Heart Valves

Heart  Valves in contentThe heart has four chambers, two atria (upper chambers) and two ventricles (lower chambers), and four heart valves. Heart valves are paper-thin flaps, called leaflets, that act as one-way inlets for blood coming into ventricles, and one-way outlets for blood leaving ventricles.

What Can Go Wrong with a Heart Valve?

As the heart muscle contracts and relaxes, healthy heart valves open and close, letting blood flow into the ventricles and out to the body at alternate times. Valves have remarkable strength and flexibility, despite taking a constant “beating” with each relaxation/contraction cycle and heartbeat.

When heart valves are unable to open and close as they’re designed, the effects can be serious. There are two main types of heart valve problems:

Heart Valve Stenosis in content Stenosis (stiff, hard, and narrow): When a valve opening becomes narrowed, it limits the flow of blood out of the atria or ventricles. The heart must pump blood with increased force to move blood through the tight, inflexible valve. Valve stenosis can cause symptoms such as extreme fatigue, dizziness, shortness of breath, lightheadedness, and fainting.

Regurgitation (leakage from a “soft” or incomplete close): When a valve does not close completely, it allows blood to flow backward through the valve. This reduces forward flow of oxygen-rich blood and can lead to volume overload in the heart. If one of your valves does not tightly close, you may feel extremely tired, short of breath, dizzy, and lightheaded.

Heart valve problems can be complicated. They can be stiff, narrow, and leak (both stenotic and regurgitant) at the same time. You may have more than one valve not working correctly and causing health concerns. Heart failure is a common result of heart valve disease.

The Tricuspid Valve

During circulation, large veins, called the superior vena cava and inferior vena cava, return oxygen-poor blood to the heart’s right atrium. The tricuspid valve is the in-let valve to the right ventricle. Symptoms of tricuspid valve disease may develop because of the lack of available oxygen-rich blood.

  • Tricuspid stenosis may result in an enlarged atrium, which could affect pressures and blood flow in the nearby veins and right ventricle. If severe, less blood will circulate through the lungs to pick up oxygen.
  • Tricuspid regurgitation is usually the result of an enlarged right ventricle that stretches its in-let valve. Endocarditis and the use of a diet substance called “Fen-Phen” (phentermine and fenfluramine) may increase the risk of tricuspid regurgitation.

The Pulmonary Valve

The pulmonary valve connects the heart’s right ventricle to the pulmonary arteries. This design allows oxygen-poor blood to travel to the lungs and exchange carbon dioxide for oxygen.

  • Pulmonary stenosis is usually caused by a congenital heart defect and rarely develops in adulthood. The high pressures created by pulmonary stenosis in the right ventricle often leads to an enlarged heart and heart failure – with or without symptoms.
  • Pulmonary regurgitation is most commonly caused by pulmonary hypertension or a congenital heart defect. Treatments are generally focused on the underlying cause and condition.

Left-sided Heart Diseases

The left side of the heart is more likely to develop a valve problem than the right side. Why? The left-sided heart valves, the mitral valve for incoming blood and the aortic valve for outflowing blood, operate under higher pressures to pump blood throughout the body.

The Mitral Valve

In normal circulation, once blood is oxygenated it flows back to the heart, into the left atrium, through the mitral valve, and into the left ventricle. While the tricuspid, pulmonary, and aortic valves have three leaflets, the mitral valve only has two. When diseased, the mitral valve can cause blood volumes and pressures in the left atrium to increase. Over time, this pumping chamber can enlarge, fluid can build-up in the lungs, and subsequent damage may lead to heart failure – making repair or replacement necessary.

  • Mitral stenosis may make one feel tired and short of breath. Medications will not cure mitral stenosis, but they are frequently used to help reduce fluid build-up in the lungs, prevent blood clots from forming, and correct heart rhythm disorders.
  • Mitral valve prolapse occurs when the valve’s two leaflets bulge upward (prolapse) into the left atrium. In some cases, the prolapsed valve can allow a small amount of blood to leak backward into the left atrium. Once a heart murmur is detected, treatment is recommended.
  • Mitral valve regurgitation allows blood flow to leak back into the left atrium.

The Aortic Valve

The aortic valve is located between the left ventricle and aorta, the body’s largest artery. If a diseased aortic valve interferes with the amount of deliverable oxygen to vital organs and body tissue, your heart must compensate by working harder. Over time, the increased work load can thicken ventricular walls, decrease the force of each contraction, and eventually lead to heart failure, sudden cardiac arrest, or death.

  • Aortic stenosis is most often caused by scarring from an injury, infection, or a build-up of cholesterol and other sticky substances that harden over time. Called atherosclerosis, these deposits can thicken, misshape, and fuse aortic valve leaflets together. Symptoms may not be noticed at first. As aortic stenosis progresses, a heart murmur may be heard and other signs such as chest pain, overwhelming fatigue, shortness of breath, dizziness, and fainting can be experienced. Once symptoms develop, the disease is life-threatening and valve replacement is highly recommended.
  • Bicuspid aortic valve disease is a congenital heart defect that leaves the bicuspid valve with two leaflets, instead of three. Research has shown that at least 25 percent of these patients have a larger than normal aorta above the valve. This malformed valve can be stenotic, and not open fully, or it may regurgitate and allow blood to flow back to the left atrium.
  • Aortic regurgitation also called aortic insufficiency, allows blood to leak back into the left atrium. Mild aortic regurgitation may be treatable with medications to ease symptoms and reduce the risk of stroke. Valve repair or replacement are often recommended for aortic regurgitation.

