HEALTH MATTERS: Is open-heart surgery the only option for a narrow valve?My elderly mother has been told that she has a severely narrow heart valve that needs to be fixed. Is open heart surgery the only option?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. My elderly mother has been told that she has a severely narrow heart valve that needs to be fixed. Is open heart surgery the only option?
A. The normal human heart has four valves, which are designed to channel the flow of blood in one direction. They open to let the blood out, and then close to prevent blood from leaking back. Valves can become damaged in one of two basic ways—they can leak when they should be closed, or they may not open properly. When the leaking or the narrowing is severe, marked cardiac symptoms (like shortness of breath and exercise intolerance) may develop, and then the usual course is to either surgically repair the valve (usually reserved for severely leaking valves) or replace the valve with a prosthetic valve. Your mother—an elderly patient with a narrowed heart valve—almost certainly has what we call aortic stenosis, narrowing (stenosis) of the aortic valve that is between the main pumping chamber of the heart and the main blood vessel, the aorta. In the past, the only option was to replace the damaged valve during open heart surgery; unfortunately, medical therapy isn’t overly helpful in this situation. But recently, a new option has appeared, called TAVR or transcatheter aortic valve replacement. In this procedure, a new prosthetic aortic valve is inserted, but it is placed on a tube that is surgically inserted into a large artery in the groin. The advantage of the procedure is that open heart surgery is avoided. But it is a new procedure with its own drawbacks and limitations, including an increased risk of stroke and the need for a permanent pacemaker in a third to almost half of the patients. Despite these concerns, it is an option that should be considered, especially in elderly, frail, and chronically ill patients. So your mother might be a candidate for TAVR; you and she should discuss this option with her health care provider.
Q. Is there any relationship between blood type and the risk of coronary heart disease?
A. Up until recently, I would have said “No, there is no relationship.” We do know of at least five factors that increase the risk of getting coronary heart disease, including diabetes, cigarette smoking, high blood pressure, high cholesterol, and being male (or being more than ten years post-menopausal in a woman). But blood type wasn’t on the list—until recently. It turns out that a just-reported study followed about 90,000 people for about 20 years, and found that blood type O—the most common—was least commonly associated with heart disease. Type A, followed by B, and especially type AB were increasingly associated with disease. However, even the “worst” one (AB) only had about a 23 percent increased risk, which in epidemiological terms is quite modest. And an association by no means implies cause. In other words, we really don’t know how blood type is related to the risk of heart disease. But this interesting finding is sure to spur further studies to try to unravel the relationship. And more knowledge about heart disease always is a good thing!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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