Valvular Heart Disease

The human heart uses four valves to control blood flow in and out of the vital organ. When one of those valves isn’t working properly, either because of a genetic defect or damage, your doctors will determine if you’re a candidate for valve repair or replacement.

 
How To Replace A Heart Valve Without Open Heart Surgery
 

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Symptoms

Signs of heart valve disease can be as obvious of chest pain, but it’s also possible you’ll never notice symptoms. Some symptoms associated with heart valve disease -- including chest pain, shortness of breath, dizziness and fatigue – are also indicators of several conditions.

When the disease progresses slowly, it’s possible your heart will adapt. When that happens, it’s even harder to detect a problem. Some people, in fact, develop congestive heart failure and serious heart muscle damage, even a fatal heart attack, without feeling a major change in general health. Yet a small, repairable valve leak can cause extreme symptoms.

Here are signs of possible heart valve disease:

  • Chest pain, palpitations.
  • Fatigue.
  • Headaches.
  • Swelling (feet, ankles, legs and neck veins).
  • Water retention.
  • Shortness of breath or wheezing, particularly when lying down or after physical activity.
  • Dizziness, fainting.
  • A cough.
  • Rapid weight gain.
  • Fever (with bacterial endocarditis).
  • Pulmonary edema, caused by fluid in the lungs.
  • Heart murmur, detected by a doctor’s stethoscope. (Note that many people who have heart murmurs do not have heart valve disease.)

Causes

If you know your heart, it’s easier to understand heart valve disease.

The heart’s four valves have tissue flaps that open and close every time the heart beats. The flaps control the movement of blood through the heart’s four chambers and into the body.

HVIheartvalves.jpg

Mitral: Separates the left atrium and left ventricle. The mitral valve opens to allow oxygenated blood to flow from the left ventricle to the rest of the body.

Tricuspid: Separates the right atrium from the right ventricle. When the tricuspid valve opens, deoxygenated blood moves into the right ventricle from the right atrium. When it closes, it prevents blood from returning to the right atrium, which forces blood through the pulmonary valve and into the pulmonary artery.  

Pulmonary valve: Separates the right ventricle from the pulmonary artery. The pulmonary valve closes the heart’s right ventricle and, when it opens, allows blood pumped from the heart to the lungs, via the pulmonary artery, where it will be oxygenated.

Aortic: Separates the left ventricle from the aorta. When it closes, it holds oxygenated blood in the heart’s lower left chamber. When it opens, blood flows from the heart – via the aorta, from the left ventricle – into the body. 

Some causes of heart valve disease:

  • High blood pressure and heart failure.
  • A damaged heart caused by injury or heart attack.
  • Cardiomyopathy, a disease of the heart muscle.
  • A heart attack.
  • A birth defect caused for unknown reasons before birth as the heart takes shape.
  • Myxomatous degeneration, a weakening of the mitral valve’s connective tissue.
  • Infective endocarditis, an inflammation of heart tissue caused by germs that enter the bloodstream through syringes and other medical  devices or through a break in the skin or gums.
  • Untreated strep throat or other strep-bacterial infections that become rheumatic fever.
  • Calcium deposits and other age-related changes.
  • Lupus, an autoimmune condition.
  • Aortic aneurysm, a swelling of the aorta.
  • Hardening of the arteries (atherosclerosis).
  • Coronary artery disease (narrowing, hardening of the arteries).
  • Syphilis, a sexually transmitted disease.

Types Of Heart Valve Disorders

Regurgitation: A backflow of blood into the heart’s chambers when a valve doesn’t close tightly. It’s often caused by mitral valve prolapse, when the valve’s two flaps bulge into the left atrium. Despite the valve’s improper closing, most people do not experience symptoms and don’t require treatment. People with mitral valve prolapse who experience chest pain, shortness of breath, heart palpitations or other symptoms should see their doctor.

Stenosis: When the flaps can’t open fully because they have thickened or stiffened, preventing normal blood flow through the valve. An estimated 2.5 million people over 75, more than 12 percent of that demographic, have aortic stenosis. And 80 percent of adults with the disease are male.

Atresia: A congenital condition with either a missing or abnormal valve. Tricuspid atresia blocks blood from flowing to the right ventricle from the right atrium.

Treatment

Heart valve disease, at its least serious level, is monitored by a physician. Here are some common treatments:

Lifestyle/Diet

  • Stop smoking.
  • Avoid heavy alcohol consumption.
  • Follow a healthful diet.
  • Avoid excess salt and diet pills, which can raise blood pressure.

Medications

Beta-blockers and calcium channel blockers to regulate heart and blood flow.

  • Vasodilators, which open or dilate vessels.
  • Diuretics to reduce fluid retention.
  • Antibiotics, to prevent turn of streptococcal infection for those who had rheumatic fever.
  • Clot-preventers, such as aspirin and ticlopidine, for those who have had transient ischemic attacks (TIAs), often called a “warning stroke.”
  • Stronger anticoagulants, such as Coumadin, often prescribed for mitral valve disease patients with atrial fibrillation or repeated TIAs.

Valve Repair (Minimally Invasive)

Repair or replace your heart valves? A doctor will consider the seriousness of your heart disease, your age and general health and whether your heart requires additional treatment such as bypass surgery.

The first choice, whenever possible, is repair over replace.

Balloon dilatation: This conventional procedure, also known as balloon valvuloplasty or balloon valvotomy, widens the stenotic valve with a balloon inserted into a blood vessel using a catheter. The balloon, placed into the narrowed valve, stretches the valve as it expands.

TAVR

For an increasing number of people with aortic stenosis, a newer procedure called transcatheter aortic valve replacement, or TAVR, has become an alternative to open-heart “sternotomy” surgery.

In the TAVR procedure, a collapsible replacement valve inserted through a catheter takes the aortic valve’s place even though surgeons do not remove the original. As the replacement expands, it displaces the original valve’s leaflets and eventually assumes its role in regulating blood flow.

TAVR, initially restricted to high-risk and mostly older patients, was approved in late 2016 for intermediate-risk patients.

Learn More About TAVR

This procedure starts with an incision in the groin or chest. In open-heart surgery, the surgeon must cut open the chest, spreading the ribs and muscles, to access the aortic valve before applying an artificial aortic valve.

TAVR through the carotid artery: