What is valvu­lar heart dis­ease?

VHD is caused by dam­age to the heart valves. Dam­age can result from aging, known as degen­er­a­tive VHD, of which aor­tic steno­sis is the lead­ing cause of ill­ness and death.

Aor­tic steno­sis, and aor­tic and mitral valve regur­gi­ta­tion are the most com­mon forms of degen­er­a­tive VHD, although any heart valve can be affect­ed.31–32 Oth­er caus­es of VHD not relat­ed to aging include a con­gen­i­tal birth defect or an infec­tion (rheumat­ic heart dis­ease*).

Symp­toms and com­pli­ca­tions
VHD makes it hard­er for the heart to cir­cu­late blood through the body and can lead to irreg­u­lar heart­beat, heart attacks, and car­diac arrest.31 VHDs are also major caus­es of acute and chron­ic heart fail­ure.33 VHD caus­es reduced car­diac per­for­mance, lead­ing to an insuf­fi­cient sup­ply of blood and oxy­gen to the organs and tis­sues. This can lead to feel­ings of dizzi­ness, black­outs, and fatigue.30 Peo­ple with aor­tic steno­sis may not have these symp­toms. How­ev­er, decline in rou­tine phys­i­cal activ­i­ties, heart pal­pi­ta­tions, short­ness of breath when inac­tive, and sig­nif­i­cant fatigue are tell­tale symp­toms.30,34–36 Oth­er com­mon symp­toms are dif­fi­cul­ty breath­ing and a feel­ing of heav­i­ness in the chest.30,34–36

Due to a lack of aware­ness about VHD, these symp­toms are fre­quent­ly mis­at­trib­uted to old age, thus leav­ing the under­ly­ing con­di­tion untreat­ed.30 Untreat­ed, VHD can lead to symp­to­matic com­pli­ca­tions, includ­ing heart fail­ure, stroke, blood clots and irreg­u­lar heart­beats.30 These com­pli­ca­tions are sig­nif­i­cant caus­es of dis­abil­i­ty and death in Sau­di Ara­bia and the world.37 Com­pli­ca­tions are pre­ventable if the con­di­tion is diag­nosed in time, enabling indi­vid­u­als to live a healthy and full life that meets a nor­mal expectan­cy of up to 80 years old.

Degen­er­a­tive VHD
Degen­er­a­tive aor­tic valve dis­ease is a con­di­tion that devel­ops pro­gres­sive­ly due to the wear and tear asso­ci­at­ed with aging. The struc­tur­al integri­ty of the heart valves weak­ens as col­la­gen fibers break down and cal­ci­um deposits accu­mu­late, caus­ing valve leaflets to thick­en, stiff­en, or func­tion poor­ly. Most peo­ple with degen­er­a­tive aor­tic valve dis­ease only have a mild thick­en­ing and nor­mal valve func­tion called aor­tic scle­ro­sis. A small per­cent­age, how­ev­er, have sig­nif­i­cant aor­tic steno­sis with restrict­ed flow of blood from the left ven­tri­cle; if not addressed, this may lead to heart fail­ure.43,44

Time­ly med­ical inter­ven­tion is piv­otal in man­ag­ing degen­er­a­tive VHD and enhanc­ing patients’ qual­i­ty of life. Diag­no­sis rates could be improved by sys­tem­at­i­cal­ly screen­ing patients with high risk of VHD, includ­ing those liv­ing with obe­si­ty, high cho­les­terol, and hyper­ten­sion. Pub­lic aware­ness and rou­tine car­dio­vas­cu­lar check-ups are essen­tial, par­tic­u­lar­ly as the Sau­di pop­u­la­tion con­tin­ues to age.

Detec­tion and diag­no­sis
VHD can be detect­ed using a stetho­scope to lis­ten for any abnor­mal heart sounds, known as a car­diac mur­mur. If a mur­mur is detect­ed, the HCP refers the patient for an echocar­dio­gram, an ultra­sound that checks the heart’s struc­ture and func­tion. This non-inva­sive pro­ce­dure is the most fre­quent­ly employed method for eval­u­at­ing and mon­i­tor­ing VHD.30

Treat­ment
Dif­fer­ent treat­ment options are avail­able for treat­ing VHD, depend­ing on var­i­ous fac­tors, such as the symp­toms expe­ri­enced, the sever­i­ty of the con­di­tion, and the pro­gres­sion of the dis­ease. Severe aor­tic steno­sis is a life-threat­en­ing con­di­tion, but it can be treat­ed by replac­ing the heart valve, and indi­vid­u­als can expect to have a nor­mal life expectan­cy.

In the past, elder­ly patients with severe symp­to­matic aor­tic steno­sis and under­ly­ing health con­di­tions were often denied sur­gi­cal aor­tic valve replace­ment (SAVR) due to the high mor­tal­i­ty rate asso­ci­at­ed with the pro­ce­dure.16 How­ev­er, advance­ments in med­ical tech­nol­o­gy have intro­duced min­i­mal­ly inva­sive treat­ments such as tran­scatheter aor­tic valve replace­ment (TAVR), also known as tran­scatheter aor­tic valve implan­ta­tion (TAVI).38 These treat­ments involve replac­ing a thick­ened aor­tic valve with­out major surgery and with min­i­mal dis­com­fort to the patient.

TAVR is now fre­quent­ly rec­om­mend­ed for patients with severe aor­tic steno­sis due to its quick­er recov­ery peri­od and short­er hos­pi­tal stays than inva­sive sur­gi­cal alter­na­tives.39 Recent research from Sau­di Ara­bia shows that TAVR is asso­ci­at­ed with low­er direct costs than open-heart surgery over a five-year hori­zon for high- and inter­me­di­ate-risk patients and equal direct costs for low-risk patients.39 This means that TAVR pro­vides bet­ter patient out­comes and is a more afford­able treat­ment option.

80%

of patients under­go­ing inter­ven­tion for aor­tic steno­sis in Sau­di Ara­bia had hyper­ten­sion and high cho­les­terol, which put indi­vid­u­als at risk for seri­ous car­diac events.45

* Rheumat­ic heart dis­ease results from per­ma­nent heart valve dam­age caused by rheumat­ic fever.40 The fever aris­es from inflam­ma­tion due to an infec­tion with Group A strep­to­coc­cus bac­te­ria.40 If left untreat­ed, it can cause per­ma­nent heart valve dam­age and oth­er seri­ous health prob­lems.41 Chil­dren and teenagers are par­tic­u­lar­ly vul­ner­a­ble. While antibi­ot­ic treat­ment is rec­om­mend­ed and can pre­vent per­ma­nent heart valve dam­age, lack of knowl­edge and aware­ness inhibits effec­tive pre­ven­tion, par­tic­u­lar­ly in remote areas.41,42 The preva­lence of rheumat­ic heart dis­ease is high in Sau­di Ara­bia and it remains a sig­nif­i­cant pub­lic health con­cern.42

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