Heart & Lung Programme

Heart & Lung Programme : Valve Surgery Malaysia

The Heart & Lung Centre at CVSKL is a comprehensive facility in Malaysia, specialising in screening, diagnosing, managing, and treating heart valve diseases, aortic diseases, and lung diseases. Our services include Valve Surgery Malaysia and personalised care for patients with Heart Valve Disease.

The Heart | Heart Valve Disease

Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease occurs when the blood vessels that carry oxygen and nutrients to your heart become thickened and narrowed — sometimes restricting blood flow. Healthy arteries are flexible and elastic, but over time, the artery wall can harden, a condition called atherosclerosis.

Risk factors for coronary artery disease:

Patients with the following risk factors are at increased risk of coronary artery disease:

High blood pressure
High cholesterol
High triglyceride
Smoking
Obesity
Unhealthy diet
Sedentary lifestyle

Treatment for Coronary Artery Disease

If you have coronary artery disease, control of risk factors is essential. This can be done through lifestyle changes or with medications. In severe cases of coronary artery disease, or if you continue to have symptoms with optimal medications, a procedure to improve blood flow to your heart can be performed. Depending on how badly diseased your coronary arteries are and how many coronary arteries are involved, coronary artery angioplasty or stenting, or coronary artery bypass graft (CABG) surgery may be needed.

Coronary artery bypass graft (CABG) surgery

During this type of heart surgery, a healthy blood vessel is taken from under your chest wall, arm or leg to create a bypass around the blocked arteries, redirecting blood flow to the heart.
The original blocked coronary arteries remain in place; additional new blood vessels are created to bring blood to your heart. This is the best treatment to improve your survival and quality of life in the long term if you have multiple diseased coronary arteries, especially if you are also diabetic or have poor heart function.

Valve Surgery Malaysia

Heart Valve Disease

Structure & function of the heart

The heart is an organ which pumps blood around the body. It has four chambers inside it. Heart valves separate the heart chambers from each other and from the rest of the body. These valves ensure that blood flows in one direction through the heart. There are four heart valves called the mitral valve, aortic valve, tricuspid valve and pulmonary valve.

Mitral Valve Disease

Types of mitral valve disease

The mitral valve separates two of the heart chambers on the left side of the heart.

It essentially separates the heart from the lungs. These valves can get diseased, e.g. they may leak (mitral regurgitation) or fail to open normally (mitral stenosis).

What causes mitral valve disease?

Several conditions can cause mitral valve disease. Among them are:

Aging (Degenerative)
Infection (Endocarditis)
Inflammation (Rheumatic)
Weak heart (Cardiomyopathy)
Congenital
Poor blood supply (Ischæmic)

What are the symptoms of mitral valve disease?

Many patients have no symptoms in the early stages as the heart enlarges to compensate for the leaking or narrowed valves. Symptoms normally occur in the later stages or if the faulty valve has developed suddenly (acutely). These include:

Shortness of breath
Irregular heart beat
Fatigue
Swollen feet or ankles

Treatment For Mitral Valve Disease

Mild to moderate conditions of mitral valve leakage and narrowing can be treated with medications. However, the more severe disease will require surgery to repair or replace the mitral valve. Once severe mitral valve leakage is diagnosed, the earlier the surgery is performed, the better the quality of life and survival in the longer term.

Mitral Valves Repair

Most cases of leaking mitral valves can be repaired. This is best as it uses your own tissue and has the best survival and quality of life. Several different techniques are used to repair the mitral valve depending on the disease present.

Mitral Valve Replacement

Some cases may require valve replacement if the valve is too badly diseased. There are two types of artificial heart valves available: a mechanical valve and a tissue valve.

Aortic Valve Disease

The aortic valve separates the heart from the aorta. It essentially separates the heart from the rest of the body. This valve can get diseased and fail to open normally (aortic stenosis) or start leaking (aortic regurgitation). As a result of either of these conditions, the heart will have to pump harder and blood flow to the rest of the body may decrease, which can eventually lead to heart failure.

