Heart Valve Disease

Your Heart

How it works

The heart is a muscular organ which pumps blood throughout the body. The right side of the heart receives oxygen-poor blood from the body and then pumps that blood to the lungs where it picks up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and then pumps that blood to the rest of the body.

heart with blood flow

Chambers and Valves

The human heart has four chambers—two upper chambers and two lower chambers. The upper chambers are called atria. The lower chambers are called ventricles.

heart with chambers

Blood moves through the four chambers as the heart pumps. There are four valves which control the flow of blood through the heart. They are called the aortic valve, the mitral valve, the pulmonary valve, and the tricuspid valve. With each beat, the valves open and close to keep blood moving in the right direction. Their proper function keeps blood moving easily.

heart with valves

A Closer Look at Healthy Heart Valves

A heart valve is made up of strong, thin pieces of tissue called leaflets. The leaflets are attached to a tough, fibrous band of tissue called the annulus. The annulus provides strength and support to the valve leaflets and helps to maintain the normal shape of the valve. Valve leaflets can be compared to doors opening and closing. The annulus can be compared to the door frame.

 

Heart Valve Disease

Types

Sometimes, a heart valve doesn’t open or close properly, disrupting normal blood flow. When a heart valve does not open properly, it is called stenosis. When a heart valve does not close properly, it is called insufficiency (or regurgitation). On occasion, a heart valve can have both stenosis and regurgitation. These problems can affect any of the four heart valves.

Causes

Some valve problems are congenital (present at birth) or acquired later in life. Causes of acquired heart valve disease include

  • Infections
  • Heart attacks
  • Heart disease
  • High blood pressure
  • Cardiomyopathy (weak heart muscle)
  • Damage to the leaflet or annulus

Symptoms

Many people who have heart valve disease do not have symptoms. The severity of symptoms do not necessarily relate to how serious heart valve disease is. Symptoms can occur quickly if heart valve disease develops suddenly. Symptoms can occur gradually, and worsen over time as heart valve disease worsens.

Common symptoms of heart valve disease can include:

  • Fatigue (feeling tired)
  • Shortness of breath (especially upon exertion)
  • Swelling in the ankles, feet, legs or abdomen
  • Rapid weight gain
  • Palpitations (racing or irregular heartbeat)
  • Chest pain or pressure
  • Weakness/dizziness
  • Fainting or passing out

If you think you might have heart valve disease, talk to your doctor. If you have been diagnosed with heart valve disease, it is important for you to know your symptoms and to monitor them for any changes. If you notice any worsening symptoms or new symptoms, tell your doctor immediately.

Diagnosis

A doctor may suspect heart valve disease if they hear a heart murmur. A heart murmur is the sound blood makes when it moves through a valve that does not open or close properly.

To determine the type and seriousness of heart valve disease, the following tests may be ordered:

  • Electrocardiogram (EKG or ECG)
    • This test records the electrical activity of the heart
  • Echocardiogram
    • This ultrasound test creates a moving (and sometimes 3D) picture of the heart
  • Chest x-ray
    • This x-ray creates an image of the chest, lungs, heart, large arteries, ribs and diaphragm
  • Cardiac catheterization
    • This is a test where a thin, flexible tube is placed into the artery in either the arm or leg and passed up to the right or left side of the heart. Contrast dye is injected. Then moving x-ray pictures are taken of the heart arteries, heart chambers and heart valves. The pressures and blood flow in the heart’s chambers and in the large arteries around the heart are also measured.
  • Further testing may include laboratory studies, heart MRI (magnetic resonance imaging), heart stress echocardiogram and heart CT scan

Click here for more information about these and other diagnostic tools.

Treatment options

There are various treatment options for heart valve disease depending on the severity of the disease and the specific problem experienced. Treatment options include:

Medication

Medications cannot currently cure heart valve disease. However, medication and lifestyle changes can often successfully treat and delay valvular heart problems for many years. Depending on the severity of the problem, medication may be all that is needed for some time.

Valvuloplasty

Heart valves that are stiff and do not open fully can be repaired using a procedure called valvuloplasty. This procedure is done by a cardiologist in the cardiac catheterization lab. A catheter which has a balloon at the tip is passed through blood vessels to the faulty heart valve. The balloon is then inflated within the valve to help widen the opening of the valve. The balloon is deflated and the wire is removed from the body. The patient is awake during this procedure but is given medication to relax them and make them groggy. Balloon valvuloplasty can relieve many of the symptoms of heart valve disease, but it is not a cure. The condition can worsen over time. Medications may be needed to treat symptoms. If it does continue to worsen, another procedure or surgery may be needed to repair or replace the valve. Balloon valvuloplasty is less invasive than surgery and the recovery time is much shorter with balloon valvuloplasty than for surgery.

Percutaneous valves
TAVR and the Edwards SAPIEN Valve

The Marshfield Clinic and Ministry Health Care heart care team is the first program in northern and central Wisconsin to offer a new procedure called Transcatheter Aortic Valve Replacement (TAVR). This revolutionary, catheter-based procedure can implant an artificial aortic valve entirely from within the heart—without open-heart surgery. The special, expandable valve is made by Edwards Lifesciences Company.

valve in place


The procedure is done in a hybrid cath lab/OR suite and is performed by the cardiologist and cardiovascular surgeon. A wire with the artificial valve at the tip is threaded through blood vessels to the aortic valve in the heart. The artificial valve is placed in the diseased natural aortic valve and seated on top of it. The wires are then pulled back through the blood vessels and taken out of the body. This procedure is much less invasive than surgery, but it is typically reserved for those patients who have aortic stenosis but who are not good candidates for open-heart surgery. In the past, these patients had little hope for long term survival. Individuals may refer themselves (or be referred by their doctors) to the Marshfield Clinic and Ministry Health Care heart care team to find out if they are a candidate for this procedure.

Valve repair surgery

Surgically repairing a valve may be recommended. The cardiovascular surgeon performs this surgery in the operating room of the hospital. Repairing the valve can prevent chronic damage to the heart and other problems associated with valve disease. Heart valve repair is usually preferred over heart valve replacement. However, heart valve repair is not always possible. It is dependent upon the severity of the patient’s valve disease, age, general health and whether additional surgery is needed for other heart conditions, such as coronary artery disease. Valve repairs preserve the strength and function of the heart muscle. People who have valve repair also have a lower risk of infectious endocarditis after surgery. With a valve repair, a patient does not need to be on blood-thinning medicines for the rest of their life.

Valve replacement surgery

Repairing the natural valve is not always possible. In these cases, the heart valve will be replaced using a manmade or biological valve. Biological valves are made from pig, cow or human heart tissue, and may have manmade parts as well. These types of valves are specially treated to prevent the body from rejecting the valve without requiring anti-rejection medicine.

Manmade, mechanical valves typically last longer than biological valves. They usually do not need to be replaced. Biological valves usually have to be replaced after 10-15 years. Some may last longer. With a manmade or mechanical valve, patients are required to take blood-thinning medications for the rest of their life. The blood-thinning medicines prevent blood clots from forming on the valve. Blood clots can cause heart attack or stroke, so it is very important to continue to take the medicine. Mechanical valves can also increase the risk of infectious endocarditis. There are many considerations to take into account when deciding whether to use a biological valve or a manmade/mechanical valve. The patient, cardiologist and cardiovascular surgeon will make the decision about which type of valve is best in each individual situation.

Percutaneous Paravalvular Leak Closure

Leaks can form around replacement valves over time. The traditional treatment is open heart surgery to install a second replacement valve. Percutaneous Paravalvular Leak Closure provides an option that avoids the extra risks of major surgery. Instead, this advanced procedure uses an expandable plug put in place using catheters that are threaded into the heart through major blood vessels. In October of 2011, the Marshfield Clinic and Ministry Health Care heart care team performed (what is believed to be) the first Percutaneous Paravalvular Leak Closure in the region.