Heart valve disease occurs when any of your heart's four valves do not function properly. Valvular heart disease can disrupt or restrict blood flow to your body's organs. Untreated heart valve problems can diminish quality of life and lead to life-threatening situations. Doctors can alleviate heart valve disease symptoms with surgical repair or replacement of tissue impacted by heart valve disease.
Heart valve disease involves two main types of malfunctions: regurgitation (valvular leakage) and stenosis of heart valves (narrowing of the valve). More than five million Americans are diagnosed with one of these types of heart valve disease each year.
Heart valves can develop both regurgitation and stenosis at the same time and more than one heart valve can be affected at once. 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.
Heart valves allow for proper blood flow within the heart and the arteries throughout the body. The four heart valves each work as one-way valves to move blood while preventing backflow of blood into one of the heart's four chambers. When the heart beats (contracts), the valves open and close in alternating fashion to pump blood through the two atria upper chambers and two ventricles, the lower chambers. The four types of heart valves are:
Heart valve disease can be caused by a variety of factors, including genetic conditions, degeneration, infections or other medical conditions. As adults age, they become more likely to suffer valvular heart disease, but heart valve disease in young adults is also possible with a genetic condition or an increase in risk factors. Studies show men may develop heart valve disease at a younger age than women.
Risk factors for heart valve damage vary according to the type of disease and may include one or more of the following:
The cause for individual cases of heart valve disease is not always known and is not always preventable. The best chance at preventing valvular heart disease or mitigating symptoms comes from reducing risk factors and creating a healthy lifestyle. Lifestyle changes may include:
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:
Heart valve disease symptoms may resemble other medical conditions and problems. Always consult a doctor for evaluation and diagnosis.
Valvular heart disease can happen to any of the four heart valves, but the mitral valve is the one most often impacted by heart disease problems. Common heart valve disease issues:
At Brigham and Women’s Hospital, our heart valve disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. To most efficiently 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 aims to protect your valve and heart from additional damage while reducing symptoms caused by valvular heart disease. Early treatment options may include medication and lifestyle changes, but often surgery is necessary to repair or replace the damaged valve or valves. Valve surgery involves two major categories—valve replacement and valve repair.
Medical experts will help decide the best treatment course based on the type of valve disease, severity of valve damage and a patient's age and medical history.
Pre-Surgery Treatment Options
Doctors may prescribe both medications and lifestyle changes to alleviate symptoms before the need for heart valve surgery. Doctors may also want time to monitor the heart valve before deciding on repair or replacement. Medications used include beta blockers to control heart rate and blood pressure medications to reduce the heart's workload.
Repair of Valves with Valvular Heart Disease
A repair of a diseased heart valve repair aims to fix the valve without a full replacement. A valve repair procedure often comes with a lower level of after-surgery monitoring and medication because the procedures are commonly less invasive with the use of catheters. A valve repair may include sculpting abnormal valve tissue to improve the function of the valve, patching holes, separating fused valve leaflets, replacing supportive cords or removing excess tissue. Surgeons may use clips or plugs and could add a ring to reinforce the valve.
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:
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:
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.
There are a variety of techniques that are used to repair or replace valves:
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:
The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham's main 75 Francis St. entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.
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. Learn more about our Heart & Vascular team.
Cardiovascular specialists from the Brigham and Women’s Hospital Division of Cardiovascular Medicine and the Division of Cardiac Surgery offer 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 echocardiography, transcatheter 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.
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, your care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with valvular disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care from 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.
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