Aortic stenosis and regurgitation may occur with age. However, it can also occur in young patients, for example: in bicuspid aortic valves (a valve with two “flaps” instead of three) and rheumatic valvular disease.

What are the causes of aortic stenosis and regurgitation?

Several conditions can cause aortic valve narrowing and leakage. These include:

Aging (Degenerative)
History of rheumatic fever (Rheumatic)
Endocarditis
Infection (Endocarditis)

Aortic regurgitation can also be caused by on enlargement of the aorta (aortic aneurysm).

What are the symptoms of aortic stenosis and regurgitation?

When you have mild aortic valve stenosis, you may not feel any symptoms. For more severe diseases, you may experience:

Chest discomfort
Dizziness
Fatigue, shortness of breath or weakness
Heart palpitations
Swollen feet or ankles
Abnormal heart sound (heart murmur)

Treatment For Aortic Valve Disease

Mild causes of aortic stenosis and regurgitation can be controlled with medication, more severe cases will require surgery to replace the diseased aortic valve.

Aortic valve replacement

Tricuspid Valve Disease

The tricuspid valve separates the right heart’s upper right chamber (right atrium) from its lower chamber (right ventricle). It ensures that blood flows in a forward direction from the right atrium to the right ventricle. Any abnormal function of the tricuspid valve is known as tricuspid valve disease.

Diseases of the tricuspid valve include:

What are the causes of tricuspid valve disease?

Several conditions can cause tricuspid valve disease. Among them are:

Rheumatic heart disease (inflammation)
Congenital
Enlarged heart (cardiomyopathy)
Endocarditis (heart infection or inflammation)
Secondary to left heart valve disease e.g. mitral regurgitation

What are the tricuspid valve disease symptoms?

Often, a patient has no symptoms associated with tricuspid valve disease; symptoms may include:

Irregular heart beat (atrial fibrillation)
Difficulty breathing
Fatigue, especially during physical activity
Swelling in the legs or abdomen

Treatment For Tricuspid Valve Disease

Treatment varies, depending on the patient’s condition. If the condition is mild, no treatment may be needed or medications to control the condition may be advised.

When tricuspid valve disease is severe, it may be necessary to repair or replace the diseased valve. Tricuspid valve repair is the preferred treatment for significant tricuspid regurgitation.

The Aorta

Aortic Aneurysm

The aorta is the large blood vessel that carries blood from the heart to the rest of the body. The aortic root is the section of the aorta closest to and attached to the heart.

An aortic aneurysm is an abnormal enlargement in the wall of the aorta. If an aneurysm develops in the aortic root, the aorta can dilate and the aortic valve can leak. If the aneurysm continues to expand, it can tear (aortic dissection) and even rupture. This is life-threatening and often fatal.

Aortic root aneurysms, like other aortic aneurysms, can be caused by atherosclerosis, or “hardening of the arteries.” In atherosclerosis, the build-up of fat and cholesterol causes the aortic wall to break down and become weak.

Aortic root aneurysms are also often found in patients with Marfan Syndrome and other genetic disorders characterised by weakened connective tissues.

Treatment For Aortic Root Aneurysm

In the early stages when the aneurysm is not too big, the aorta can be strengthened to prevent it from getting any bigger. In more advanced stages when the aneurysm is already large, the dilated part of the aorta will need to be replaced.

Aortic root replacement

This surgery involves the removal of a section of the aorta and the aortic valve. The enlarged section of the aorta is replaced with an artificial tube (graft), and the aortic valve is replaced with a mechanical or biological valve. If a mechanical valve is used, a blood-thinning medication called warfarin will be needed to prevent blood clots from forming.

Valve sparing aortic root replacement

In this surgery, the portion of the aorta which is dilated is replaced, while preserving the patient’s own aortic valve. In this procedure, your surgeon replaces the enlarged section of your aorta with an artificial tube (graft). Your aortic valve remains in place.

