Valvular Heart Disease

What is Valvular Heart Disease?
Heart valves are flaps, or leaflets, of tissue that ensure that blood entering or leaving the heart moves in the proper direction with no backflow. The heart has a total of four valves, the mitral, triscupid, aortic and pulmonary valve.  Valvular disease can affect any of these four valves, and can interfere with the normal flow of blood through the heart

Valvular stenosis, or a narrowing of the valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body. The tissues forming the valve leaflets become stiffer, narrowing the valve opening and reducing the amount of blood that can flow through it. If the narrowing is mild, the overall functioning of the heart may not be reduced. However, the valve can become so narrow (stenotic) that heart function is reduced, and the rest of the body may not receive adequate blood flow.   Valvular regurgitation (incompetent, insufficient, or leaky) valve does not close completely, letting blood move backward through the valve.  This backward flow is referred to as “regurgitant flow.”

Causes of Valvular Heart Disease
There are many types of valve disease .Valve disease can be congenital (present at birth) or may be acquired later in life. Acquired valve disease includes problems that develop with valves that were once normal. These may involve changes in the structure of your valve or infection, such as rheumatic fever which causes a the heart valve leaflets to become inflamed, and may cause the leaflets to stick together and become scarred, rigid, thickened and shortened. Other causes of valve disease include: coronary artery disease, heart attacks, cardiomyopathy (heart muscle disease), syphilis, hypertension, aortic aneurysms, connective tissue diseases, and less commonly, tumors, some types of drugs and radiation.

Symptoms of Valvular Heart Disease
If the valve disease is more serious, the symptoms can include:

  • Breathlessness during exertion
  • Waking up at night short of breath
  • Palpitations (irregular, fluttery heartbeat)
  • Angina (chest pain) because the blood vessels supplying the heart muscle are not getting enough blood
  • Swelling of the ankles or feet
  • Tiredness
  • Dizziness or fainting

Treatments for Valvular Heart Disease
Treatment depends on what is wrong with the valve and how serious the problem is.  If the disease is minimal, medical therapy may be prescribed to relieve the symptoms.

For Treatments of Advanced Valvular Disease
Balloon Valvuloplasty is a procedure in which the narrowed heart valve is stretched open.  A small incision is made in the skin and a catheter is inserted into an artery in the leg, where a balloon-tipped catheter is advanced into the heart and across the narrowed valve.  When in place, the balloon is expanded to open the valve, resulting in improved blood flow across the diseased valve.

Non-Surgical Valve Repair or Replacement
Most patients are able to undergo surgery without difficulty. However, for people whose heart function is too severely compromised to withstand surgery, several approaches to treat heart valve disease without surgery have been developed.  Percutaneous valve repair and replacement are currently only available through a Food and Drug Administration clinical trial.  Click here for information regarding the PARTNER trial.

Percutaneous mitral valve repair (MVR) is a new treatment being investigated to determine the effectiveness of a percutaneous approach for treating mitral valve regurgitation. The procedure is performed in the cardiac catheterization laboratory with the aid of echocardiography.  During this procedure, a very small, specially made metal clip device is delivered through a catheter inserted into the femoral vein (in the groin) and advanced to the heart.  Guided by echocardiography, the cardiologist attaches the clip to the flaps of the mitral valve. Placement of the clip is adjusted until optimal improvement in blood flow and pressures through the valve are observed. Then, the clip is released, and the catheter is withdrawn. The clip holds the valve flaps in position, which limits the leakage.

For more information regarding the diagnosis and treatment of adult congenital Heart disease or to make an appointment with a CIVT physician call 212.305.7060.

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