Paravalvular Leaks

A paravalvular leak occurs in a small number of patients who have previously had valve replacement. The leak is caused by a space between the patient’s natural heart tissue and the replacement valve. This condition most commonly affects the mitral valve, but can also occur in replacement aortic and tricuspid valves.

Patients are at increased risk of a paravalvular leak if they have had the same valve replaced several times, they are being treated for endocarditis, or if the ring around the valve is severely diseased. This is a condition for your health care provider to consider if you’ve had a heart valve replacement and then develop symptoms of heart failure or hemolytic anemia that requires frequent blood transfusions.

Symptoms, Diagnosis, and Medical Management of Heart Valve Disease

Find more information about symptoms, diagnosis, planning your care, and medical management of structural heart diseases.

Heart Valve Treatments: Repair or Replace?

SHP Treatment 2 in contentMedications and a heart-healthy lifestyle can often treat symptoms and delay complications, but they cannot cure heart valve disease. Unfortunately, as certain conditions progress, medical management becomes less effective. However, in many cases, heart valves can be repaired or replaced to restore normal function. Most people who have valve surgeries can live normal lives after recovery.

Timing is an important part of a successful valve operation. Signs and symptoms should not be ignored. Ignoring symptoms too long may cause your heart to become weaker, and heart damage can increase risks related to surgery. We encourage you to schedule regular check-ups with your health care provider, so that a significant valve problem is recognized early and corrected before it does long-term damage.

During a heart valve repair, the cardiothoracic surgeon fixes the damaged or faulty valve, often without using artificial parts. The mitral valve is the most commonly repaired valve, but repairs are also performed on diseased tricuspid valves. Advantages to valve repair include a potentially lower risk of infection, decreasing the need for lifelong blood thinning medication, and preserving heart muscle strength.

Valve replacement is performed when a repair is not an option. With an open-chest surgical valve replacement, your surgeon will remove the diseased valve and implant a bioprosthetic heart valve in its place. Artificial heart valves that are used to replace diseased natural valves can be made from a variety of materials in various sizes.

The Premier Health structural heart team offers a broad range of care for individuals with heart valve disease. Currently, most heart valve surgeries require an open-chest surgical procedure.

We also offer innovative therapies for the treatment of heart valve disease that use minimally-invasive or catheter-based approaches. These advanced techniques and technology are designed to help people with complex structural heart disease, particularly those who, because of age or other medical issues, are not good candidates for traditional surgery.

Certain interventions may be currently limited to select groups of patients. Please speak with your physician or one of our team members to learn more.

Balloon Valvuloplasty (Transcatheter Approach)

Balloon valvuloplasty uses a transcatheter approach to treat a stenotic aortic or mitral heart valve by widening its opening with an inflatable balloon. This therapy can be an effective treatment for children, teens, and young people. For older adults, whose stenosis is caused by atherosclerosis, this is generally used as a temporary measure until a repair or replacement can be performed.

Transcatheter Mitral Valve Repair with MitraClip®

Mitral regurgitation, caused by a leaky heart valve, places an extra burden on the heart and lungs. If not treated, mitral regurgitation can cause serious problems, such as heart failure, fluid buildup in the lungs and an enlarged heart. Traditional treatments include medication and open-heart surgery to fix the mitral valve.

For patients with significant, symptomatic, degenerative mitral regurgitation who are not good candidates for surgery, Premier Health offers a less invasive treatment option: transcatheter mitral valve repair using MitraClip®, a small clip that doctors attach to the mitral valve. Instead of opening the chest and temporarily stopping the heart, our structural heart team delivers the MitraClip® to the mitral valve by gently guiding a catheter through a leg vein to the heart. Once in place, MitraClip® treats mitral regurgitation by allowing the mitral valve to close more completely, helping to restore normal blood flow through the heart.

Transcatheter Aortic Valve Replacement (TAVR)

Balloon TAVR graphic  Transcatheter aortic valve replacement or (TAVR): As its name implies, TAVR technology uses a special catheter designed to carry an expandable, prosthetic heart valve. Our structural heart team gently guides it through the circulatory system and places the new aortic valve between the heart’s left ventricle and aorta. The natural, or in some cases, the current but poorly functioning bioprosthetic aortic valve, is not removed, but is used as an anchor for the TAVR valve. Once in position the replacement valve is deployed, the catheter is gently guided out, removed, and the TAVR procedure is finished.

Originally, the US Food and Drug AdministrationOff Site Icon (FDA) approved TAVR for patients with severe symptomatic aortic stenosis who were at high or prohibitive open-chest surgical risk. Historically, such patients often refused or were denied surgery. In 2016, TAVR was approved by the FDA for an expanded indication, and now includes those patients at intermediate-surgical risk, allowing Premier Health to offer more patients new hope for an improved quality of life.

See an animated TAVR procedureOff Site Icon or watch physician videos of Premier Health cardiologists answering common questions about aortic stenosis to learn more.

Paravalvular Leak Transcatheter Closure

Traditionally, when there is a space between the natural heart tissue and replacement valve that allows leakage, the patient is returned to the operating room for a repeat heart surgery. On select patients, we offer a catheter-based paravalvular leak closure to position a permanent device around the leak to stop the backward flow of blood.

Don’t Give Your Heart to Anyone. Trust Premier Health

The Structural Heart Program’s innovative technologies and techniques are designed to provide quality care for positive patient outcomes — with fewer complications, shorter recoveries, and long-lasting benefits. We welcome patients seeking second opinions on their heart disease treatment options.

If you or a loved one would like more information about the many services our Structural Heart Program offers, please call (937) 499-7427(937) 499-7427.

Content Updated: January 4, 2019

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