Chippenham Hospital January 01, 2016

8 Things to Know About Heart Valve Disease

Chiwon Hahn, MD | Cardiothoracic Surgical Associates

Many people will go their whole lives not thinking twice about the health of their heart valves, but for approximately 5 million Americans annually, Heart Valve Disease is cause for very serious concern.

What is a heart valve and how does it work?

Humans have four distinct heart valves – the mitral and aortic valves on the left side of the heart, and the tricuspid and pulmonic valves on the right side. The job of these valves is to move blood properly through the heart, preventing blood at different stages of circulation from mixing.

What causes heart valve disease?

There are several factors, both genetic and environmental, that can contribute to heart valve disease. Congenital heart valve defects are those that occur before birth, and are detected later in life. Environmental factors that increase risk include a history of rheumatic fever, infective endocarditis, heart attack, arrhythmia, or cardiomyopathy. Calcification of the arteries (arteriosclerosis) is also a risk factor, as plaque build-up narrows the arterial tubes delivering blood to the heart. Not only can this affect valve health, but also can increase a person’s risk for heart attack and stroke.

What are some common types of heart valve problems?

  • Aortic Stenosis: The aorta is the artery by which blood leaves the heart, exiting through the aortic valve. In aortic stenosis, this valve does not open fully, decreasing blood flow from the heart to the body. The primary cause of aortic stenosis is arterial calcification; it usually develops later in life, and mostly affects older patients.
  • Mitral Valve Prolapse (MVP): MVP is a condition that affects 1-2% of the population, by which the leaflets of the mitral valve enter the left atrium during the heart’s contractions. The tissues in the valve can stretch, causing the valve to leak. MVP usually is mild and does not require treatment.
  • Mitral Valve Regurgitation (MVR): If left untreated, MVP can lead to MVR, which is a leakage of blood backward through the mitral valve into the atrium. This backward flow can cause pressure and fluid volume to build, ultimately increasing pressure in the veins leading from the lungs to the heart.

What are the symptoms of heart valve disease?

Symptoms can range from severe to non-existent, depending on the type of valve disease. Patients who suffer from valve disease may feel abnormal shortness of breath, weakness, dizziness, palpitations or other chest discomfort, especially when subjected to activity or cold air. Edema (swelling of the ankles, feet, or abdomen) is also a possible indicator, as is rapid, unexplained weight gain in a very short period of time.

How is heart valve disease diagnosed?

Many heart valve issues are first identified by the presence of an atypical murmur in the heart’s normal beating pattern that your physician would hear during a routine stethoscope chest exam. Upon suspicion of an issue, your doctor would conduct a full physical exam, potentially an echocardiogram, a set of x-rays, an electrocardiogram (EKG), and a cardiac catheterization (angiogram), which is the insertion of a tube-like device into the heart through an artery in order to accurately define the valve issue.

What are the treatments for heart valve disease?

There are two main avenues for treatment – management with medication, and surgical intervention. If surgery is indicated, you will work with your surgeon to determine if your valve needs to be repaired or replaced, with normally only one valve being replaced at a time. New heart valves can be either synthetic or tissue-based from a pig, cow, or a human donor.

  • Balloon Valvuloplasty is a surgical repair option, and is a procedure done during a cardiac catheterization whereby an expandable “balloon” is threaded into the heart, placed inside the tightened valve, and then inflated in order to stretch open the valve, restoring proper blood flow.
  • Transcatheter Aortic Valve Replacement (TAVR) is a relatively new minimally-invasive procedure that inserts a new temporarily collapsed valve into the damaged valve, effectively replacing it. The surgeon then “inflates” the new valve, and as it expands, it assumes blood flow management going forward. TAVR is a procedure ideally suited for those who are unable to undergo a traditional open-chest procedure, as it can be completed through small incisions that do not disturb the chest wall. The cardiothoracic surgical team at HCA Virginia was the first to complete this procedure in Central Virginia, and recently celebrated their 100th TAVR operation.

Are the surgical options for treatment safe?

As with any surgical intervention, there are potential complications. Because heart valve surgery can be highly invasive, patients can normally expect a hospital stay of 2-5 days post-surgery, with intensive monitoring by a highly specialized staff. Because heart valve replacement surgery has been evolving over many years, most techniques are considered to be very safe and highly effective. There are some lifestyle factors that can increase complication rates such as smoking, a pre-existing heart or lung condition, advanced age, or a recent illness or infection. All of these factors would be assessed by the patient’s surgeon prior to operating.

How long does a heart valve replacement last?

The lifetime of the replacement valve depends on whether it is synthetic or natural. Manufactured mechanical heart valves are the most long-lasting replacement valves, but they can come with a lifetime of blood-thinning medications in order to prevent clotting and embolisms. Natural replacement valves, either from a human donor or animal tissue, generally last between 10-20 years and in many cases can be maintained without medication assistance.

There are more options today for safe and effective heart valve disease treatments than ever before, and surgeons continue to innovate in the field. As with any medical intervention, you should discuss all appropriate treatment options with your physician before pursuing any course of action.

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