Heart Valve Disease
Approximately five million Americans are diagnosed with heart valve disease each year. Some valve problems are minor and do not need treatment. Others may require medical procedures or surgery to repair or replace their valves. Left untreated, advanced valve disease can cause heart failure, strokes, blood clots or sudden cardiac death.
What is heart valve disease?
Valve disease is defined as damage to or a defect in one or more of the heart’s four valves: the tricuspid, pulmonary, mitral or aortic. These tissue-thin valves are located between the chambers in your heart. They constantly open and close to regulate the flow of blood from chamber to chamber, sealing tightly as the blood passes through on its way to your lungs where it receives oxygen and then on to other parts of the body. When your heart valves fail to open or close properly, the heart loses its ability to pump effectively, and your body fails to receive the oxygenated blood it needs.
In a condition called stenosis, a valve isn't able to open properly. In a condition called regurgitation, a valve doesn't close properly and can leak. Both regurgitation and stenosis make the heart work harder, which over time may weaken your heart’s pumping action and enlarge your heart, increasing your risk of developing heart failure.
What are the symptoms of heart valve disease?
Many people with valve disease have no symptoms. The most common sign is an unusual heartbeat sound called a heart murmur, but many people have heart murmurs without having valve disease. Other symptoms, which may be related to heart valve disease, include:
- Shortness of breath or difficulty breathing
- Swollen ankles or feet
- Wheezing or coughing
- Dizziness and/or fainting
- Rapid or irregular heartbeat
- Chest pain or pressure
What causes valve disease?
Some of the most common causes include:
- Degenerative disease—As people age, their valves may become damaged. This condition affects the mitral valve most commonly as the valve’s small parts, called leaflets, become fragile and tear, resulting in the back up and leakage of blood through the valve.
- Calcification—As we age, calcium in our bodies can build up on our valves. This process, which most commonly affects the aortic valve, results in a hardening and thickening of the valve, which interferes with blood flow.
- Cardiovascular disease—A history of heart attacks, coronary artery disease, and heart failure can result in damage to the heart valves.
- Infection—Infections such as rheumatic fever or strep may cause scar tissue to form on your valves, which may result in stiff valves that open and close with difficulty. Bacterial endocarditis is an infection of the inner surface of the heart or the heart valves caused by bacteria usually found in the mouth, intestinal tract or urinary tract. This condition occurs most commonly in people with defective, damaged or artificial valves.
- Congenital abnormalities—Some people are born with defective valves, ranging from mild defects such as a misshaped valve to more severe conditions such as a missing heart valve.
How is heart valve disease diagnosed?
Your doctor has several diagnostic tools to help determine whether you have heart valve disease. As part of a physical exam, your doctor will listen to your heart for evidence of a heart murmur. Your doctor may order diagnostic tests, including:
- Echocardiography—An echocardiogram is a test that uses ultrasound to evaluate your heart muscle, heart valves, and risk for heart disease.
- Transesophageal echocardiogram—An alternative way to perform an echocardiogram, which makes it possible to get a clearer image of your heart, particularly the structures in the back such as your left atrium, which may not be seen as well by a standard echo.
- Cardiac catheterization or angiogram—A test that enables your doctor to look inside your heart to examine your coronary arteries, heart chambers, and heart valves.
- Heart magnetic resonance imaging (MRI) —An imaging method that uses powerful magnets and radio waves to create pictures of the heart.
- Chest X-ray
What are the treatment options?
If valve damage is mild, your doctor may decide to take a “wait and see” approach and/or treat your symptoms with medication. If damage to the valve is more severe, surgery to repair or replace the valve may be needed.
Significant advances in the surgical treatment of diseased heart valves over the last decade present several surgical alternatives. Your doctor will discuss your best option based on your age, lifestyle and the type, location, and extent of your valve disease. These considerations will also determine whether traditional open-heart valve surgery or minimally invasive valve surgery is the best option for you and whether your valve can be repaired or needs to be replaced.
There are several valve-repair techniques your surgeon can use to restore valve function. Valve repair has several advantages over replacement procedures, including lower rates of infection and less need for lifelong blood-thinning medicine.
To replace diseased valves, surgeons insert mechanical valves made from metal or carbon or biological valves made of human or animal tissue. Mechanical valves are more durable than biological valves, but they require lifelong blood-thinning medication to lower the risk of blood clots.
For patients with aortic valve disease, the Ross procedure is an innovative approach that uses one’s own pulmonary valve to replace the aortic valve. The surgeon replaces the pulmonary valve with one from a donor. This procedure does not necessitate blood-thinning medicine and offers the patient a more durable option than a mechanical valve.
News You Can Use
The American Heart Association and the American College of Cardiology advise prospective heart valve surgical patients to strongly consider a hospital that performs a high volume of these specialized procedures. Each year Wake Forest Baptist’s heart surgeons perform hundreds of valve repair and replacement surgeries, and its cardiac surgery service has received the highest quality ranking from the Society of Thoracic Surgeons.
Wake Forest Baptist’s cardiologists, cardiac surgeons, nurse specialists, and researchers work as a team to provide the best possible care for patients with heart valve disease. When possible, Wake Forest surgeons use minimally invasive heart surgery, ensuring a quicker recovery, a smaller scar and less pain after surgery. They also offer the most advanced techniques, including the Ross procedure, stentless aortic valves, and advanced mitral valve repair for mitral prolapse.
State-of-the-art imaging technology is an essential part of advanced heart valve care, and the Heart Center’s cardiologists and radiologists have made Wake Forest a nationally recognized center for cardiovascular imaging. They use these technologies to identify the presence of abnormalities in our patients’ heart valves with clarity and precision, offering valuable guidance to surgeons planning valve repair and replacement.
Wake Forest heart surgeons have been involved in developing innovative heart valve surgical techniques. Recently the chief of cardiothoracic surgery led a multidisciplinary team in a new nonsurgical, less-invasive treatment option for patients with severe aortic stenosis whose condition makes them ineligible for open-heart valve replacement surgery. During the procedure, physicians inserted a biological valve through an artery in the patient’s groin to reach the heart where it replaced the diseased valve. This treatment offers new hope to the 50 percent of aortic stenosis patients with severe symptoms who may die within two years without treatment.
For more information, to schedule an appointment or for a physician referral, please call 336-716-WAKE (toll-free 888-716-WAKE) or request an appointment online.