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Professor Dr. Dale Adler MD, prominent cardiologist and medical heart disease treatment expert, and Dr. Anton Titov MD PhD MBA / Exclusive interview on medical therapy for coronary heart disease, high cholesterol and hypertension treatment, and sudden death prevention and treatment.
Let's start with valvular heart disease. My mother had mitral valve repair at Brigham and Women's Hospital several years ago. So I learned a lot about mitral valve repair surgery from a patient perspective. Process of treating valvular heart disease is intricate. Valvular heart disease treatment has to be perfectly timed and choreographed. Only then treatment cures the patient with mitral valve prolapse. But not everyone needs the surgery immediately. What is the role for medical treatment in valvular heart disease? How to prepare a patient for valvular heart disease surgery? How to treat the patient after surgical operation for valvular heart disease? You are asking a very interesting question in the entire realm of cardiology. Let's talk about mitral valve prolapse repair. 2.5% of males and 6.5% of females in the United States have mitral valve prolapse. A study was done many years ago to listen to the heart of young people. 15% of all young people entering college had mitral valve click So 15% of all people have mitral valve click. But only 6.5% of all women and 2.5% of all men have real mitral valve prolapse. In real life 90% of all people who have mitral valve click will do perfectly fine throughout their life span. Only 10% percent of people with mitral valve murmur will need attention to their mitral valve. So it is a becoming a progressively smaller number of people who need medical attention to their heart valve. We see patients and take a good listen to their heart. Some of them have mitral regurgitation. So we do an echocardiogram. Some patients have a classic mitral valve prolapse. The leaflets of mitral valve are thickened. Some leaflets of mitral valve prolapse. Mitral valve leaflets open perfectly well. Leaflets move from exactly where they should be and open up nicely. Then it's time for mitral valve leaflets to close. But one or both of the leaflets will move backwards into the top chamber the heart on the left side. This backward movement of mitral valve leaflet will cause a leak. Most people with mitral valve prolapse will not need any medical help for a long period of time. But we are always interested in a group of people who have symptoms of mitral valve prolapse. Mitral valve prolapse symptoms are shortness of breath. Patients with mitral valve prolapse have fatigue and struggle on exertion. We are interested to help this group of people with mitral valve prolapse symptoms. Sometimes mitral valve prolapse causes enlargement of heart chambers because the leak is very severe. Enlargement of heart chambers in mitral valve prolapse sometimes increases pressure in the lungs. Patients with mitral valve prolapse also stretch the top chamber their heart on the left This can lead to cardiac rhythm disturbances So we are interested in this group of patients. Dr. Dale Adler, MD: How can you prevent mitral valve prolapse consequences? Are there medical solutions to treat valvular heart disease? This is the most important lesson that we have learned over many years. Mitral valve prolapse causes the leaflets to prolapse more with time. Mitral valve leaflets are having a harder time keeping the blood moving forward. The chambers of the heart are starting to stretch In this situation it is a mistake to try to use medicines to treat patients with mitral valve prolapse. We could use medicine, but it is not a good decision. We could use diuretics. We can make the heart a little smaller. We can use "ace inhibitors" and "unloading" medicines to make it a little easier for the heart to pump the blood forward. These medications might help a person to feel better. But even if patients feel better, the underlying process of mitral valve prolapse and stretching of the heart is still continuing. Heart function is getting worse. Research studies showed nicely that medical treatment of bad valvular heart disease does not help the patients. Eventually patients get worse and worse. In mitral valve prolapse the heart has a mechanical problem. Clinical examination and echocardiography may confirm that mechanical problem of the heart is getting worse
When to Use Medical or Surgical Treatment for Heart Valve Disease? (1) top doctors washingtonian | |
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| Science & Technology | Upload TimePublished on 14 Jul 2018 |
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