Right valve disease

The heart is an organ with four chambers: two atria and two ventricles. The atria receive blood from the vena cava and pulmonary veins and the ventricles push it through the aorta and pulmonary arteries. The cavities can contract, pushing the blood, and relax, allowing it to enter. The blood that comes through the veins, passes to the atria and from these, to the ventricles. Valves exist between the atria and ventricles to prevent backward flow of blood and blood flow in only one direction.

The four valves of the heart are:

• Aortic valve between the left ventricle and the aorta.
• Tricuspid valve between the right atrium and ventricle.
• Pulmonary valve between the right ventricle and the pulmonary artery.
• Mitral valve between the left atrium and ventricle.

An abnormality in any of the heart valves is called valvular disease. These can be of two types: stenosis or insufficiency.

Stenosis is an abnormal narrowing of the valve, which prevents it from opening properly which causes an obstruction of the blood outlet.

Insufficiency occurs when the valve is not working properly, is more weakened or bulged, and does not close completely, causing some of the blood to flow back when the valve should be fully closed.

Right heart valve diseases include those that affect the right heart valves, that is, the pulmonary and the tricuspid. These valves can present any of these alterations: being narrower, which is known as tricuspid stenosis or pulmonary stenosis (depending on the affected valve) or not closing properly, which is known as tricuspid or pulmonary regurgitation.

Valvular heart disease is classified as mild, moderate, or severe (severe) depending on the degree of valve involvement and its impact.

How is it produced?

A valve disease can be congenital, that is, it can be present from birth or acquired, which is when it appears throughout life, for example, due to an infection. The most common infectious causes are endocarditis and rheumatic fever.

Currently, due to the longer life expectancy, a large part of valvular heart disease appears due to deterioration of the valve in the aging process (degeneration), which causes valvular hardening and calcification.

The most common cause of pulmonary stenosis is congenital, while pulmonary insufficiency is usually infectious, due to rheumatic fever, degenerative fever, or congenital malformations.

In the case of the tricuspid valve, the most frequent causes include rheumatic fever, infections (endocarditis) or congenital malformations.

Generally, valve disease of the right heart is associated with valve disease of the left heart.

They are less severe, have fewer symptoms, and usually do not require surgical treatment.

Symptoms or symptoms

Right heart valve disease is less severe than left heart disease and has fewer symptoms.

When they appear they are due to the malfunction of the right heart that results in an accumulation of fluids in the body (congestive symptoms) and that include weight gain, ascites (abdominal fluid), edema (fluid in the legs) and fatigue. Arrhythmias may also appear.

Diagnosis

The diagnosis is based on the set of symptoms of the patient, the physical examination where a heart murmur is usually detected that indicates that there may be a valve disease.

The recording of the electrocardiogram can reveal the involvement of the right heart due to valve disease.

Diagnostic confirmation is performed using imaging techniques that allow a detailed view of the morphology of the valve and its degree of involvement, as well as the consequences on the rest of the cardiac structures and blood flow.

These techniques mainly include:

• Doppler echocardiography: it is the technique of choice, it allows to see the degree of involvement of the valve and the rest of the cardiac structures, as well as the functioning of the blood flow through the heart chambers.
• Transesophageal echocardiography: This is the same procedure as echocardiography but the transducer is inserted into the patient's esophagus to see the heart valves in greater detail than with transthoracic echocardiography (where the transducer is applied to the chest).

Treatment

Valvular heart disease generally does not require treatment with surgery.

Surgical treatment with valve replacement is only performed in severe pulmonary insufficiency and if left valve disease replacement surgery is considered.

Tricuspid regurgitation generally does not require treatment, in severe cases a repair surgery can be performed on the valve called annuloplasty.

In severe tricuspid and pulmonary stenosis, it can be dilated using a procedure called percutaneous balloon valvuloplasty. It consists of introducing a catheter through a blood vessel (usually through the groin) to the heart. Once located in the diseased valve, a small balloon at the tip of the catheter is inflated, opening the area of ​​the narrowed valve.

It is used especially in those cases in which a left valve disease is associated.

Prevention

Streptococcal infections must be treated to prevent rheumatic fever that can cause heart valve disease.

Patients with valvular heart disease are at greater risk of valve infections (endocarditis), so they should follow preventive measures with antibiotics before certain procedures such as minor surgeries or dental interventions. Your doctor will advise you on the advice to follow.