Treatment of Atrioventricular Valve Dysplasia (avd) in Germany
Best hospitals and doctors for atrioventricular valve dysplasia (avd) treatment in Germany
Leading hospitals
Cost for treatment
Dysplasias, based on genetically determined disorganization of the fibrous basis of the mitral and tricuspid valve leaflets, inevitably progress with age. Most often, clinical manifestations of such valve impairment with signs of central hemodynamic disorders and heart failure develop after the third and fourth decade of life.
Content
- About atrioventricular valve dysplasia
- Clinical manifestation of atrioventricular valve dysplasia
- Diagnostics for atrioventricular valve dysplasia before treatment
- Treatment of atrioventricular valve dysplasia
- Complications of atrioventricular valve dysplasia
- Why undergo treatment in hospitals in Germany?
- The cost of treatment in Germany
- Treatment in Germany with Booking Health
About atrioventricular valve dysplasia
The term "dysplasia" refers to the abnormal formation, development, in a particular case, of connective tissue. Connective tissue is widely present in our body. It is present in the skin, cartilage, tendons, ligaments, blood vessels, and muscles, including the heart. Collagen is the main protein in the fibers of connective tissue, the process of its formation is complex, and if changes (mutations) occur, abnormal collagen is formed. If the mutations are serious, the organ damage is significant.
However, mutations are much more common when certain characteristics are inherited. There are many people with dysplasia, where abnormal collagen is not so harmless. Indeed, such cases are common. As a rule, children with this health condition are energetic, hyperactive, but at the same time, their parents are full of anxiety and bewilderment because they feel problems with their health. One of the frequent manifestations of atrioventricular valve dysplasia that affects valve apparatus is structurally manifested as abnormally developed cusps, rings, chords, and functionally and clinically by sagging cusps (valve prolapse).
Atrioventricular valve dysplasia is a genetically determined developmental disorder characterized by defects in the valve’s fibers and structures. As a result, there are numerous disorders of cardiac tissues, and the body functioning as a whole. Most manifestations of atrioventricular valve dysplasia are characterized by ambiguous clinical symptomatology, lack of clear diagnostic criteria, and contradictory ideas about the mechanisms of formation. There is a growing understanding among the medical community of the great importance of this problem in the etiopathogenesis of a wide range of diseases.
Atrioventricular valve dysplasia mostly has dominant inheritance mutations that disrupt the synthesis and patterning of collagen and elastin fibrous proteins. In cardiac surgery, these are primarily the patients with large vessel aneurysms, non-rheumatic mitral and aortic insufficiency, and non-coronary cardiomyopathies that are also accompanied by dysplasia.
With combined mitral and tricuspid valve dysplasia, tricuspid valve insufficiency is secondary and relative in the vast majority of cases. It implies primary mitral valve defect followed by secondary tricuspid valve defect, which is functional without organic pathology of the latter. The combined mitral and tricuspid valve dysplasia leads to subsequent development of relative tricuspid valve insufficiency, which is of a secondary character.
Mitral valve prolapse, as a primary cause of pathology, is the most common form of heart valve apparatus structural and functional abnormality and is characterized by valve leaflets deflection into the left atrium cavity during left ventricular systole. In atrioventricular valve dysplasia, such a valve impairment involves isolated and combined cases of myxomatous valve degeneration. In some cases, these changes are accompanied by regurgitation phenomena, which are reflected in myocardial contractility and cardiac volumetric parameters. It should be noted that echocardiographic data are dynamic: more pronounced changes are observed at subsequent examinations, which reflects the influence of age on the state of the valve apparatus. In addition, the severity of valve changes is affected by the severity of atrioventricular valve dysplasia and ventricular volume.
Clinical manifestation of atrioventricular valve dysplasia
The clinical manifestations of atrioventricular valve dysplasia in children range from minimal to significant and are determined by the degree of dysplasia of the heart, autonomic and neuropsychiatric abnormalities.
Most older children complain of transient chest pain, heart palpitations, shortness of breath, dizziness, weakness, and headaches. Children describe heart pain as stabbing, pressing, aching, and felt in the left side of the chest without any irradiation. Symptoms arise due to emotional tension and are usually accompanied by vegetative disorders, such as unstable mood, coldness of extremities, palpitations, sweating. The symptoms may disappear spontaneously or after taking sedatives.
According to complex examination, the absence of ischemic changes in the myocardium mostly allows considering heart pain as a manifestation of sympathies, associated with psychoemotional features of children with atrioventricular valve dysplasia. Pain in atrioventricular valve dysplasia can be associated with regional ischemia of papillary muscles with their excessive tension. Heart palpitations, the feeling of "interruptions" in heart function, "tingling", "freezing" of the heart are also associated with neurovegetative disorders. Headaches occur more often with overwork, anxiety, in the morning before school and are combined with irritability, sleep disturbance, anxiety, and dizziness.
Congenital defects are often diagnosed in children with atrioventricular valve dysplasia such as tracheobronchomegaly, tracheobronchomalacia, and pulmonary hypoplasia. Due to atrioventricular valve dysplasia, these heart diseases are often accompanied by the development of severe complications in the form of pulmonary fibrosis, pulmonary hypertension, bronchiectasis, and spontaneous pneumothorax.
Unfortunately, unlike the above mentioned pronounced manifestations of atrioventricular valve dysplasia in children, subclinical variants are usually not diagnosed. This often leads to misinterpretation of the pathological process and serious pediatric errors.
Diagnostics for atrioventricular valve dysplasia before treatment
The choice of treatment tactics for atrioventricular valve dysplasia is largely determined by the accuracy of not only anatomical but also etiological diagnosis of the disease. The main criteria for diagnosis of atrioventricular valve dysplasia in hospital observations are the following:
- Clinical (early or sudden systolic murmur, supraventricular tachyarrhythmia, dyspnea on exertion).
