Valve defects are one of the more common cardiac diseases in the elderly. Due to advanced age, not only the frequency and symptoms of these diseases are different, but also sometimes their management. Find out why these differences arise and why the elderly with valvular disease should be treated as a separate group of patients.

Contents :

  1. Valvular disease in the elderly - occurrence
  2. Valve defects in the elderly - diagnosis
  3. Aortic valve defects
  4. Defects of the left - mitral atrioventricular valve
  5. Defects of the right-tricuspid atrioventricular valve
  6. Valvular disease in the elderly - treatment

Valve defects are most common in the elderly- it is estimated that 40% of valve defects occur after the age of 70. This is due not only to comorbidities that increase the risk of developing the disease, but also to the degenerative process - age-related wear of the valves.

Aortic valve stenosis is most common in the elderly group. Treatment of valve defects in seniors is difficult, if the defect is advanced, it requires surgical correction, and this requires a thorough consideration of the risks and potential benefits of cardiac surgery. In some patients, minimally invasive procedures, such as transcatheter aortic valve implantation, are becoming a good solution.

There are four valves in the heart of a he althy person: two atrioventricular valves - between the right atrium and the right ventricle, and between the left atrium and the left ventricle, one between the left ventricle and the aorta, and one between the right ventricle and the pulmonary trunk.

All valves are made of a ring and leaflets. Additionally, atrioventricular valve leaflets are attached with tendon threads to the papillary muscles in the ventricles.

The primary function of valves is to prevent blood from flowing back into the ventricles or the atria. During ventricular relaxation, the atria contract, which allows the ventricles to be filled with blood, then the ventricles begin to contract, this causes the atrioventricular valves to close and the blood cannot flow back into the atria - it flows into the aorta or into the pulmonary trunk. When the contraction endsthe pressure in the ventricles drops, a small amount of blood begins to regress, causing the aortic valves and the pulmonary trunk to close.

The proper functioning of all valves is essential for the best possible work of the heart. As a result of various factors - damage, wear and tear, or other diseases, the valves may narrow, on the other hand, changes in the structure - the shape of the heart cavities, widening of the vessels coming from the heart or other diseases lead to their regurgitation.

A valve stenosis is actually a reduction in the surface area of ​​the valve opening, which forces the heart to do more work to pump out the same volume of blood.

Regurgitation also adversely affects the efficiency of the heart. In the case of atrioventricular regurgitation, the contraction of the ventricle causes not only the outflow of blood to the aorta or the pulmonary trunk, but also its return to the atrium, thus causing a "waste" of part of the ventricular work, and also additional stress on the atrium.

Valvular disease in the elderly - occurrence

Valve disease is one of the most common heart diseases, and many studies have shown that their incidence increases with age.

Heart valves, like other tissues, wear out over the years of work, which leads to degeneration, and this is the direct cause of valve regurgitation or stenosis. Increasing life expectancy and the high availability of heart disease diagnostics mean that the number of elderly people diagnosed with valvular disease is growing rapidly, it is believed that the disease of at least one valve occurs in up to 10% of people over 75 years of age.

Deviations from the norm in the appearance of the valve found in echocardiography are observed in up to 40% of people over 80 years of age, of course, not all these changes result in abnormal function and the occurrence of the disease - stenosis or regurgitation.

The most frequently diagnosed valvular disease in the elderly is aortic stenosis, i.e. a narrowing of the left arterial outlet, it is led by degeneration, which can be observed in the form of calcification on the valve leaflets in echocardiography.

Valve defects in the elderly - diagnosis

The diagnosis begins with a thorough history taking, unfortunately, few symptoms are characteristic of valve defects, especially in the elderly. The most common: shortness of breath and fatigue can be attributed to many other diseases that occur in seniors, but also to advanced age itself.

In addition, limiting physical activity in the elderly may cause no symptoms at allrelated to valvular defects, as these most often appear with effort. All this makes the diagnosis of valve defects and the selection of appropriate treatment in the elderly very difficult.

In the field of additional tests, echocardiographic evaluation is the basic diagnostic method. Unfortunately, it can be difficult in the elderly, which is due to lung diseases, changes in the structure of the chest, or the presence of materials inside the heart - artificial valves or pacemaker electrodes.

Despite this, echocardiography is the most common and reliable method of diagnosing valvular disease. It allows not only to recognize the disease, but also to assess its advancement and monitor its progress. Rarely, for the diagnostic purposes of valvular defects, ECG, chest X-ray or cardiac magnetic resonance imaging are performed.

Aortic valve defects

As mentioned, valve diseases most often affect the left arterial outlet. This is due to many reasons, first of all, this valve is loaded with the highest pressures in the entire circulatory system, which leads to its wear. It has also been proven that it is more likely to be damaged in people with diabetes, kidney failure, hypertension and high cholesterol.

Older age not only causes long-term exposure of the valve to the degenerative process, but also contributes to the occurrence of the above-mentioned diseases.

The symptoms of this defect are independent of age, it is believed that about 50% of patients do not experience any symptoms, especially if the stenosis is minor. However, if the disease progresses or is accompanied by other cardiac conditions, symptoms appear faster and are more pronounced, including:

  • angina symptoms - chest pains characteristic of ischemic heart disease. Many elderly people have atherosclerotic changes in the coronary arteries, it impairs the blood supply to the muscle - it supplies it with oxygen and nutrients, if the amount of blood flowing out of the left ventricle is additionally reduced by stenosis of the valve, the symptoms of ischemia appear earlier, more often and are more severe.
  • palpitations can be a symptom of a disease in itself or atrial fibrillation, which can be either a consequence of stenosis or a separate disease common to the elderly.
  • the so-called low-attack symptoms - periodic ischemia, mainly of the central nervous system, which causes dizziness or fainting.

Another defect of the aortic valve - its regurgitation is much rarer. Her speech is favored by:endocarditis, rheumatic diseases, hypertension and atherosclerosis, all of them are more common in elderly people, so regurgitation itself is also diagnosed rather in seniors.

If this defect develops gradually and is minor, it rarely causes annoying symptoms, most often it causes fatigue, and with the increase of the defect, shortness of breath and chest pain appear.

There are two basic strategies for treating aortic valve defects: surgical or conservative.

The second of these is used in the case of minor defects, usually asymptomatic, it consists in the use of pharmacotherapy and periodic control of the disease's progress in echocardiography.

The surgical treatment is selected in the case of advanced, symptomatic defects, always after consulting a cardiologist with a cardiac surgeon, they choose the right strategy and the right moment to carry it out.

In the case of older people, it is often difficult to talk about the symptomatic nature of valvular defects, because they usually lead a quiet lifestyle with little physical exertion, and this is when the symptoms of the disease are most often noticed.

The possibilities of surgery for seniors are, unfortunately, often limited. This is due not to advanced age, but to comorbidities that often prevent the safe conduct of cardiac surgery, for example:

  • kidney disease
  • diseases of the brain vessels
  • heart failure
  • chronic obstructive pulmonary disease

As a result, surgical treatment in the elderly is more and more often performed using new techniques: minimally invasive procedures are performed, such as TAVI, i.e. transcatheter aortic valve replacement. This procedure is performed under echocardiographic and X-ray control and involves the insertion and implantation of a new aortic valve through the femoral artery. Thanks to this, you can avoid the burden of cutting the sternum, which is associated with long convalescence and rehabilitation.

Defects of the left - mitral atrioventricular valve

These defects are the second most common valve disease. Mitral stenosis is the reduction of the surface area of ​​the atrioventricular opening, which makes it difficult for blood to flow to the left ventricle and puts a lot of stress on the atrium.

The causes of this defect, more common in the elderly, include rheumatological diseases and the degenerative process associated with valve calcification.

The symptoms of this disease are similar at all ages, they include:

  • fatigue
  • shortness of breath
  • recurrent pneumonia
  • palpitations

Treatment, as in the case of aortic valve defects, can be twofold: conservative treatment with periodic echocardiographic control or surgical repair of the damaged valve.

In the case of the latter strategy, surgical replacement or repair of the valve can be performed, or, if surgery is not possible, the therapeutic option is minimally invasive correction of the defect, i.e. mitral commissurotomy. This procedure consists in separating the fused valve leaflets with a balloon.

Mitral regurgitation causes abnormal flow of blood from the left ventricle to the left atrium. Its causes more common in the elderly are: degenerative changes, connective tissue diseases, infective endocarditis, other risk factors are equally common in all age groups.

Unfortunately, in the case of surgical treatment of mitral valve insufficiency, surgery is the first choice. Minimally invasive treatment, i.e. installing a special MitraClip system, is limited due to its limited availability in Poland.

Defects of the right-tricuspid atrioventricular valve

Tricuspid valve defects in all age groups are characterized by similar symptoms, causes and treatment. Both stenosis and regurgitation of this valve are very rare, usually due to rheumatic disease.

The ailments are very nonspecific:

  • shortness of breath
  • appetite disorders
  • fatigue

Surgical treatment is usually undertaken if this defect is accompanied by disorders of other valves, then both corrections are performed simultaneously.

Valvular disease in the elderly - treatment

As has been mentioned many times, the treatment of valvular defects may consist of conservative, pharmacological or surgical procedures - surgical or minimally invasive. Unfortunately, minimally invasive therapy options are not available for all valves and all types of defects.

If it is necessary to undertake surgical treatment, the risks and benefits of the operation should always be considered. Surgical treatment is undertaken in order to improve the quality of life and prognosis, but it should be remembered that cardiac surgeries are very burdensome, serious and at risk of complications. In addition, they are associated with long-term, arduous rehabilitation. However, the results of this procedure are, in most cases, very good.

Decision on the choice of methodthe procedure is very difficult, therefore they are undertaken by a wide group of experts composed of cardiologists and cardiac surgeons who, considering the balance of benefits and risks, propose the best treatment for the patient.

It is worth knowing that older age increases the risk of surgery itself, and that other diseases, often found in seniors, have a negative impact, for example :

  • chronic kidney disease
  • diseases of the cerebral and cervical vessels
  • heart damage
  • heart failure
  • hypertension
  • diabetes
  • lung diseases
  • atrial fibrillation

Therefore, in many cases, if it is possible, the elderly are offered a minimally invasive procedure:

  • TAVI
  • MitraClip
  • commissurotomy

These treatments are not always as effective as surgery, but in many ways they are safer.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

Category:

Geriatrics