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 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.
Risk factors for heart valve damage vary according the type of disease and may include one or more of the following:
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:
Symptoms of heart valve disease may resemble other medical conditions and problems. Always consult a doctor for evaluation and diagnosis.
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.
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:
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:
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:
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:
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.
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.
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