Personalised External Aortic Root Support (PEARS) Surgery

Marfan’s syndrome is a genetic disorder of the connective tissues of which the most serious complication involves the heart and aorta. The aorta can dilate and form aneurysms and may dissect (tear) if it reaches a certain size.

Personalised external aortic root support (PEARS) surgery is performed to prevent continued dilatation of the aortic root and ascending aorta in Marfan patients. It involves surgical implantation of custom-made mesh support around the aortic root and the ascending aorta. With 3-dimensional CT-guided imaging, a supporting mesh resembling the aortic root and ascending aorta is produced. This is then sutured around the dilated aorta so that it has a perfect fit around it.

Aortic Dissection

An aortic dissection is a serious condition in which the inner layer of the aorta, the main blood vessel coming off from the heart tears with separation of the inner and middle layers (aortic dissection). The condition is fatal if the aorta ruptures completely.

Aortic dissections are divided into two groups, depending on which part of the aorta is affected:

Type A. This involves a tear in the first part of the aorta where it exits the heart (ascending aorta). The tear may extend further into the descending aorta and also into the abdominal aorta.

Type B. This involves a tear in the lower part of the aorta only (descending aorta). The tear may also extend into the abdomen but does not involve the ascending aorta.

What are the causes of aortic dissection?

Several conditions can cause aortic dissection. Among them are:

Chronic high blood pressure
Connective tissue disease (Marfan Syndrome)
Traumatic injury
Aortic Aneurysm

Treatment For Aortic Dissection

A Type A aortic dissection involving the ascending aorta will need surgery to replace the torn part of the Aorta. A Type B dissection which does not involve the ascending aorta is often managed with medications to control the blood pressure. In most cases, this is sufficient but in some cases, intervention may be needed through endovascular stenting.

Medications

Medications to control your blood pressure and relief any pain will be given.

Surgeries

The torn section of the aorta is removed and replaced with a synthetic graft. If one of your heart valves has been damaged, this is also replaced.

What causes an aortic aneurysm?

Several conditions can cause an aortic aneurysm. Among them are:

Atherosclerosis
High blood pressure
Connective tissue disease (Marfan Syndrome)
Trauma

What are the symptoms of an aortic aneurysm?

Symptoms may vary depending on the severity of your case, its causes and your overall health. You may notice:

Chest Pain
Back Pain

The Lungs

Asthma

What is asthma?

Asthma is an inflammatory lung disease that can lead to mild to severe symptoms. In most cases, you can control asthma by avoiding triggers, daily medications and other treatment options.

If you continue to have symptoms, you may need additional medications such as corticosteroids.

For those with severe asthma, the highest dose of standard medications may not alleviate frequent and life-threatening asthma attacks. Few treatment options are available to adequately control the disease, which can have a significant impact on quality of life.

Treatment For Severe Asthma

Bronchial Thermoplasty
Non-drug Treatment for Severe Asthma

Bronchial Thermoplasty (BT) is a procedure to reduce the smooth muscle mass of the airway. With less smooth muscle, the airways constrict less, reducing severe asthma attacks.

Bronchial Thermoplasty (BT) is the first non-drug treatment option for patients with severe asthma who are 18 years and older and whose asthma is not well controlled by inhaled corticosteroids and long-acting beta-agonists. This minimally invasive outpatient procedure supplements conventional asthma drug treatments for better management of the disease.

It’s a heat treatment that reduces the amount of thickened smooth muscle on the inside walls of the airways. Over time, severe asthma causes the smooth muscle tissue lining the airways to thicken. This means the airways are narrower and it’s harder to breathe.

Emphysema

What is Emphysema?

Emphysema is a type of chronic obstructive pulmonary disease (COPD). In this condition, the air sacs in the lungs become damaged and stretched. This damage is permanent and irreversible, this results in a chronic cough and difficulty breathing.

Smoking is the number one factor. Because of this, emphysema is one of the most preventable types of respiratory disease.

