Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today I'd like to share with you some bits and pieces about the valves in your heart and where technology is taking us. Well, there's four main valves in the heart. As we think about blood flowing back to the heart from the body through the venous system, the blood all comes together into the superior vena cavia. draining the blood from the top of the body, and the inferior vena cava, draining the blood from the bottom of the body. The superior and inferior vena cava run into the right atrium. The right atrium then connects to the right ventricle through a one-way valve. That one-way valve is called the tricuspid valve. When the heart contracts, blood in the right ventricle heads out towards the lungs. Through a valve called the pulmonary valve. In the lungs the blood is oxygenated. And carbon dioxide is removed. And then the blood comes back to the heart again. But this time on the left side. To the left atrium. The left atrium is connected to the left ventricle. Through the mitral valve. When the blood in the left ventricle is then expelled. aortic valve. Well, all these valves can be subject to wear and tear and therefore can cause problems if they leak or become too narrowed. And I wanted to share with you just some of the technology that's on the way to potentially help people with valve issues. Really interestingly is that we're seeing more and more opportunity of improving valve function or altering valve function or even deploying new valves through non-invasive techniques. And the way we describe that is percutaneously or through the skin without the need for major surgery. Well, probably one of the most common types of valve problems that we see is narrowing of the aortic valve. The main valve. leading into the aorta as blood is expelled from the left ventricle. Well, a sticky aortic valve can be a real trouble and we do see it at a rate of about 1% across the population. As people get older and as people therefore have greater risk of going through surgery, it becomes more and more entertaining to think about techniques that can avoid people going through surgery. percutaneous or transcatheter techniques where literally access is obtained via a blood vessel in the leg. There's tubes and wires and deployment devices threaded from the leg back towards the heart through the diseased valve and deployment of a new valve, which is quite remarkable technology. It turns out this is becoming more and more accepted practice, and certainly for high-risk patients who have lots of risk of getting through surgery, it makes perfect sense. We're starting to see this technology being used more and more, however, in intermediate-risk patients. Certainly, the opportunity to do this and get a good result is pretty good, but currently at the moment, we tend to think about major surgery, opening up the heart via a thoracotomy or an opening in the chest wall and implanting a valve under visual guidance by a surgeon in patients who are able to get through the surgery without significant risk and certainly for patients who may need other surgical procedures done at the same time, such as having their arteries grafted and often coronary artery disease. and narrowed aortic valve are common companions. So we try and match up the patient's needs and risks with what might be a sensible way to try and deal with their valve issue, but quite remarkable technology. And this has been evolving over probably the last 5 to 10 years, and we're now seeing it as a fairly regular treatment option, particularly for that older. high risk population. I've sent a good number of patients of mine for this procedure myself already and have had great results. The other valve that can cause a lot of trouble is the mitral valve. This is the one between the left atrium and the left ventricle. Now if this valve leaks, which we sometimes see, there are techniques percutaneously that allow us to thread a device up through the leg into position to clip the two sides of the valve and to pose them together. This is called a transcatheter edge-to-edge repair. You don't need to remember that, but suffice to say there is technology for the mitral valve as well as the aortic valve. If we need to consider it, it is available. It's not really as advanced as the aortic deployment technology. It's currently got some teething problems and really is for the very high-risk patients who just wouldn't get through surgery. When we compare the transcatheter edge-to-edge repair, there's about a 4% mortality rate at 30 days, probably reflecting that these patients are generally the sickest. of the patients who would go for this sort of procedure. In comparison, the patients with severe mitral regurgitation who go through surgery and get a repair to their valve, if all goes well, overall, their 12-month mortality is 1%. So to a large degree, for our patients with mitral regurgitation, we would still opt for a surgical option really forced into a corner. It's important to remember as well that the transcatheter edge-to-edge repair isn't a stepping stone procedure to surgery because the deployment of that device actually negates subsequent valve repair and will necessitate that that valve is replaced completely. Not ideal. but important to be aware of. A very interesting space. Remember the mitral valve is under considerable stress as it will really represent and be under the load of the stress of the contraction of the left ventricle, which is systolic blood pressure at its maximum. So a high stress area as well. I think this is a space to watch, but... it does open the door for consideration of a similar sort of device for the tricuspid valve, which is a lower pressure system. The tricuspid valve or venous side, right heart, out to the lungs, runs at much lower pressures than the left side. And therefore, some sort of device may work a little better. Well, it turns out that there's been a number of trials looking at tricuspid regurgitation and deployment of a... a device, a percutaneous transcatheter edge-to-edge device, and these appear to work very well. Principally because there's lower pressures allowing these devices to hold those valves together more effectively with less strain. Overall, the tricuspid percutaneous repair is really quite a positive. and optimistic space because we know that tricuspid regurgitation, and this is leaking of the tricuspid valve, where blood really regurgitates back into the venous system, which leads to congestion of generalized organs such as the liver, the abdomen, and congestion of the legs with edema. This is a really bad condition if left to its late stages. patients who have severe tricuspid regurgitation really fare very badly with any sort of intervention at all. And even if their tricuspid regurgitation is repaired, the underlying condition of their body through the longstanding repair leaves them at very, very high mortality. Well, the nice thing about this... percutaneous transcatheter edge-to-edge repair of the tricuspid valve is it can be done quite effectively and can be done while patients still only have moderate TR and have not yet advanced. So this could well be a way, without putting people through surgery, to mitigate the risk of longer-term tricuspid regurgitation leaky valve. and really make a substantial difference as we know that these patients with torrential tricuspid regurgitation end up with extremely high in-hospital mortality and extremely high morbidity and mortality. Well, an interesting space. We're going to see more and more of these fantastic techniques become available, but really... Probably one of the most important things you can do is check out whether your valves are okay. Often we get a clue early on and my practice these days is as part of a general workup to make sure I've had an up-to-date ultrasound of the patients I see. This will give us an indication if the aortic valve, for example, is a bit crusty and may progress over time or if the mitral valve is a bit leaky or if the tricuspid valve, for whatever reason, is not. demonstrating normal apposition of the valve leaflets. So for you, make sure you're locked in with your GP for standard preventative and maintenance strategies. Perhaps see a cardiologist. Consider a baseline echocardiogram. And because it's my soapbox and because there's now Medicare rebate for it, I think it's really valuable to get a 24-hour blood pressure monitor. Why is that? Because blood pressure. is one of the major bits of wear and tear on any of our valves. If you think about it, if the pressure is high, then the pressure on the valve is increased. So there you go. Think about getting your heart checked. Think about an echo. Think about a 24-hour blood pressure monitor. Let's hope you never need any of this fabulous technology. But it is there, should you ever need it, or your loved ones. I hope you found this interesting. discussion about a fascinating area of medicine which is only going to progress. If you've got any queries or questions, drop us a note. If you've got any suggestions, let us know as well. For now, however, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
