Dr A.G.K.Gokhale, Cardiothoracic and minimal access surgeon, Apollo Hospitals explains about structural heart diseases
Heart disease, especially that caused due to reduced blood flow to the heart (known as Ischaemic heart disease), is the leading cause of death in India and its incidence has increased by >40 per cent over the past 10 years.Ischaemic heart disease can also damage the structure of the heart over time.
The conditions/defects that affect the structure of the heart come under the umbrella term of ‘Structural heart disease.’Surprisingly most patients with structural heart disease do not show any symptoms. Even when they do occur, they are common ones such as breathlessness upon exertion, tiredness or swelling of the feet. The patient may also experience palpitations (rapid beating of the heart), chest pain or fainting episodes (syncope).
Such symptoms are seen in other diseases too. For example, breathlessness is common in patients with low haemoglobin or those with lung disorders. Swelling of the feet can occur in individuals with liver or nutritional problems. Regular and complete health checkups are hence particularly important to pinpoint the exact cause and to detect heart disease in time.
When does structural heart disease occur and what are its causes?
Our heart is the central pump that controls the flow of blood throughout the body. It is divided into four chambers. The upper smaller ones are called atria and the lower larger ones are called ventricles. Within the heart, the unidirectional flow of blood is maintained with the help of four valves (mitral, pulmonary, aortic and tricuspid). Structural heart disease encompasses any condition/defect which affects the valves, chambers or tissuesof the heart.
Structural heart disease can be congenital (present since birth) or can be acquired (due to age, infections,ischaemic heart disease, disease of the heart muscle i.e. cardiomyopathy, sudden trauma, certain medications, etc.).
In a year, nearly 2,00,000 children in India are born with congenital heart disease (CHD). One of every 5 such children has a serious defect thatshould be corrected within the first year.Common congenital defects include atrial septal defect (hole in the wall between the atria) and patent ductus arteriosus (an abnormal connection between the aorta and the pulmonary artery).
The most common structural diseases of the valves are aortic stenosis (narrowing of the aortic valve which controls the flow of blood from the heart to the rest of the body) and mitral regurgitation (leakage of mitral valve present between the left atrium and ventricle). If left untreated, these conditions increase the strain on the heart, forcing it to pump harder to ensure adequate blood supply. This may lead to abnormal enlargement of the left ventricle, ultimately causing heart failure.
Rheumatic fever (RF) contributes to almost 25-45 per cent of acquired heart disease in our country.RF occurs when a bacterial sore throat is not treated properly and in turn, causes permanent damage to the valves of the heart. This condition is called rheumatic heart disease (RHD). RHD particularly affects children and young adults.
On the other hand, increasing age and calcium deposition on the valves can cause their malfunction. Reduction or stoppage in the supply of oxygen-rich blood to the heart leads to ischaemic heart disease which can impact the structure of the heart.
How have the treatment options for structural heart disease improved over the years?
If detected in time and during its early stages, structural heart disease and its symptoms can be managed with medication to some extent. However, surgery to either repair the defect or replace the faulty valve remains the gold standard for treatment. Earlier, open-heart surgery was the only option available to such patientsbut several of them were not eligible for surgery due to their advanced age or coexisting illnesses.
Newer technological advances have ensured that minimally invasive options such as transcatheter valve replacement and robotic surgery have made heart surgery safer for highrisk patients. In transcatheter valve replacement, a catheter (thin tube) carrying the man-madevalve is inserted through the leg and implanted in the heart. In patients with an atrial septal defect, an umbrella-shaped device called an ‘occluder’ can be similarly inserted to sealthe hole.
Instead of surgery through splitting of breast bone on the front of the chest, these days many heart surgeries can be done through small incisions on the side of chest below nipple (minimally invasive hert surgeries-key hole surgeries). Latest in these is Robotic surgery (surgery with the assistance of robotic systems) to carry out heart surgeries like mitral valve replacement, aortic valve replacement, double valve replacements, coronary srtery bypass surgeries and atrial septal defect repair. The use of robotics in heart surgery allows the specially-trainedsurgeon to carry out complex procedures with greater flexibility and precision vs. traditional open-heart surgery.
For the patient, these minimally invasive procedures have resulted in smaller incisions (surgical cuts), less blood loss, fewer complications, faster recovery, reduced pain and hospital stay along with a quicker return to normal life.
Are there any specific precautions to be taken after heart surgery?
Irrespective of the type of surgery (open heart, transcatheter or minimally invasive/robotic), regular follow-ups and strict adherence to the doctor’s instructions are a must for every patient. A nutritious diet, avoidance of alcohol/smoking, regular exercise, weight management and maintenance of mental/spiritual balance go a long way towards improving the lifespan of the patient.
Regular and thorough medical check-ups thus remain the key to the early detection of several diseases, including heart disease. If symptoms do occur, don’t ignore them and reach out to a doctor at once to avoid future complications.
Last, but not the least is- don’t forget to take health insurance. Inspite of all the precautions, we can still get health issues.
Saxena A. Congenital Heart Disease in India: A Status Report. Indian Pediatr. 2018 Dec 15;55(12):1075-1082.
Dey I et al. Int J Med Res Health Sci. 2014;3(3):521-525