Cigarette smoking not only destroys lung tissue but also irritates the airways. This causes inflammation and damage to the cilia that line the bronchial tubes. This results in swollen airways, mucus production, and difficulty clearing the airways. All of these changes can lead to shortness of breath.

Treatment For Emphysema

Bronchoscopic lung volume reduction (BLVR)

Most people with emphysema also have chronic bronchitis. Chronic bronchitis is an inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough.

BLVR is a minimally invasive procedure that involves no incisions or stitches, to relieve lung hyperinflation. BLVR can help people with severe emphysema that doesn’t improve with other standard treatments, such as medications, pulmonary rehabilitation, and oxygen treatment.

In BLVR, our doctor will place a tiny, one-way valve in the airways in the hyperinflated emphysematous sections of the lungs. The valves prevent air from entering the diseased areas but allow trapped air and secretions to escape.

Lung Cancer

Lung cancer is a type of cancer that originates in the lungs. There are two main types of lung cancer; 80-85% of the cases are non-small cell lung cancer (NSCLC) and 10-15% are small cell lung cancer (SCLC).

The subtypes under NSCLC originate from larger cells and are generally less aggressive. SCLC subtypes appear small and round under a microscope and tend to spread faster than NSCLC.

What are the risk factors of lung cancer?

There are certain risk factors that can increase a person’s chance of getting lung cancer, such as:

Tobacco smoke
Second-hand smoke
Exposure to radon
Exposure asbestos
Air pollution
Family history of lung cancer

What are the sign & symptoms of lung cancer?

There are usually no signs of early-stage lung cancer. Symptoms of lung cancer develop as the cancer progresses. If you have these symptoms, it’s important to see a doctor immediately:

A cough that does not go away or gets worse
Coughing up blood or rust-coloured phlegm
Chest pain
Loss of appetite
Unexplained weight loss

Diagnosis of Lung Cancer

Lung cancer, including early lung cancer, can be detected by a low-dose CT scan with minimal radiation. This is helpful for those with risk factors for lung cancer e.g. smokers. A CT scan will pick up growth in the lung. If this is seen, a tissue biopsy can be arranged. A bronchoscopy, which is an endoscopic examination of the airways, can also be done which will identify more central tumours. This investigation is often done in those who cough up blood. Additional tests may be required to stage i.e. determine how advanced the cancer is. These tests include endobronchial ultrasound and biopsy, mediastinoscopy and biopsy, anterior mediastinotomy and biopsy, and VATS biopsy.

Treatment For Lung Cancer

The best outcome for lung cancer is to remove it surgically. In the early stages of lung cancer, this is all that may be needed. If the lung cancer is larger or involves the lymph nodes, additional treatment with immunotherapy or chemotherapy may also be needed in addition to surgery. If lung cancer is very advanced and has spread to other organs elsewhere, treatment is usually only with immunotherapy and chemotherapy with or without radiotherapy. Examples of lung resection surgery are lobectomy, pneumonectomy, segmentectomy, and wedge resections.

Lobectomy

Your right lung is divided into three parts called lobes, and the left lung into two parts. Lobectomy is the removal of one of the lobes of the lung that is affected by lung cancer.

Pneumonectomy

This procedure is the removal of the entire lung affected by cancer. The procedure is usually done if cancer cannot be fully removed by lobectomy or the lesion is centrally located.

Pneumothorax

A pneumothorax is a medical term for a collapsed lung. This occurs when air leaks into the space between your lungs and chest wall, causing your lung to collapse.

A pneumothorax could cause a partial lung collapse or a complete lung collapse.

What causes pneumothorax?

A pneumothorax can be traumatic or non-traumatic. Traumatic pneumothorax occurs when there is an injury that damage the chest, leading to an air leak, caused by:

Motor vehicle accidents
Broken ribs
Stab wounds
Medical procedures such as lung biopsies or CPR

Non-traumatic pneumothorax can be caused by:

Smoking
Lung bullae (cysts)
Emphysema
Previous pneumothorax

What are the signs & symptoms of pneumothorax?

