Valvular Heart Disease

What Is Valvular Heart Disease?

Valvular heart disease is an abnormality involving one or more of the four valves of the heart (aortic, mitral, pulmonary, and tricuspid). These abnormalities typically occur from aging, but can be congenital, rheumatic, or due to other causes.

Heart valves are part of the cardiac skeleton, and function to move blood in the right direction through the body. The tricuspid and pulmonary valves sit in the right-side and move blood from the heart to the lungs, while the mitral and aortic valves occupy the left-side and move blood from the lungs to the body.

Disease of the heart valves are generally classified as abnormalities resulting in the valve being too narrow (i.e., “stenosis”) or too leaky (i.e., “regurgitation” or “insufficiency”). Many times, the valve can be both narrow and leaky. When the valve disease is present, heart failure can occur due to poor circulation.

Common Valvular Conditions

Aortic Stenosis

 

Video courtesy of Edwards Life Sciences, Inc.

Aortic valve stenosis is common, affecting 3 to 4% of people over 65 years of age (>220,000 in the United States alone). The most frequent cause is calcific degeneration, an age-related process that leads to hardening and narrowing of the valve. Once aortic stenosis becomes severe, pressure builds in the pumping chamber of the heart, and heart failure or even sudden death may occur. Replacement of the valve is the only effective therapy, and is life-saving.

Timely intervention is essential because patients with symptoms due to aortic stenosis often survive only 1 to 2 years without therapy.

Aortic valve replacement (AVR) can be performed with either surgery (SAVR) or a transcatheter approach (TAVR). In the U.S., TAVR is available for patients who are not low surgical risk. For those who are at low surgical risk, TAVR can only be performed as part of a clinical trial. Learn more about participating in the trial here.

The Valve Science Center offers state-of-the-art interventions for aortic valve stenosis and participation in all major research studies with latest AVR technologies. Contact us at research@mhif.org or 612-863-3980 to make an appointment.

To learn more about aortic stenosis, visit https://newheartvalve.com/

Mitral Stenosis

Mitral stenosis is commonly due to rheumatic disease, in which a bacterial infection causes an immune response that damages the valve. Rheumatic mitral disease is highly prevalent in undeveloped countries, with relatively few cases occurring in the U.S. Mitral annular calcification (MAC), an age-related condition, is another frequent cause of mitral stenosis.

Mitral stenosis progresses slowly, over decades, and eventually can cause atrial fibrillation, pulmonary hypertension, heart failure, and stroke.

In some cases, medications may be used to slow the heart rate and improve function of the valve. In more severe cases, surgical relief with either a balloon procedure (i.e., “valvuloplasty”) or valve replacement may be recommended. The choice of these procedures depends on the anatomic findings present, with replacement usually recommended for the most severe abnormalities.

The Valve Science Center offers state-of-the-art interventions for mitral valve stenosis. For patients with mitral annular calcification, the Valve Science Center has developed special transcatheter therapies and is leading clinical studies in these area. Contact us at research@mhif.org or 612-863-3980 to make an appointment.

Mitral Regurgitation

The mitral valve is composed of two leaflets that normally touch to close when the heart beats. Regurgitation (or insufficiency) is an abnormality in which leaking occurs because the mitral valve fails to close properly. In the U.S. alone, 2 to 4 million people have mitral regurgitation.

Mitral regurgitation may be due to weakening of the valve structure, such as prolapse, infection, or tears (also known as flail leaflet). In other cases, mitral regurgitation may come from weakening of the heart muscle (like a heart attack), and the leakage is from stretching of the valve by the enlarged heart.

Mitral regurgitation, when severe, leads to congestion of blood in the lungs and heart failure. When treated early, patients can have a normal or near-normal life after surgery. The type of treatment, repair or replacement, depends on the anatomic abnormality. Repairs and replacements can both be done either surgically or with transcatheter techniques.

Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium. When the heart pumps (contracts) part of one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur. In most cases, it’s harmless. Most people who have the condition are unaware of it and their health is not affected. However, in some cases treatment is required.

The Valve Science Center is a world-class leader in therapy for mitral regurgitation, especially minimally-invasive approaches. The Center performed the first transcatheter mitral valve replacement in the U.S., and remains the most experienced site in the world. The faculty also is renown for transcatheter mitral valve repair and offers multiple opportunities for innovative techniques in this field. Learn more about participating in the trial here. Contact us at research@mhif.org or 612-863-3980 to make an appointment.

Tricuspid Regurgitation

The tricuspid valve consists of three leaflets that normally touch when the right ventricle pumps blood to the lungs. Regurgitation of the tricuspid valve occurs when these leaflets do not touch properly. Causes of tricuspid regurgitation are broadly classified into those due to 1) disease within the lungs; 2) high pressure transmitted across the lungs from left-sided heart disease; or 3) abnormalities of the tricuspid valve leaflets, including injury from pacemaker leads.

Tricuspid regurgitation can be clinically silent for many years, but can lead to symptoms of fatigue and/or congestion, such as leg swelling or edema. Diuretics or water pills can alleviate symptoms. In other patients, surgical correction may be required, most often with valve repair. The most common type of surgery is annuloplasty, in which the tricuspid valve is “cinched” closed.

New therapies can also treat tricuspid regurgitation with catheter-based approaches or minimally invasive techniques, and include repair or replacement of the tricuspid valve. The Valve Science Center was the first in the world to treat tricuspid regurgitation with the TriClip device, which is currently under investigation. Multiple other technologies are also available as part of research trials.  Contact us at research@mhif.org or 612-863-3980 to make an appointment.

How Is Valvular Heart Disease Treated?

Many people live long and full lives with mild valvular problems and never become impaired nor require surgery. However, once a heart valve begins to significantly affect the heart’s ability to pump blood, it should be repaired or replaced. Warning signs include symptoms of heart failure (e.g., shortness of breath, fatigue, leg swelling) or enlargement of the heart.

Timely surgery is life-saving for patients with valvular heart disease.

Valve repair restores the normal function of the patient’s own leaflets, while valve replacement involves insertion of a prosthesis. In many cases, both of these procedures may be performed with minimally-invasive surgery.

Video courtesy of Edwards Life Sciences, Inc.

Video courtesy of Edwards Life Sciences, Inc.

Frequently asked questions

How do I know that something is wrong with my heart valves?
Common symptoms are shortness of breath, loss of energy, weakness, dizziness or fainting spells, and chest pain or pressure. If you have experienced any of these, see your care provider for a check-up or seek immediate medical attention if your symptoms are severe. The described symptoms may be due to other conditions, but valvular heart disease could be one of them.

How will my doctor check my heart valves?
Your care provider will do a physical exam. If the provider finds a problem during the exam, he/she will order an echocardiogram (a sonogram of your heart) in order to take a closer look at your heart valves.

Which heart valves are most commonly affected?
In adulthood the most commonly affected valves are the aortic and mitral valves. The most common aortic abnormality is aortic stenosis. For mitral valves, the most common abnormality in the western world is regurgitation, while stenosis may also occur from rheumatic disease. The tricuspid and pulmonary valves are less commonly affected.

Why do issues develop with heart valves?
Heart valve disease can arise from age-related degeneration, a congenital abnormality (e.g., bicuspid disease), rheumatic disease, infections (i.e., endocarditis), radiation, exposure to toxic agents, or other less common causes.

What can be done to treat valvular heart disease?
As a mechanical problem, valvular heart disease can only be effectively treated with surgery. Fortunately, nearly all valvular heart disease is treatable, often with minimally-invasive procedures. These therapies can improve the symptoms of patients and, in many instances, are life-saving.

Does that mean open heart surgery?
Not necessarily. Minimally-invasive technologies are available for all types of valve disease, and are offered when feasible and advisable. In choosing the most appropriate therapy, you and the clinician will discuss what is best for you for both the short-term and long-term. You, your family, and your team of providers are essential to choosing what’s right at every decision point.

Additional Resources

Community Support

Mended Hearts www.mendedhearts.org

Online Resources

Alliance for Aging Research www.agingresearch.org
CardioSmart www.CardioSmart.org/HeartValveDisease
Women Heart www.womenheart.org

Caregiver Resources

Family Caregiver Alliance www.caregiver.org