Overview of Valve Disease

There are four valves that allow blood flow into and out of the heart. These valves are the mitral, the tricuspid, the aortic and the pulmonic valve. The mitral and tricuspid valves are located between the top and bottom chambers of the heart. The aortic and pulmonic valves control blood leaving the heart.

 The valves are composed of leaflets which act as gates that open and close allowing blood to flow only one way. When part of a heart valve is damaged or defective it can cause leakage or back flow into the the chambers of the heart. Other conditions can stiffen the leaflets and prevent blood from pumping freely from the heart.

This leakage, or the inhibition of blood to to leave the chambers causes the heart to pump harder, which thickens the muscle and can lead to heart enlargement and ultimately heart failure.

How do you know something is wrong?

Symptoms of heart valve disease

  • Shortness of breath
  • Chest pain or discomfort
  • Palpitations
  • Unexplained fatigue
  • Dizziness
  • Swelling in your abdomen, ankles or feet
  • Unexplained, quick weight gain

These symptoms can also be caused by other cardiac conditions. The severity of symptoms can vary so it is best to schedule an appointment with a cardiologist to evaluate the seriousness of the condition.

Click here for a listing of St. Dominic’s Cardiologists

Diagnosis

Typically, a primary care physician (family physician) will hear a swishing or clicking noise through his or her stethoscope. This is also referred to as a heart murmur. The primary care physician will then refer you to a cardiologist for further testing.

Once you schedule an appointment with a cardiologist, a number of tests could be used to determine how the valves are functioning.

  • Echocardiogram: This is a non-invasive ultrasound of the heart. It is performed in the office and takes about thirty minutes. It can determine the exact size of the heart and quantitate its function. It will also determine the presence of valvular heart disease and its severity.
  • Transesophageal: This is an ultrasound of the heart that is performed with a probe that is inserted into the esophagus. This is performed in the hospital setting and requires sedatives by IV. This test is sometimes necessary to get more information about the heart valves to help determine if the valve can be repaired or if it needs to be completely replaced.
  • Cardiac catheterization: This is another hospital based procedure that requires insertion of small tubes into the heart. This test will determine exact pressures within the heart chambers. The arteries of the heart are also examined. If a heart surgery is needed, the cardiologists want to know if a bypass of the arteries is needed.
  • Electrocardiogram: This is a simple office based test that measures the electrical activity of the heart. It looks for irregular heartbeats and arrhythmias.

Diseases and Conditions

A heart valve can either have valvular stenosis or valvular insufficiency. In the case of stenosis, the leaflets of the heart valve become stiff and decrease the amount of blood flow that can pass through it. When a valve is insufficient, the leaflets can be floppy or flimsy, allowing leakage back into the chamber it was just pumped from. This leaky flow is also called regurgitant flow. This puts strain on the heart.

How Does Heart Disease Occur?

There are many causes of heart valve disease which range from infections to conditions that cause it to occur later in life.

Congenital Heart Disease: this means an abnormality formed in the womb and a person is born with a defect. There are several types of congenital heart defects, but related to valve, the leaflets may be improperly formed, not large enough or too big, or there may be an irregularity in the way a leaflet is attached.

Bicuspid Aortic Valve Disease: This is a condition in which a person is born with two leaflets, instead of the normal three. The two leaflets function well for a time but have a high propensity to become very stiff later in life.

Infections: Such as endocarditis or rheumatic fever.

Rheumatic fever: This can cause the valve leaflets to swell and stick together.

Endocarditis: This is a serious infection caused by germs that enter the blood stream and attack the heart valves causing leakage, stenosis, growths on the valve or holes in the leaflet.

Coronary Artery Disease: This is the condition where plaque and lipid deposits form on the inside walls of the heart arteries causing blockage to blood flow.

Cardiomyopathy: This is a general term meaning the heart is not pumping blood normally.

Aortic Aneurysms: When a blood vessel wall becomes weak, it tends to bulge or balloon outward. This is called an aneurysm. When it occurs in the aorta it can become a life threatening condition.

Connective Tissue Diseases: These are a myriad of conditions that cause the fibrous connective tissue in the body to become weak or fragile. Since the heart valves are made of this tissue, heart valves can be damaged in this condition.

Structural Changes

Overtime, the structure of the valve may change due to age, high blood pressure or heart attack.

Tears in or stretching of the Chordae: This is most commonly seen in the mitral valve. The chordae, which are like strings attached to the valves, open and close the valve each time your heart muscle contracts. If these break, it can cause a leaky valve.

Change in valve’s annulus:  The annulus is the outer ring of tough tissue that supports the valves helps them keep their shape. When this ring of tissue stretches or changes shape the valves lose their shape and support. This can cause a leaky valve.

Calcification: This is most commonly found in the older population and within the aortic valve. The leaflets become tough and thick and cannot close completely.

Valve Surgery

Valves can be repaired or replaced, depending upon your physician’s findings. Repair should be encouraged if replacing a valve can be avoided. Using the original or “native” valve improves life expectancy, keeps patients from having to use anticoagulation medication for the duration of their life and preserves original heart function.

St. Dominic’s interventionalists and cardiothoracic surgeons have special training in valve repair and the expertise to perform this type of procedure with the best possible outcomes.

Your valve can be repaired or replaced through traditional heart valve surgery, or through a minimally invasive technique. What type of disease a patient has will determine the type of surgery needed.

A mitral valve repair is the most common type of repair procedure that is done. Many times the tricuspid and aortic valves can undergo similar types of repair that the mitral valve may receive.

Types of Repairs

  1. A leaflet may be flimsy or floppy and require a resection. Part of this leaflet is removed. When the leaflet is sewn back together, it is reinforced and strengthened and returns to normal function.
  2. If two leaflets become fused, the surgeon can detach them from one another, widening the valve to its original formation.
  3. Calcium deposits that have formed on the leaflets, most common in the aortic valve, are removed allowing the valve to return to normal function.
  4. The valve’s annulus, the supportive ring that holds the leaflets in place, may lose its shape, and a supportive ring may be sewn onto it to make it sturdy again.
  5. A leaflet may have a hole that requires a patch.
  6. Sometimes a person is born with two leaflets, instead of three, and this may require a surgeon to perform “plastic surgery” to shape the leaflets to allow more blood flow through the valve.

When a valve cannot be repaired and it is recommended that it is replaced, a tissue valve or mechanical valve will be used. The type of device used is dependent upon your physician and the hospital. You should openly question the devices and their outcomes with your physician.