The severity of symptoms may vary depending on the portion of the lung that is collapsed. Some pneumothorax can be life-threatening, so see a doctor if you experience:

Sudden chest pain
Shortness of breath
Tightness in the chest
Turning blue
Fast heart rate

Treatment For Pneumothorax

Treatment will depend on the severity, past experience and symptoms experienced. The main goal of pneumothorax treatments is to relieve pressure on the lungs allowing them to re-expand.

Mild cases of pneumothorax do not require treatment and can be observed with chest X-rays. In more severe cases, the air in the chest cavity can be aspirated or a chest drain inserted.

If the pneumothorax persists, or if it recurs, then keyhole surgery is advised. This is performed through small incisions, a procedure called Video Assisted Thoracoscopic (VATS) surgery. The part of the lung which is leaking air is excised and inflammation is triggered between the lung and the chest wall so that the lung will stick to the chest wall and not collapse again even if the air should leak again.

The Chest

Tumours can arise in the chest or mediastinum. This can cause chest discomfort or shortness of breath but is often asymptomatic. It is often first suspected on a chest XRay and then diagnosed on a CT scan. If a tumour is seen on a CT scan, additional blood tests will be required to help determine the type of tumour. Some tumours e.g. lymphoma can be treated with chemotherapy.

Mediastinal Tumor

Mediastinal tumours are growths that form in the area of the chest outside the lungs. This area, called the mediastinum, is surrounded by the breastbone in front, the spine in the back, and the lungs on each side. The mediastinum contains the heart, aorta, oesophagus, thymus, trachea, lymph nodes and nerves. The thymus is an organ that is part of the immune system. The lymph system, or lymphatic system, is also part of the immune system and helps to protect the body. Tumours can form in the mediastinum.

What causes a mediastinal tumour?

There are several causes of mediastinal tumours. These include:

Thymomas
Germ cell tumours
Teratomas
Lymphomas
Cysts
Neurofibromas

Depending on the type of tumour suspected, surgical removal of the tumour, treatment with chemotherapy or observation only will be advised.

What are the sign & symptoms of a mediastinal tumour?

If you have a mediastinal tumour, you may not have any symptoms. Tumours are typically found during a chest X-ray that was ordered to diagnose another health condition.

If symptoms develop, it’s often because the tumour is pushing on surrounding organs. Symptoms can include:

cough
shortness of breath
chest pain
fever/chills
coughing up blood

Treatment For Mediastinal Tumors

Treatment for mediastinal tumours depends on the type of tumour and symptoms:

Thymomas, thymic cancers and neurogenic tumours are treated with surgery. It may be followed by radiation or chemotherapy, depending on the stage of the tumour.
Germ cell tumours and lymphomas are usually treated with chemotherapy.

Thymoma

The thymus gland is a pinkish-grey organ located behind the breast bone and between the lungs. This organ plays an important role in our immune system and hormone production.

Thymoma is when there is a tumour growth on the surface of the thymus gland which is usually harmless but can potentially be cancerous. The tumour cells look similar to the thymus cells and are slow-growing. Therefore, migration of tumour cells is usually confined within the thoracic area. This disease is often linked with other autoimmune diseases which cause the immune system to attack healthy tissue and organs.

What causes thymoma?

Despite extensive research, the exact causes of thymoma are not fully understood. Autoimmune-related conditions might cause cellular changes in the thymus and trigger thymoma. However, most people with these conditions never develop thymoma, so there is no known risk factor linked so far.

What are the signs & symptoms of thymoma?

Thymoma may not cause early symptoms and is usually found through routine x-ray screening. Although some of these symptoms might be caused by other diseases, thymoma could exhibit the following symptoms:

Persistent cough
Shortness of breath
Pain and pressure in the chest
Muscle weakness
Fatigue

Treatment For Thymoma

Surgical resection is advised for thymomas as, without surgery, they will continue to grow and may turn cancerous. In more advanced cases, this may be combined with chemotherapy or radiotherapy.