On World Heart Day 2024, Dr Haresh G. Mehta, Director of Interventional Cardiology at S.L. Raheja Hospital, Mahim—A Fortis Associate, highlights the latest advancements in heart diseases treatment
Structural heart disease refers to abnormalities developing in the hearts valves, walls or chambers which result in alteration in the normal structure and functioning of the heart. However, nowadays this term has become increasingly synonymous with degenerative valvular diseases, given the pandemic proportion of valvular disease burden in our aging population. So, the valve either becomes too small (stenotic) or too leaky (regurgitation). Severe aortic stenosis is one such common condition in which there is age related calcium buildup in the valve causing it to become small and reduce the flow of blood across it. Another commonly affected valve is the mitral valve which can become excessively leaky and is known as mitral regurgitation.
The usual symptoms of this disease are breathlessness, swelling of feet, giddiness, chest pain, palpitations and effort intolerance. Reduction in forward cardiac output and increased intracardiac pressures, causing most patients to remain severely symptomatic needing recurrent hospitalisations despite maximal medical therapies. It severely limits the persons functional status and their ability to carry out day to day activities. If left untreated, it is then a downward spiral with a progressively dilating heart and declining function resulting in end stage heart failure and death.
Advancement in diagnostic technology
There have been significant innovations in diagnostic modalities in the last few years including 3D echocardiography, 4D Cardiac MRI, single photon Cardiac CT’s, intracardiac echocardiography (ICE) etc. These have not only simplified but also increased the accuracy and precision in the early diagnoses and management of these conditions.
Advancement in treatment
Management of structural heart disease, especially in older patients and in those with multiple comorbidities and thus at high surgical risk, had been an unmet need since very long. More so since valvular degeneration tends to disproportionately occur in these very patients who are often found unfit for surgery. It is only now in recent years that transcatheter interventions like transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR), transcatheter tricuspid valve replacement (TTVR), MitraClips, TriClips etc have been able to solve this conundrum. Any heart valve can be replaced using these specialised catheters which are small tubes inserted through the leg into the heart and deploy the new valve. Often the results are dramatic and there is immediate improvement in haemodynamics. All these procedures are minimally invasive, done under local anaesthesia and most patients get discharged from the hospital the very next day. They are becoming the standard of care in cardiac centers across the world.
The development of novel transcatheter devices and delivery systems including biodegradable materials and next generation stent technologies have redefined the landscape in management of structural heart disease. This has provided a new lease of life for a lot of these patients who were out of treatment options before. This entirely percutaneous endovascular approach offers significant advantages over conventional open-heart surgery in terms of being less invasive, shorter post operative recovery time, shorter hospital stays, no surgical scar and can be done in patients who are unfit or high risk for surgery. The future in cardiology seems to be finally arriving.