Any disease or damage that affects one of the heart’s valves is known as valvular heart disease. Any valve in the heart can become diseased, but it is most common in the mitral and aortic valves. Diseased valves may fail to close completely, which can cause blood to leak back into the chamber it came from. If this happens, not enough blood flows through the heart. This is called regurgitation. Diseased valves may also become narrow and stiff. This can cause the valve to open incompletely, preventing blood from flowing through properly. This is called stenosis.

1. Anaesthesia for
Valvular Heart Diseases
By: Ms. Sujata Walode, MSc OT & AT, MGM SBSA

2. VHD
• Any disease or damage that affects one of the heart’s valves is
known as valvular heart disease.
• Any valve in the heart can become diseased, but it is most
common in the mitral and aortic valves.
• Diseased valves may fail to close completely, which can cause
blood to leak back into the chamber it came from. If this
happens, not enough blood flows through the heart. This is
called regurgitation.
• Diseased valves may also become narrow and stiff. This can
cause the valve to open incompletely, preventing blood from
flowing through properly. This is called stenosis.

3. Sign & symptoms
• Different valvular heart diseases can develop quickly or over a longer period. If valvular
heart disease develops slowly, a person may not experience symptoms until the disease
becomes advanced.
• If a person’s disease develops more rapidly, a person may experience various symptoms.
• Common symptoms of valvular heart disease
• shortness of breath
• chest pain
• dizziness
• fainting
• fever
• fatigue
• sudden weight gain
• irregular heartbeat

4. Causes
• Common causes of valvular heart disease
• Rheumatic disease: This occurs due to an infection from the bacteria that cause strep throat. If a
person does not treat this infection with antibiotics, it can cause scarring of the heart valves.
• Endocarditis: Endocarditis occurs when a severe blood infection causes inflammation of the inner
heart lining. This infection may settle on the heart’s valves and damage them. A person may also
contract endocarditis through intravenous drug use.
• Congenital heart valve diseases: These are malformations of the heart valves that are present at
birth. A bicuspid aortic valve is the most common form of congenital heart valve disease.
• Heart disease: Other types of heart disease can lead to damaged valves. These include heart
failure, atherosclerosis, thoracic aortic aneurysm, high blood pressure, and heart attack.
• Other conditions that may cause valvular heart disease include:
• autoimmune diseases, such as lupus
• Marfan syndrome, a genetic condition that affects connective tissues
• exposure to high doses of radiation
• The aging process can also cause calcium deposits on the heart’s valves. This can cause them to
stiffen or thicken, which makes them less efficient.

5. Risk Factors
• Age: As a person gets older, their risk of valvular heart disease increases.
• Family history: Some heart issues can run in families. If a person has relatives with mitral valve
prolapse or bicuspid aortic valve problems, they may have an increased risk of valvular heart
disease. A family history of early coronary heart disease can also increase a person’s chances of
developing valvular heart disease.
• Lifestyle: Certain lifestyle factors can raise a person’s risk of other types of heart diseases as well
as valvular heart disease. Lifestyle risk factors include a lack of physical activity, an unhealthy diet,
smoking, and obesity.
• Medical devices: Some medical devices, such as defibrillators and pacemakers, may rub against
certain valves. This can create scar tissue and may stimulate the heart to beat out of rhythm. This
can also stretch a heart valve, raising the risk of valvular heart diseases.
• Other health conditions: Health conditions such as high blood pressure, diabetes, autoimmune
disorders, and heart conditions can increase a person’s risk of valvular heart disease.
• Radiation treatment: Radiation treatment for cancers can cause heart valves to thicken and
narrow.
• Sex: Males are more likely than females to develop valvular heart disease.

6. Mitral stenosis
• Mitral valve stenosis — sometimes called mitral stenosis — is a narrowing of
the heart's mitral valve. This abnormal valve doesn't open properly, blocking
blood flow into the main pumping chamber of your heart (left ventricle).
• It is considered to be present if trans valvular pressure gradient is >10
mmHg(normal <5 mmHg)

7. Anesthesia
• Induction- Etomidate
• Maintenance- 02+N20+opioid or low dose isoflurane
• Relaxant- vecuronium
• Reversal – neostigmine+glyco

8. Anaesthetic consideration
• Avoid tachycardia – atrial fibrillation can be induced
• Avoid sudden increase in blood volume- it can induce pulmonary
edema in these patients so fluid must be guided by CVP.
• Avoid hypoxia, hypercarbia- these conditions increase pulmonary
vascular resistance and induce pulmonary hypertension.

9. Aortic Regurgitation
• Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the
leaking of the aortic valve of the heart that causes blood to flow in the
reverse direction during ventricular diastole, from the aorta into the left
ventricle. As a consequence, the cardiac muscle is forced to work harder
than normal.
• Symptoms of aortic regurgitation are similar to those of heart failure and
include the following:
• Dyspnea on exertion
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Palpitations
• Angina pectoris
• Cyanosis (in acute cases)

10. Anaesthetic Consideration
• Avoid bradycardia & HTN – hypertension by increasing the afterload
increases regurgitation.
• GA is preferred due to hypotension.
• Etomidate for induction
• Vecuroium
• Maintenance same as MS.