Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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When a structural heart problem is diagnosed, there is often a sense of urgency, but the good news is that we are currently experiencing a plethora of treatment options. Open-heart surgery is no longer the sole option. While traditional surgery remains a life-saving and effective option for many, a wide array of minimally invasive therapies is now available. These procedures allow doctors to repair or replace heart valves and close holes without opening the chest.
This section explores the spectrum of treatments available for structural heart disease. We will discuss medication management, which is often the first line of defense. We will then dive into the revolutionary catheter-based procedures, like TAVR and MitraClip. Finally, we will cover the crucial phase of rehabilitation, where you rebuild your strength and confidence after treatment. These therapies aim to restore your quality of life, not just fix your heart.
For many patients, especially those with mild to moderate disease, the first step is medication. It is important to understand that medicines cannot mechanically fix a broken valve or close a hole. A pill cannot dissolve the calcium on a stiff valve or stitch up a leak. However, medications are vital for managing symptoms and protecting the heart from further strain.
Diuretics, or water pills, are commonly prescribed to reduce fluid buildup. By helping the kidneys remove excess water, they reduce the workload on the heart and relieve shortness of breath and swelling. Blood pressure medications (like beta-blockers or ACE inhibitors) help relax the blood vessels, making it easier for the heart to pump blood against a damaged valve. If you have an arrhythmia like atrial fibrillation, blood thinners (anticoagulants) are essential to prevent strokes.
TAVR (Transcatheter Aortic Valve Replacement) is one of the biggest breakthroughs in cardiac medicine. It is used to treat aortic stenosis. In the past, replacing the aortic valve required cutting the chest open. With TAVR, the doctor makes a small incision in the groin (leg) and inserts a catheter.
A new, collapsible valve is crimped onto the end of the catheter. The doctor guides it up the femoral artery, around the aorta, and directly into the heart. Once it is positioned inside the old, diseased valve, the new valve is expanded. It pushes the old valve leaflets out of the way and takes over the job immediately.
The new valve is usually made of animal tissue (cow or pig) supported by a metal frame. Because the chest is not opened, the recovery is remarkably quick. Patients are often awake (under sedation) during the procedure and can go home the next day.
Compared to open surgery, TAVR involves less pain, a shorter hospital stay, and a quicker return to normal life. It was originally approved only for patients too sick for surgery, but it is now an option for many people with aortic stenosis. It allows elderly patients to regain their quality of life without the trauma of a major operation.
The mitral valve is more complex than the aortic valve, making it harder to treat. However, transcatheter solutions exist here too. For mitral regurgitation (a leaky valve), a common procedure uses a device called a clip (like the MitraClip).
The doctor guides a catheter through a vein in the leg to reach the heart. The device is a small clip that grasps the two leaflets of the mitral valve in the middle, pinning them together. This creates a double opening that still allows blood to flow but significantly reduces the leak. It essentially turns a large, gaping door into two smaller, tighter ones.
In some cases, the valve is too damaged to be clipped. Transcatheter mitral valve replacement (TMVR) is an emerging technology where a completely new valve is implanted inside the old one via a catheter. This is an area of rapid innovation, offering hope to patients who were previously told they had no options.
For congenital defects like PFO (Patent Foramen Ovale) or ASD (Atrial Septal Defect), doctors use closure devices that look like tiny umbrellas or double-sided discs. The procedure is done through a vein in the leg.
The device is folded up inside a catheter. When it reaches the hole in the heart wall, the doctor pushes it out. One side of the disc opens in the left atrium, and the other opens in the right atrium, sandwiching the hole shut. Over time, the heart tissue grows over the device, permanently sealing the wall. This type of surgery is a highly effective way to prevent strokes in people with these defects.
People with atrial fibrillation are at high risk for stroke because blood can pool and clot in a small pocket of the heart called the Left Atrial Appendage (LAA). For patients who cannot take blood thinners long-term due to bleeding risks, a structural procedure can close this pocket.
Devices (like the Watchman) are inserted via catheter to plug the opening of this appendage. It acts like a cork in a bottle. By sealing off this pocket, clots cannot escape into the bloodstream to cause a stroke. This allows many patients to eventually stop taking strong blood thinners.
After any heart procedure, whether it is surgery or a catheter intervention, cardiac rehabilitation is key. Cardiac rehab is a medically supervised program designed to improve your cardiovascular health. It involves exercise counseling, education about heart-healthy living, and stress reduction.
You will exercise in a safe environment while hooked up to a heart monitor. Nurses and exercise physiologists watch your heart rate and rhythm to ensure you are safe. They teach you how to move without fear. This program is not just about physical strength; it provides emotional support and helps you trust your heart again. It is proven to lower the risk of future hospitalizations and improve long-term survival.
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Current data suggest that TAVR valves are durable and can last as long as surgical tissue valves, typically 10 to 15 years or more. If a TAVR valve wears out, it is sometimes possible to place a second valve inside the first one (valve-in-valve procedure).
Yes. For younger patients, or those with complex anatomy (like bicuspid valves or multiple valve issues), surgical replacement might still be the best long-term option. Your “Heart Team” (surgeons and cardiologists) will discuss which is best for you.
No. You will not feel the valve, clip, or plug working. The heart tissue has no sensation of touch inside. You will simply feel the benefit of better blood flow, such as having more energy and less shortness of breath.
Usually, yes, but for a limited time. After a valve replacement or repair, you typically take blood thinners for a few months to prevent clots while the device heals. Some patients with mechanical valves or AFib will need them for life.
After a catheter procedure (TAVR, clip), you can usually drive within a week, once the groin site is healed. After open-heart surgery, you typically must wait 4 to 6 weeks to allow the breastbone to heal properly before steering a car.
At LivHospital, we focus on new treatments for heart disease. Heart surgery balloon procedures, like balloon angioplasty, are small and don’t cut open the body.
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