Heart Valve Disease

Heart valve disease involves two main types of malfunctions: regurgitation (leakage of the valve) and stenosis (narrowing of the valve). More than five million Americans are diagnosed with one of these valve disease types each year.

With regurgitation,the valve does not completely close, causing the blood to flow backward. This forces the heart to pump more blood on the next beat, making it work harder. During stenosis, the valve opening becomes narrowed, limiting the flow of blood out of the ventricles or atria. This causes the heart to pump blood with increased force in order to move blood through the narrowed or stiff (stenotic) valve.

Heart valves can develop both malfunctions at the same time (regurgitation and stenosis). More than one heart valve can be affected at the same time. When heart valves fail to open and close properly, the implications for the heart can be serious, possibly hampering the heart's ability to pump blood adequately through the body. This can lead to a variety of complications, including heart failure.

Cardiovascular specialists from the Brigham and Women’s Hospital (BWH) Division of Cardiovascular Medicine and the Division of Cardiac Surgeryoffer collaborative, comprehensive inpatient and outpatient clinical services to adults with heart valve disease. Part of the Heart & Vascular Center’s Surgical Treatment of Heart Valve Disease program, these services include a broad range of innovative diagnostics and leading-edge medical, interventional and surgical therapies such as three-dimensional echocardiographytranscatheter aortic valve replacement (TAVR)repair of tricuspid and pulmonic valves, homograft valve replacement for endocarditis, and repair and replacement of aortic valves and mitral valves.

Watch this video case study of a transcatheter aortic valve replacement, a minimally invasive surgical treatment.

Read this article about aortic valve replacement without general anesthesia.

Heart Valve Disease Topics

Risk Factors for Heart Valve Disease

Risk factors for heart valve damage vary according the type of disease and may include one or more of the following:

  • Heart attack
  • Infection
  • Aging
  • Congenital birth defect
  • Syphilis
  • Myxomatous degeneration, an inherited connective tissue disorder
  • History of rheumatic fever
Symptoms of Heart Valve Disease

Each individual may experience heart valve disease symptoms differently, and mild heart valve disease may not cause any symptoms. The following are the most common symptoms of heart valve disease:

  • Chest pain
  • Palpitations caused by irregular heartbeats
  • Fatigue
  • Dizziness
  • Low blood pressure
  • Shortness of breath
  • Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)

Symptoms of heart valve disease may resemble other medical conditions and problems. Always consult a doctor for evaluation and diagnosis.

Diagnosis of Heart Valve Disease

At BWH, our heart valve disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. In order to diagnose and determine treatment for valve disease, a complete medical history, a thorough physical exam, and one or more of the special diagnostic tests below may be provided.

Treatment for Heart Valve Disease

Heart valve disease initially may be treated medically, but, in most cases, surgery is necessary to repair or replace the damaged valve or valves. Valve surgery involves two major categories – valve replacement and valve repair.  Valve replacement involves removing the native valve and replacing it with an artificial valve made of either mechanical parts or biological tissues. The choice between a mechanical valve and a biological valve is based on many factors, including:

  • Patient preference
  • Age
  • Overall health
  • Medical history
  • Severity and form of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

Types of Replacement Valves

A heart valve replacement may involve a biological (from animal tissue), mechanical, or homograft (from a human cadaver donor) prosthesis.  Types of prosthetic valves used in valve replacement include:

  • Mechanical valves are made of graphite and pyrolytic carbon, or other synthetic materials, which are non-reactive and tolerated well in the human body. While designed to last as long as 30 years, mechanical valves require lifelong blood thinning medications to avoid blood clots forming on the valve, which can cause stroke and other complications. Because of the need for lifelong blood thinning medications, patients with a mechanical valve carry a higher risk of bleeding complications following surgery.
  • Biologic (tissue) valves are made from animal tissue (pig or cow) or a donated human heart. The animal tissue valves are sterilized and chemically treated for human use and then sewn onto a frame (stented) or left intact (stentless). These types of valves last approximately 10-20 years or longer, depending on the age of the patient at the time of implant. An additional replacement, therefore, isn’t uncommon in younger patients. Long-term blood-thinning medications are not required following valve replacement with biological valves, but may be needed in the first 4-6 weeks following the surgery.

Surgeons at Brigham and Women’s Hospital will walk you through this decision process, the expected outcomes, and address any and all concerns throughout your pre-operative assessment.

Replacement or Repair Procedures

There are a variety of techniques that are used to repair or replace valves:

  • Aortic valve replacement treats narrowing and/or leakage of the aortic valve.
  • Root-enlarging procedure, which is effective in smaller aortic valves
  • Aortic root replacement, which is used in connective tissue disorders, large aortic root aneurysms, endocarditis, or aortic dissections
  • Valve-sparing root surgery, usually used for young patients with intact aortic valves and isolated disease of the aortic root who wish to avoid blood-thinning medications
  • Stented biological aortic valve replacement
  • Stentless biological aortic valve replacement
  • Homograft mitral valve surgery, which is typically performed for mitral valve disease. Leaflet repair through patching of holes or tears in the valve leaflets and/or by reconstructing leaflets to rebuild the native valveRing annuloplasty, which is a ring attached to the tissue around the valve, to provide the support needed for the valve to close tightly
  • Tricuspid valve surgery, which includes a variety of techniques, is used to treat leakage and safely repair tricuspid valve disorders.

Open Surgery or Minimally Invasive Approaches

Open heart surgery, which involves opening the chest with a nine-inch incision and cutting through the sternum (sternotomy), has long been the standard approach for any of the valve replacement procedures described above. Our heart valve specialists also offer several minimally invasive valve replacement procedures that are designed to result in less trauma, less blood loss, less pain and a shorter hospital stay:

  • Upper mini-sternotomy For this technique, a small (three-inch) incision is made in the chest, and much of the sternum remains intactMinimally invasive surgery can be then performed through this incision 6cm in length.
  • Minimally invasive mitral valve surgery can be performed through a lower sternotomy.
  • Transcatheter aortic valve replacement (TAVR)
  • Other Interventional cardiology procedures:
    • Percutaneous mitral valvuloplasty (widening of the valve)
    • Percutaneous aortic valvuloplasty
    • MitraClip 
What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with heart valve disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Download Cardiac Surgery: A Guide for Patients

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiac valve disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about heart valve disease in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Visit the Brigham and Women’s Hospital HealthHub Blog, which features information on a variety of topics, including heart disease.

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