Heart Murmur: When Do You Need Cardiac Surgery Procedures?

The diagnosis of “heart murmur” can be frightening, but in most children, it is not a cause for concern and only requires monthly monitoring. In a much smaller number of cases, however, the first sign is a murmur, which may eventually lead to one of several cardiac surgeries.

Dr. Ghulam Sarwar is one of the top cardiac surgeons in Lahore, with years of experience in heart valve repair, replacement, and minimally invasive heart surgery. Read on to discover what a heart murmur is and when cardiac surgery procedures could be the best option. 

What Exactly Is a Heart Murmur?

A heart murmur is an abnormal whooshing, swishing, or rasping sound heard during the heartbeat, which is caused by turbulent blood flow in or near the heart. Murmurs are usually noticed during a routine physical exam, when a doctor uses a stethoscope to listen to the heart.  

There are two broad categories:

• Innocent (functional) murmurs: These are common, harmless, and often found in children or during pregnancy; they do not indicate any structural heart problem.
• Abnormal (pathological) murmurs: They are caused by an actual problem with the heart’s valves and may eventually require cardiac procedures and surgeries.

Common Causes of an Abnormal Heart Murmur

Most murmurs that require further investigation are linked to problems with the heart valves, which keep blood flowing in one direction through the heart. The most common causes are: 

• Valve stenosis: a valve that has become stiff or narrowed, restricting blood flow
• Valve regurgitation: a valve that doesn’t close properly, allowing blood to leak backward
• Congenital heart defects: structural abnormalities present from birth
• Endocarditis: an infection that damages the heart valves
• Cardiomyopathy: a disease of the heart muscle that can affect valve function indirectly

How Doctors Evaluate a Heart Murmur

Not all murmurs require immediate attention, but all new or unexplained murmurs should be evaluated. A cardiac specialist typically uses a combination of cardiac tests to determine the cause and severity: 

1. Echocardiogram: The primary tool for visualising heart valves and chambers in real time.
2. Electrocardiogram (ECG): checks the heart’s electrical rhythm for related abnormalities.
3. Chest X-ray: Helps assess heart size and lung involvement.
4. Cardiac MRI or CT: Used for a more detailed structural assessment in complex cases.
5. Stress testing: Identify how the heart and valves perform under physical exertion.

These are some of the standard heart tests used to determine whether a murmur is harmless or requires further treatment.

When Does a Heart Murmur Require Surgery?

Surgery is not always the first treatment for a murmur, but it is often recommended when a murmur is severe enough to affect the heart’s overall function or when it worsens despite careful monitoring. When one of several cardiac surgery procedures is recommended, it is usually by a cardiac surgeon when: 

• The valve narrowing or leakage is severe, and imaging shows the heart working harder than it should to compensate
• Symptoms are present, such as shortness of breath, fatigue, chest pain, dizziness, or fainting
• The heart chambers are enlarging, or the heart function is beginning to decline, as a result of the valve problem
• There’s a risk of heart failure if the valve issue is left untreated
• Infection or structural damage has significantly compromised the valve’s ability to function

In these situations, the two most common surgical options are:

1. Valve repair: preserving the patient’s own valve while correcting the structural problem, when feasible
2. Valve replacement: replacing the damaged valve with a mechanical or biological substitute when repair isn’t possible

Is Surgery for a Heart Murmur Always Open-Heart Surgery?

Not necessarily. Depending on the type of valve and the surgical challenge, advances in minimally invasive cardiac surgical techniques have made it possible to perform many valve repairs and replacements through smaller incisions rather than a large one through the sternum. Dr. Ghulam Sarwar is experienced in minimally invasive techniques, which he evaluates on a patient-by-patient basis to determine whether a patient is a good candidate for this less invasive treatment option to minimize pain, hospital stays, and activity restrictions. 

Understanding the Risks

Any surgical procedure on the heart carries risks, and patients are typically informed of them before surgery. Valve-related cardiac surgery also has some risks. Bleeding, infection, abnormal heart rhythms, or a reaction to anaesthetic are possible complications of cardiac surgery, although the risk of serious complications is greatly reduced when the procedure is performed by a highly experienced cardiac surgical team with thorough pre-operative assessment and post-operative monitoring. 

When to See a Cardiac Specialist

If you or a family member has been diagnosed with a heart murmur, it is wise to have it evaluated, especially if you are an adult and it is new, or if you are experiencing any symptoms. Early assessment can help a heart specialist in Lahore detect valve issues before they become serious enough to affect the heart.

For more than 25 years, Dr. Ghulam Sarwar has diagnosed and treated structural heart diseases and given patients a clear, accurate evaluation of their treatment options: monitoring, medication, or surgical intervention. A consultation with a heart expert can provide the clarity and peace of mind you need if you’ve been diagnosed with a heart murmur and want an expert opinion on what it is and what it means for your heart health.