Heart
Valve
Disease
What is heart valve disease?

Heart valve disease is the name given to any malfunction or abnormality of one or more of the heart’s four valves, affecting blood flow through the heart. The condition is usually caused by wear, disease, or damage of one or more of the heart’s valves.

The heart has four chambers that pump blood around the body. There are a series of valves in the heart that, when working properly, ensure blood flows in the right direction through the heart’s chambers, which are closed off by a one-way valve. Diseased or defective heart valves – those that have become narrowed (stenosis), leaky (regurgitation), or both – may not open or close properly and can interfere with the flow of blood.

The primary types of heart valve disease are:

  • Valve Stenosis or Obstruction: As a result of certain medical conditions or anatomical abnormalities, a valve can either be exceptionally narrow, known as having a stenosis, or have a blockage or obstruction. Either of these conditions can limit the blood flow through the valve, which may result in a “back-up” of blood behind the valve and cause the heart to pump inefficiently or build up blood pressure in the lungs. This condition is often due to age-related hardening (calcification) of the aortic valve leading to progressive narrowing and is most commonly associated with aortic stenosis or mitral stenosis.
  • Valve Regurgitation or Insufficiency: When a valve fails to fully close, the valve itself can become “leaky”, allowing blood to backwash down through the valve, known as regurgitation. In addition, the valve may not ever completely move the volume of blood to the next appropriate chamber. This condition includes mitral regurgitation and aortic regurgitation.
Signs and Symptoms

The signs of heart valve disease include, but are not limited to:

  • Shortness of breath
  • Fainting
  • Coughing
  • Chest tightness and/or pain
  • Fatigue
  • Light-headedness or dizziness
  • Abnormal heart rhythm sensations (i.e. irregular heart beat)

These symptoms are not always severe or visible, and are often seen as a part of the natural aging process, meaning the symptoms are classified as ‘asymptomatic’. They are also similar to symptoms of other forms of heart disease and lung-related problems.

Diagnosis

Heart valve disease is a treatable condition if diagnosed early. Diagnosing heart valve disease starts with a simple stethoscope check. Your doctor will use a stethoscope to listen to your heart for the characteristic heart “murmur” or “click-murmur” that is usually the first indication of a heart valve disorder. After that initial diagnosis, a more sophisticated investigation with either an echocardiogram or another form of heart scan can be undertaken to understand the exact type of heart valve disease and the severity of the abnormality.

If you are over 65 or think you may have any of the symptoms of heart valve disease, please see your primary care physician.

Treatment

During the early stages of heart valve disease, when it is less severe and not causing significant symptoms or issues, it may be best to simply monitor your condition to see how things develop. However, the earlier the diagnosis and treatment of heart valve disease, the better the patient prognosis. Therefore, it is very important to ensure regular monitoring of your symptoms with your doctor so that any deterioration or change is recognized quickly and can be treated appropriately.

Treatment for heart valve disease varies according to the severity of the disease, but generally requires either valve repair or replacement through surgery. In some cases, the aortic valve can be repaired during surgery and the patient’s tissue maintained. More often however, aortic valve replacement is required using either a mechanical valve or a tissue valve from an animal. Mitral valves are more commonly treated with repair procedures, but can also require a valve replacement.

Traditional heart valve surgery has proven to be an effective method for repair and replacement for more than 50 years. In addition to the more traditional forms of open heart surgery, there are also more innovative and less invasive approaches available today, such as the transcatheter aortic valve implantation (TAVI) procedure. These types of treatments may be suitable for patients who are at higher risk for the more traditional forms of surgery. Your doctor will be able to advise on the most appropriate treatment for you.

Heart Valve Replacement

Based on your symptoms and the overall condition of your heart, your health care provider may recommend that your diseased heart valve(s) should be surgically repaired or replaced. Traditionally, open-heart surgery is used to repair or replace heart valves. This means that an incision will be made in your chest and your heart will be stopped for a time so that your surgeon can repair or replace your affected heart valve(s).

Your mitral valve may be repaired by removing or realigning valve tissue.  A ring may be used to support the repaired valve.  Your entire valve may be removed and replaced by an artificial valve. Artificial valves are classified as biologic or mechanical.  Biologic valves are made from tissue from an animal or are donated as a whole human valve (aortic valve only). Mechanical valves are completely man-made.  Each have different requirements for drug therapy after implantation.

This procedure can last a few hours. Patients can remain in hospital up to a few weeks and recovery can take around three months. Heart valve surgery has proven to be a successful method of valve repair or replacement for more than 50 years.

Balloon Valvuloplasty Procedure

For a few people with severely narrowed aortic or mitral valves, valve narrowing may be relieved during a procedure called balloon valvuloplasty, which is less invasive than open heart surgery but is less durable. For this procedure, a small catheter holding an expandable balloon is threaded into your heart and placed into your tightened valve. Next, the balloon is expanded to stretch open your valve and separate the leaflets.

Surgical Valve Repair and Replacement

Your diseased valve may be repaired using a ring to support the damaged valve, which is a method that is more often used for the mitral or tricuspid valves. Alternatively, your entire valve may be removed and replaced. This procedure can last a few hours. Patients can remain in hospital up to a few weeks and recovery can take around three months. The replacement valve can be either mechanical or made of animal tissue.

Heart valve surgery has proven to be a successful method of valve repair or replacement for more than 50 years.

Minimally Invasive Valve Surgery

Minimally invasive surgery is another approach to treating heart valve disease that is less invasive than general or open-heart surgery. With minimally invasive valve disease surgery, your heart is accessed through a small incision on the right side of your chest, which can be as small as five centimetres long. Your surgeon will insert a camera that will allow them to see your heart so that they can repair or replace your damaged valve.

Minimally invasive surgery often involves a shorter stay in the hospital compared to the traditional surgical treatment and can also have a shorter recovery time. Additionally, this procedure can be known for reduced discomfort, lower risk of infection and less scarring.

Minimally invasive surgery can also be used to replace the aortic valve either via a short vertical incision in the middle of the chest, or through a small horizontal incision in the upper right chest.  

Transcatheter Aortic Valve Implantation (TAVI)

TAVI is a minimally invasive procedure often used to treat patients with aortic stenosis. It is performed by inserting the new valve via a sheath (catheter) in the femoral artery in the groin and positioning the valve in the heart under fluoroscopic guidance. The replacement valve will be inside your natural aortic valve and the replacement valve will expand while pushing the diseased aortic valve aside.

The TAVI procedure uses local anesthetic and some sedation.  The new valve is made from tissue from a cow (pericardium).      

Because the replacement valve is placed using minimally invasive techniques, many patients can experience a faster recovery than they would from a traditional, open-heart valve replacement.

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