Valvular Heart Disease
The valves of the heart are comprised of two or three strong flaps of tissue, called leaflets, that open and close as the heart contracts and relaxes. The tricuspid and mitral valves control the flow of blood from the upper chambers of the heart to the lower chambers. The pulmonary and aortic valves control blood flow out of the lower chambers. Disease of these valves can prevent the valves from opening or closing properly, thereby interfering with normal blood flow through the heart. There are two major types of heart valve disease. One is obstruction (or stenosis), when the valve fails to open properly, making it difficult for blood to pass through the valve. The other major problem is leakage (regurgitation or insufficiency), when a valve fails to close completely, causing blood to leak backward instead of flowing forward. Aortic valve problems may be congenital (present from birth) or may be a result of infection, rheumatic fever or atherosclerosis. Mitral valve disease may be congenital or due to rheumatic fever, infection or heart disease. Valve disease causes the heart muscle to work harder to pump blood in adequate amounts to the body.
Symptoms of Valve Disease
- Palpitations – irregular heart beats or a fluttering sensation.
- Shortness of breath – may occur with exertion or even at rest. It may be present when lying flat in bed.
- Edema – swelling in the ankles or feet, sometimes in the abdomen.
- Weakness, dizziness or fatigue – fainting may occur.
- Chest discomfort or tightness.
- Congestive heart failure (fluid in the lungs) may result from the heart being unable to effectively pump blood.
Diagnosis of Valve Disease
Diagnosis begins by assessment of symptoms and physical exam. The first detection of valve disease may be when a physician hears a cardiac murmur. Echocardiography (echo) involves placing a probe on the surface of the chest. Sound waves are used to provide pictures of the heart valves and chambers and to evaluate the pumping action of the heart. Cardiac catheterization (cardiac cath or angiogram) is a test in which a catheter is inserted into the leg and guided to the heart. Contrast dye is injected and movies are taken of the valves, heart chambers and coronary arteries.Treatment of Valve Disease
Medications may be effective in improving the heart's ability to pump and in relieving heart failure. When valve disease becomes more severe, surgery may need to be considered.Valve Repair Surgery
This approach uses special techniques to fix the way the valve opens and closes. The valve may need to be trimmed or sewn to make it close properly. A patch of tissue from around the heart (a piece of pericardium) may be utilized in a repair. Repairs can be attempted for some type of valve problems but cannot be utilized in all cases.Valve Replacement Surgery
This approach involves removing the damaged heart valve and replacing it with one of three types of valves: a mechanical (metal) valve, a tissue valve (from a cow or pig) or a human valve that has been frozen (cryo-preserved). The mechanical valve has the advantage of being very durable. However, because it is foreign to the body, blood clots have a tendency to form on it. Therefore, with this type of valve, a person must take a blood thinner medication called Coumadin. Coumadin therapy carries a risk of bleeding and is contraindicated for certain patients.Tissue valves from animals have the advantage of not requiring the long term use of blood thinners. However, the durability of these valves is limited, making them less advisable for younger patients.
Human (cryo-preserved) heart valves are of limited supply and the long-term results are not clearly established. Therefore, they are not frequently utilized.
Repair vs. replacement: Valve repair when possible, offers the advantage of using the patient's own tissue and not requiring the use of long-term blood thinners. A valve repair may not last however, and a subsequent operation may need to be done and the valve replaced.
Minimally Invasive Valve Surgery
This procedure involves a smaller surgical incision through the breastbone, rather than the full sternotomy typically used in conventional valve surgery. Benefits to patients having the minimally invasive approach include faster recovery and improved cosmetic result.Next: Aortic Surgery