Valvular Heart Disease


Description
Valvular heart disease occurs when one or more of the four valves of the heart stop functioning properly.

  • The aortic valve regulates blood flow from the heart to the body.
  • The mitral valve regulates blood flow from the lungs into the heart.
  • The tricuspid valve regulates blood flow returning from the body to the heart.
  • The pulmonary valve regulates blood flow from the heart to the lungs.

These valves are comprised of specialized flaps of tissues called leaflets.  These valves are designed to allow blood flow in one direction.  If they become diseased, blood flow may be restricted through the valve (stenosis) or the valve may become leaky (regurgitation or insufficiency).  If these problems are severe and persist, serious damage will occur to the heart and other organs.

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Common Risk Factors

  • Aging
  • History of rheumatic fever
  • Infection such as endocarditis
  • Previous heart attack
  • Connective tissue disease
  • Aortic aneurysms

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Symptoms

Patients with valvular heart disease may experience a number of symptoms including:

  • Fatigue
  • Dizziness
  • Shortness of breath
  • Swelling within the legs
  • Chest discomfort or tightness.

These symptoms may be rapid in onset (days to weeks) or more insidious in onset (months or even years).  Sometimes there are no symptoms despite serious valvular heart disease and end organ damage.

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Tests and Diagnosis:

Fortunately physicians today have many tools at their disposal to help accurately diagnose and treat valvular heart disease. The first and most important begins with a thorough history and physical. Physicians may detect a murmur during a physical which could be the result of inappropriate valve function.

Common tests include:  

  • Echocardiogram is an ultrasound test that displays valve characteristics and function. 
  • Cardiac catheterization may be used to determine the severity of the valvular disease. A dye is injected into the chambers of the heart and through special x-rays and pressure measurements, information is obtained that may be necessary to determine if a patient is a surgical candidate.

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Treatment options

When one of the valves within the heart becomes diseased, it may require surgical repair or replacement. When a valve is repaired, special surgical techniques are utilized to improve the way a valve opens and closes.

Valve Surgery
Diseased valves can be repaired or replaced.  Whenever possible, it is repaired.  The mitral valve is most commonly repaired especially for certain types of mitral valve problems.  If the disease is too extensive then the valve is replaced.  The aortic valve is the most commonly replaced valve.

Valve repair, typically involves adding a supporting ring to the valve to return it to its normal shape.  In addition, some parts of the valve may be removed and reattached with suture.

When a diseased valve cannot be repaired, it requires replacement. This surgical technique involves removing the damaged valve and replacing it with a mechanical (metal) valve or a tissue valve (from a pig, cow or horse).   A mechanical valve has the benefits of lasting a very long time. However, when a mechanical valve is utilized, a blood thinner, (or Coumadin) will need to be taken by the patient for the rest of his or her life. Though tissue valves traditionally do not last as long as mechanical valves, they have the benefit of not requiring a lifetime of Coumadin. New advances in tissue valve technology have resulted in valves that may last over 20 years. Age and location of the valve are important factors in deciding what type of valve to insert. For certain extremely high risk patients, a new option of “percutaneous” valve replacement has become available. This is performed on the aortic valve currently.  In depth discussion with your surgeon regarding this option is recommended in high risk cases.

Minimally Invasive Heart Valve Surgery
Minimally invasive heart valve surgery enables a surgeon to replace or repair a valve using smaller incisions on the side of the chest. This results in less bleeding, lower wound complication rates, less pain, shorter hospital stay, and allows the patient to return to their normal activities in much less time.  The valve operation is the same as when performed through the traditional sternotomy approach but just through a different incision.  Each surgeon determines which patients are potential candidates for this technique.

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FAQs

1. What type of valve will be used for my surgery?

Most valves implanted are tissue valves of either pig (porcine), cow (bovine) or horse (equine) origin. Occasionally, tissue is obtained from human valves. The type of valve that is best for you is determined after in depth discussion with your surgeon.

2. Will my body reject the valve?

No, all tissues valves are chemically treated and are not rejected although, over time, calcium build up may occur. Mechanical valves are made of inert materials.

3. How long does the surgery take?

Valve surgery usually takes between 3 and 5 hours depending on the complexity of the procedure.

4. Is the heart-lung (bypass) machine used?

Yes, the heart-lung machine is necessary to perform safe valve surgery and is the standard for nearly all cases.

5. What are my risks for getting through the surgery?

Risk depends on the type of valve surgery and each patient’s risk factors. This can vary widely from as little as 1% or less to over 20%. Each patient’s risk is something that needs the be discussed with your surgeon.

6. How long will I be in the hospital?

Average length of stay for valve surgery is about a week. This can vary however, depending on age, risk factors and type of surgery.  Following surgery, each patient spends one night in the intensive care unit. Some patients go home as soon as 3 days post-op while others may need to stay more than a week

7. How long do I need to recover?

Recovery time may take two to eight weeks depending on the type and complexity of the valve surgery done.

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Helpful links

American heart association guidelines for valvular heart disease:
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.190748

Mended hearts (support group)
http://www.mendedhearts.org/ 

DaVinci Robot Surgery
http://www.davincisurgery.com/

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