- Echocardiographic (valve prolapse, moderate fibrosis, malformed flaps and subclavian apparatus, chordal detachment, enlarged left ventricle and atrium, and regurgitation).
- Medical and genetic (heart rhythm disturbances, autonomic disorders, syncope, and presyncope history).
- Histological (fragmentation and disintegration of collagen, myxomatous transformation, and decreased density of fibrous structures).
Atrioventricular valve dysplasia can be diagnosed already at the stage of physical examination by complex evaluation of the so-called phenotypic markers.
Treatment of atrioventricular valve dysplasia
The tactics of management of patients with primary atrioventricular valve dysplasia vary depending on the severity of autonomic and cardiovascular changes. The main principles of treatment that doctors evaluate while choosing the treatment tactics are complexity, duration, and consideration of the direction of functioning of the autonomic nervous system.
In case of moderate mitral valve prolapse, its surgical reconstruction can be performed. It is absolutely reliable and long-lasting in the long-term period.
The main therapeutic directions for treatment of atrioventricular valve dysplasia in hospitals in Germany are:
- Non-drug therapy (individual adequate regimen, exercise therapy, and psychotherapy).
- Individually tailored and adequate diet regimen (enriched with proteins, microelements, and vitamins).
- Medical therapy (correction of the impaired metabolism, collagen genesis stimulation). It includes collagen-forming stimulating preparations, medical correctors of catabolism disorders, and stabilization of the mineral metabolism. Stimulation of collagen formation is performed by a complex of vitamins, and minerals (copper, zinc, magnesium, iron).
Normalization of work, rest, daily routine, and a correct regimen with a sufficient duration of sleep are indispensable.
Complications of atrioventricular valve dysplasia
Severe complications in children with atrioventricular valve dysplasia are uncommon but possible.
Acute mitral insufficiency in atrioventricular valve dysplasia occurs due to tendon threads detachment from mitral valve leaflets. It is observed rarely in childhood and is mainly associated with chest trauma in patients with myxomatous chord degeneration. The main pathogenetic mechanism of acute mitral insufficiency is pulmonary venous hypertension, resulting from a large volume of regurgitation into the insufficiently distended left atrium. Clinical symptomatology is manifested by the sudden development of pulmonary edema. In children, mitral insufficiency in atrioventricular valve dysplasia is mostly asymptomatic and is diagnosed by Doppler echocardiography. Subsequently, with regurgitation progressing, the complaints of dyspnea on physical load, decreased physical performance, weakness, and retardation of physical development appear.
The patients suffering from atrioventricular valve dysplasia are at a high-risk factor for infectious endocarditis. The absolute risk of the disease is four times higher than in the rest of the population.
The incidence of sudden cardiac death in the presence of atrioventricular valve dysplasia depends on many factors, the main of which are electrical instability of the myocardium with long QT interval syndrome, ventricular arrhythmias, concomitant mitral insufficiency, and neurohumoral imbalance.
Why undergo treatment in hospitals in Germany?
A person's most valuable resource is health, so health care should be entrusted only to the best professionals. More and more often people go for treatment in Germany. This is due to the high qualification and excellent reputation of doctors working at German hospitals, excellent conditions of hospital setting, individual approach to each patient, and the generally high level of medical services provided by hospitals in Germany.
Undergoing treatment in Germany means that the patient will be provided with professional care, accurate diagnosis, and effective therapy. Doctors working in hospitals in Germany undertake even the most complicated cases that require surgical correction of the heart defects and interventions on the working heart. In the overwhelming majority of cases, the cutting-edge equipment, quality medications, extensive practical experience, and multidisciplinary approach help the specialists of German hospitals to succeed in treatment.
Thus, feedback from many patients testifies to the high quality of medical services, and the development of medicine enables all kinds of treatment to be performed at the highest professional level. It is worth noting that German hospitals are among the leaders in the world in terms of both quality and level of services provided.
The conditions under which treatment in Germany will be carried out depend primarily on the needs of the patient. Hospitals in Germany provide services of diagnosis, prevention, emergency medical care, inpatient or outpatient treatment, and complex elective surgery.
The best hospitals for the treatment of atrioventricular valve dysplasia are:
- University Hospital Oldenburg.
- University Hospital Essen.
- University Hospital Ulm.
- University Hospital Frankfurt am Main.
- University Hospital Tuebingen.
- University Hospital Erlangen.
In many cases, patients themselves express a desire and initiative to find a hospital. There is also an option of using the services of a medical tourism agency for hospital selection that is the most convenient, fastest, and comfortable for the patient, as it eliminates the need to deal with organizational issues.
You can contact Booking Health for assistance in hospital selection.
The cost of treatment in Germany
The cost of treatment in hospitals in Germany fully corresponds to the level of medical services provided. This is both due to the professionalism of doctors and the strict rules and regulations under which each hospital operates.
The average prices for the treatment of atrioventricular valve dysplasia are as follows:
- The prices for diagnostics of atrioventricular valve dysplasia start at 492 EUR.
- The cost of treatment with surgical correction starts at 9,833 EUR.
- The prices for rehabilitation start at 566 EUR.
Feel free to contact Booking Health for more information about the cost of treatment in Germany.
Treatment in Germany with Booking Health
The strong asset of Booking Health is a unique approach to the solution for an individual clinical situation. Booking Health provides personalized hospital options and treatment programs.
This makes it easy for patients to approach the idea of treatment abroad, which eliminates the tons of stress associated with this decision.
You can find out how treatment in Germany will be organized in your case by filling in the request form on the Booking Health website.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko