If you had a heart valve problem in the 1940s, you faced dangerous open-heart surgery and a 50-50 survival rate. Today, new, technologically advanced treatments can help anyone, even patients in their mid-90s, said Robert Riley, MD, a thoracic and cardiac surgeon who's an independent member of the HonorHealth medical staff.
The result is an improvement in symptoms, a longer life, better quality of life, reduced cost of care, reduction of heart failure and less time in the hospital.
In fact, the advances in surgical treatment of valve disease can mean minimally invasive surgery with an incision of less than three inches. Or older individuals can benefit from an FDA-approved TAVR (transcatheter aortic valve replacement) procedure, in which a replacement valve is inserted through a blood vessel in the groin.
Two of four valves in your heart, the aortic and mitral valves do important work. The mitral valve controls blood flow from your lungs into the left ventricle, the main pumping chamber. The aortic valve controls the blood flow to the aorta, which brings oxygen-rich blood to the body.
Causes of heart valve disease
An infection in the heart called endocarditis can cause heart valve disease. The disease presents itself in the valves in two different ways — either tight (stenotic) or leaky (regurgitant).
Tight aortic valves are the most common in the U.S. because of the aging population. The valve gets harder because of the natural wear and tear of doing its job. Another, less common, cause may be a heart valve that didn’t develop properly before birth.
Leaky aortic valves generally are caused by an aneurism or a bicuspid aortic valve that’s present at birth. A bicuspid valve means instead of the normal three leaflets, the valve only has two, limiting the flow of blood.
The most common problem with the mitral valve is leakage. With mitral valve prolapse, the valve opens and closes normally, but extra tissue causes it to be floppy, hampering the flow of blood.
Mitral valve stenosis is a narrowing of the valve, which means it does not open properly. A common cause is rheumatic fever or recurrent strep throat. Mitral valve stenosis is less common in the U.S. because antibiotics successfully treat strep throat, erasing the chances of rheumatic fever.
Symptoms of heart valve disease
See your doctor if you have one or more of these symptoms:
- Squeezing, tightness or discomfort in your chest
- Shortness of breath
- Pressure in the area of your heart
- Lightheadedness or dizziness
- Swelling in the legs
- Pulmonary edema (excess fluid in the lungs)
To determine whether you have a heart valve problem, your doctor first will use a stethoscope to listen to your heart. If he or she hears something abnormal — a heart murmur — the next step will be an echocardiogram or transesophageal (done via an instrument in your esophagus) echocardiogram to evaluate the function of your heart valves. Depending on what the doctor discovers, he or she will decide whether to watch the valve for changes or fix it. “Not every leaky valve needs to be treated, but they all need to be investigated,” Dr. Riley said.
Heart valve treatments
Valve replacement is the best treatment for aortic or mitral valve disease, Dr. Riley said. Doctors today often use minimally invasive surgery to replace a valve. A small incision enables the surgeon to operate from the “inside,” reducing risk and improving outcomes. Mechanical valves no longer are commonly used. Today, the most common replacement is a valve from a cow or a pig.
The FDA recently approved the TAVR procedure for high-risk and moderately high-risk individuals. By navigating a blood vessel in the groin as the avenue to the heart, a surgeon can use a catheter to put the valve in place, pushing aside the old valve. Although TAVR is being used more and more frequently, patients need to go to a center, such as HonorHealth Scottsdale Shea Medical Center, that specializes in the procedure for the best outcomes.