The human heart, the rhythmic coordinator of life, is a marvel of engineering! Yet, even this intricate organ is prone to structural abnormalities that can affect its functionality. Structural heart diseases, encompassing a variety of conditions, necessitate a detailed understanding and innovative treatment approaches. In this article, we delve into the world of structural heart diseases and explore the diverse modalities transforming their treatment landscape.
Understanding structural heart diseases
Structural heart diseases involve abnormalities in the valves, chambers, walls or blood vessels of the heart. These conditions can be congenital or acquired over time due to aging, infections or other medical conditions. Common structural heart diseases include incompetent tricuspid valve, aortic stenosis, mitral regurgitation, insufficiency of pulmonary valve, atrial septal defects and patent foramen ovale.
Diagnosis
Accurate diagnosis is the key to effective treatment. Advanced imaging technologies, such as echocardiography, cardiac MRI and CT scans, enable clinicians to visualize the heart’s structure and identify abnormalities with unprecedented precision.
Treatment modalities
1. Transcatheter Tricuspid Valve Repair (TTVR)
The tricuspid valve, situated between the right atrium and right ventricle, ensures the unidirectional flow of blood. However, diseases such as tricuspid regurgitation, where blood leaks backward into the right atrium during the heartbeat, can compromise the heart’s efficiency, associated with significant morbidity and mortality. Historically, surgical options were the primary recourse for tricuspid valve repair. Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of significant TR, offering hope to patients previously deemed inoperable or high-risk. Several devices with different mechanisms of action have been developed and are classified into annuloplasty devices, valve replacement devices, heterotopic/caval valve implants, tricuspid TEER and coaptation devices.
CAVI (Caval Valve Implantation): Heterotopic valve implantation called as caval valve implantation (CAVI), is the transcatheter bicaval valves system of two self-expanding biological valves implanted percutaneously into the inferior vena cava (IVC) and superior vena cava (SVC) to protect the end organs and also prevent progression of right heart failure.
2. Transcatheter Aortic Valve Replacement (TAVR)
TAVR has revolutionized the treatment of aortic stenosis, especially in patients deemed high risk for traditional open-heart surgery. This minimally invasive procedure involves guiding a replacement valve through blood vessels to the heart, eliminating the need for open-heart surgery.
3. Transcatheter Mitral Valve Replacement (TMVR)
TMVR is a minimally invasive structural heart disease treatment option to replace a damaged mitral valve without open-heart surgery. Transcatheter mitral valve replacement may be suitable for patients who have mitral regurgitation or mitral stenosis, but is not suitable for open-chest mitral valve repair and replacement surgery. Older people with underlying health conditions are at higher risk for open heart surgery and may be better suited for TMVR.
Transcatheter Edge-to-Edge Repair (TEER) is an innovative and minimally invasive procedure designed to address mitral valve regurgitation, a condition where blood leaks backward into the left atrium during the heartbeat. While TEER has shown promising results, ongoing research is essential to refine techniques, make it less cumbersome, expand patient eligibility criteria and evaluate long-term outcomes.
4. Transcatheter Pulmonary Valve Replacement (TPVR)
Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive surgery to replace a failing pulmonary valve in the heart. A surgeon performs the procedure through tiny skin incisions in the groin, rather than opening chest with surgery. Pulmonary valves are important as they control blood flow from the heart to the lungs. People who are born with a congenital heart defect and have surgery during childhood often develop problems with their pulmonary valves as adults. Replacing a defective pulmonary valve can have a significant impact on lifespan and quality of life, and can delay or avoid repeat surgeries.
5. Congenital Heart conditions
An Atrial Septal Defect (ASD) is a congenital heart condition where there is an abnormal opening in the atrial septum—the wall that separates the heart’s upper chambers. Ventricular Septal Defect (VSD) is another congenital heart anomaly, characterized by a hole in the septum between the heart’s lower chambers, the ventricles. Patent Foramen Ovale (PFO) is a condition where the flap-like opening between the atria, present in foetal circulation, fails to close after birth.
Structural abnormalities like ASD, VSD and PFO can lead to complications. Catheter-based closure procedures involve deploying a closure device through a thin tube to seal the opening, preventing abnormal blood flow between heart chambers.
6. Left Atrial Appendage Closure (LAAC)
In conditions like atrial fibrillation, the left atrial appendage can pose a risk for blood clots. LAAC procedures involve closing off this area to reduce the risk of stroke without the need for long-term anticoagulation.
7. Balloon Valvuloplasty
This technique involves using a catheter with a balloon to widen a narrowed heart valve. While not suitable for all patients, it can be an effective treatment for specific conditions.
Challenges and future directions
While these advancements mark incredible strides in the treatment of structural heart diseases, still there are many challenges to be addressed. Further research is needed to refine techniques, expand patient eligibility and improve long-term outcomes. Additionally, ongoing innovation in transcatheter technologies holds promise for addressing a broader range of structural heart conditions.
As technology continues to evolve, we find ourselves on the verge of a new era in cardiac care, where precision, minimally invasive procedures and improved patient outcomes take centre stage. The heart, after all, deserves nothing less than our most innovative and compassionate care.