Patient Education
Valvular Heart Disease

Valvular Stenosis

Stenosis means "narrowing". Mitral stenosis means narrowing of the mitral valve, and aortic stenosis means narrowing of the aortic valve. A stenotic valve results in a build up of pressure. Valve stenosis is caused by:

• a congenital birth defect
• progressive wear and tear or hardening of a valve from old age
• scarring from disease, including rheumatic fever as a child or young adult
• infection of a valve or heart muscle

Valvular Regurgitation

Regurgitation means "backward leaking". A regurgitant valve does not close properly so that blood leaks back into the chamber it is supposed to be leaving. For example, aortic regurgitation occurs when blood that is pumped into the aorta leaks back into the left ventricle during diastole, which results in decreased forward flow of blood into the rest of the body as well as diminished perfusion of vital organs.

Heart Valve Surgery

Heart valve disease occurs when a valve doesn't work right. A valve may not open all the way. Or, a valve may have problems closing. If this happens, blood doesn't move through the heart's chambers the way it should.

Problems with Your Heart Valves

If a valve doesn't open all the way, less blood moves through to the next chamber. If a valve doesn't close tightly, blood may leak backward. These problems may mean that the heart must work harder to pump the same amount of blood. Or, blood may back up in the lungs or body because it's not moving through the heart as it should.

Problems Opening

Stenosis occurs when a valve doesn't open fully. The valve may have become hardened or stiff with calcium deposits or scarring. So, it's hard to push open. Blood has to flow through a smaller opening, so less blood gets through the valve into the next chamber.

Problems Closing

Insufficiency (also called regurgitation) results when the valve doesn't close tightly. The valve's supportive structures may be loose or torn. Or, the valve itself may have stretched or thinned. Blood may then leak back the wrong way through the valve.

Heart Valve Surgery

During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means your diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can only be decided once surgery has begun. Your surgeon will talk with you about his or her plans for surgery and any other procedures you may need.

Repairing a Valve

During valve repair, a ring may be sewn around the opening of the valve to tighten it. Other parts of the valve may be cut, shortened, separated, or made stronger to help the valve open and close right.

Replacing a Valve

If a valve can't be repaired, it may be replaced with a prosthetic valve. Two kinds of prosthetic heart valves are available:

Mechanical valves are created from man-made materials. Lifetime therapy with an anticoagulant (sometimes called a "blood thinner") is needed when these types of valves are used. This medication prevents blood clots from forming on or around the valve.

Biological (tissue) valves are taken from pig, cow, or human donors. Xenograft valves are made from animal tissues, while homograft or allograft valves are retrieved from human cadavers. Pulmonary autograft valves are moved from the patient's pulmonary artery on the right side of the heart to the aortic position on the left. Biological valves don't last as long as mechanical valves, but the use of an anticoagulant often isn't needed.

Your doctor will talk with you about choosing the best valve for you. Factors weighed such as include your age, your occupation, the size of your valve, how well your heart is working, your heart's rhythm, your ability to take an anticoagulant, and how many new valves you need are important in the decision process .

Reaching Your Heart

To get to your heart, one or more incisions must be made in your chest. For minimally invasive valve surgery, these incisions are most often much smaller than those made for traditional valve surgery. One of two types of incisions may be used. Which type your surgeon chooses depends on the location of the valve and the method of surgery used. Your surgeon will talk with you about which incision you will receive.

Stopping Your Heart

During valve surgery, your heart must not beat. To keep your blood flowing, it is passed through a heart-lung machine. This machine gives oxygen to your blood and pumps the blood back through your body. Your surgeon may choose to connect your body to the machine through the vessels in your heart or through vessels in your groin. Once the valve surgery is done, your heart and lungs take over again.

Repairing or Replacing the Valve

To reach the valve, an incision is made in your heart or aorta. If the valve can be mended, the needed repairs are done. If the valve must be replaced, part or all of the damaged valve and its supportive structures may be removed. The right-sized replacement valve is selected, positioned in the valve opening, and sewn firmly into place. The incision in your heart or aorta is closed. Your heart is then started so it beats on its own again.

Aortic Valve Replacement

Aortic valve replacement is heart surgery performed to replace a malfunctioning aortic valve, due to narrowing (stenosis) or leakage (regurgitation). The aortic valve can malfunction because of a congenital abnormality (abnormal from birth) or an acquired disease (diseased with age).

One of the most common congenital heart defects affecting babies is a bicuspid aortic valve, where the aortic valve does not develop normally while the baby is in the womb. A normal aortic valve has three leaflets, whereas a bicuspid aortic valve has only two leaflets. Patients with a bicuspid aortic valve may develop a narrowing or leakage of the aortic valve.

Two types of prosthetic (artificial) valves are available to replace the malfunctioning aortic valve:

Mechanical Valves

Mechanical valves are created from man-made materials and are very durable. Because there is a tendency for blood to clot on mechanical valves, patients with artificial valves must take anticoagulants (sometimes called "blood thinners") for the rest of their lives. This medication prevents blood clots from forming on or around the valve.

Biological Valves

Biological (tissue) valves are taken from pig, cow, or human donors. Xenograft valves are made from animal tissues, while homograft or allograft valves are retrieved from human cadavers. Pulmonary autograft valves are moved from the patient's pulmonary artery on the right side of the heart to the aortic position on the left. Biological valves don't last as long as mechanical valves, but the use of an anticoagulant often isn't needed. Minimally Invasive Heart Valve Surgery

Minimally invasive heart valve surgery replaces or repairs heart valves using smaller incisions. This results in less pain for the patient, a shorter hospital stay and a faster recovery time. There is also less bleeding and potential for infection. In some cases, a robot can be used to help the surgeon perform the procedure.

During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means the diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can only be decided once surgery has begun.

Mitral Valve Repair

Mitral valve repair is heart surgery performed to repair a malfunctioning mitral valve, due to narrowing (stenosis) or leakage (regurgitation). The mitral valve can malfunction because of a congenital abnormality (abnormal from birth) or an acquired disease (diseased with age) or as a result of rheumatic fever. In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease).

Repairing a Stenotic (Narrow) Mitral Valve

One type of mitral valve repair is called mitral commisurotomy, performed on valves that are stenotic, or narrow, either from birth or from damage by rheumatic fever . Most often today, rheumatic mitral stenosis is treated by balloon valvuloplasty , a procedure performed in the cardiac catheterization laboratory by interventional cardiologists . Using a catheter with a balloon on the end, the balloon is expanded inside the valve to "stretch" it open.

Repairing a Regurgitant (Leaking) Mitral Valve

More often, mitral valve repair is performed to correct a leaking, or regurgitant, valve. Congenital mitral regurgitation may be due to a cleft mitral valve (a valve with a separation or cleft down the middle) associated with an atrial septal defect, a type of hole in the heart between the low pressure chambers or atria. Such valves can sometimes be repaired simply by closing the cleft with sutures. Mitral valve disease also may be due to an elongation or rupture of the chordal apparatus, the "heart-strings" that support the valve normally, or due to a more generalized weakness of the valve itself, such as the "floppy valve" syndrome in which all of the components of the valve are enlarged and elongated.

Patients that undergo mitral valve surgery require prophylactic antibiotics as a preventive measure against infection whenever dental work is done.