Valve disease in the elderly is often referred to abnormalities in the heart valves that affect their function. Symptoms like shortness of breath, chest pain, and fatigue are common. There are two types of valve diseases which include aortic stenosis and mitral regurgitation.
Vinoth Kumar, Senior Interventional Cardiologist, CARE Hospitals, HITEC City, Hyderabad, says, “Valve disease, particularly aortic stenosis, is a significant health concern among the elderly population in India. With increasing age, the heart valves can deteriorate, leading to conditions such as valve regurgitation or stenosis. This can result in symptoms like shortness of breath, chest pain, fatigue, and fainting. Aortic stenosis, characterized by the narrowing of the aortic valve, is the most common valve disease among the elderly in India.”
Studies have highlighted the prevalence of valve disease in India. According to a study published in the Indian Heart Journal in 2019, the overall prevalence of valvular heart disease among the elderly (aged 60 years and above) was approximately 10.7%. Among these cases, aortic stenosis accounted for a significant proportion.
Dr. Srinivasa Prasad B V, Consultant, Interventional Cardiology, Fortis Hospital, Bengaluru, opines, “Valve disease in elderly is quite common affecting one in eight (1 of 8) among the individuals aged 65 years and more. Degenerative Aortic Stenosis is the most common among them. Most often these patients are relatively asymptomatic till the disease progresses to advanced stage. Only initial symptoms could be reduced physical activity or mild fatiguability.”
Most often these symptoms are attributed to aging process by the family members. A physician consultation can help detecting these valve issues by looking out for murmur and then further investigating with Echocardiography. These patients can be treated with valve replacement either by surgery and transcatheter procedure percutaneously.
Dr. Sunil Dwivedi, Consultant, Cardiology, Manipal Hospital Millers Road, says, “The commonest cause of valve disease in the elderly is degenerative valvular heart disease. These conditions can be significant or non-significant. Non-significant ones are often treated with medicines. Whereas significant valve disease mostly needs surgical treatment. In current times, percutaneous treatments are gaining popularity as non-surgical treatment options for significant valve disease.”
Treatment
Doctors play a vital role in the treatment of valve disease in the elderly. They are responsible for diagnosing the condition through physical examinations and diagnostic tests like echocardiography. By evaluating the severity of valve disease, doctors can determine the most appropriate treatment approach.
“In recent years, transcatheter aortic valve replacement (TAVR) has gained recognition as a less invasive treatment option for elderly patients with aortic stenosis. TAVR procedures have shown promising outcomes in India, offering reduced hospital stays, quicker recovery, and improved quality of life compared to traditional open-heart surgeries. Doctors also play a crucial role in post-treatment care. They monitor patients’ progress, ensure proper medication management, and address any potential complications. Regular follow-up visits are important for assessing the effectiveness of treatment and making necessary adjustments,” says Dr Kumar.
Valve disease, particularly aortic stenosis, is a prevalent condition among the elderly in India. Doctors play a vital role in diagnosing, treating, and providing post-treatment care for patients. While recent data is unavailable, it is important to consult medical professionals or refer to reputable health organizations for the most up-to-date information on valve disease in the elderly in India.
“TAVI and TMVR (percutaneous valve replacement procedures) has helped many elderly individuals who were at high risk for surgery to regain their activities completely and lead normal life,” adds Dr Prasad.
For mitral wall for mitral stenosis (mitral valve narrowing), the choice of treatment is ballooning or surgery, or both. For regurgitation, the opening is not needed. Either surgical replacement or percutaneous procedure like Mitraclip or Mitral valve ring can be done.
“Abnormalities of tricuspid and pulmonary valves on the right side of the heart are less common and rarely need surgery. They are complicated to treat surgically and are associated with more complications and higher risk in terms of morbidity and mortality,” signs off Dr Dwivedi.
