptoms or have increasing shortness of breath when they exercise or difficulty in breathing even at rest. If the degree of leakiness is sufficiently bad the valve may need to be surgically replaced.
 
Traditionally the replacement of the valve is done by surgery however when the risk of surgery is very high some patients have had the procedure done via a tube inserted in the leg (a percutaneous procedure). The reason for not offering this to everyone is that the long term results of this are not certain.
 
If you are being worked up for an aortic valve replacement you may need an coronary angiogram to look at the blood vessels of the heart (the coronary arteries). Please previous blog on coronary angiograms.
 
If you have any questions about your case please drop me an email.

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