Cardiovascular Center

Heart Valve Disease

Overview
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There are four valves in your heart: the tricuspid, pulmonary, mitral and aortic valves. Each is made of thin (but strong) flaps of tissue that open and close as your heart pumps. Blood is pumped through your heart in one direction while the heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their cusps or leaflets at just the right time, and then close tightly to prevent a backflow of blood.

Valvular heart disease occurs when your heart's valves do not work correctly causing the heart muscle to work harder in order to circulate the right amount of blood through the body. Valve disease can eventually lead to Congestive Heart Failure or CHF. There are generally two types of problems that can disrupt blood flow though the valves: stenosis or regurgitation.

Stenosis occurs when the leaflets thicken, stiffen, or fuse together narrowing the valve opening and reducing the amount of blood that can flow through it. Because of the narrowed valve, the heart must work harder but its ability to function is reduced and the rest of the body may not receive adequate blood flow.

Regurgitation also called insufficiency, incompetence or leaky valve, happens when the leaflets of the valve do not close properly and blood leaks backward instead of moving in the proper one-way flow. Once too much blood flows backward and only a small amount can move forward to the body's organs, the heart will try to compensate for this reduced blood flow by working harder. Over time the heart will become enlarged and less cable of pumping blood through your body resulting in heart failure.

What causes valve disease?

Valve disease can be congenital (present at birth) or may be acquired later in life; there are a variety of causes:

Congenital valve disease is an abnormality that develops before birth. It may be related to improper valve size, malformed leaflets, or an irregularity in the way the leaflets are attached. This most often affects the aortic or pulmonic valve.
Aging can make valves weaken or harden this is called myxomatous degeneration. It most commonly affects the mitral valve.
Calcific degeneration is a buildup of calcium usually on the aortic or mitral valves which causes the valves to thicken.
Medication induced from the use of the anti-obesity medicines fen-phen and Redux, which were removed from the market after being linked to heart valve disease.
Infection in the lining of the heart's walls and valves also called infective endocarditis.
Coronary artery disease
Heart attack
Rheumatic heart disease

Surgical Treatment Options

When valve damage is mild, doctors may be able to treat it with medicines. Once the damage to the valve becomes severe, surgery to repair or replace the valve may be required.

What is valve repair?

There are several different procedures surgeons may use to repair a valve:

Valvuloplasty, which strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
Commissurotomy, which is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
Decalcification, which removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.
Repair of structural support, which replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.

What is valve replacement?

Severe valve damage means that the valve will need to be replaced. Valve replacement is most often used to treat aortic valves and severely damaged mitral valves. It is also used to treat any valve disease that is life-threatening. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.

There are two kinds of valves used for valve replacement:

Mechanical valves are strong and usually last a long time because they are made from materials such as plastic, carbon, or metal. However due to the artificial material involved, blood tends to stick to mechanical valves and create blood clots. Patients receiving these valves require lifelong treatment with a blood-thinning (anticoagulant) medication. Blood-thinners are medications such as warfarin or Coumadin that delay the clotting action of the blood.

Biological or tissue valves also called bioprosthetic valves are made of human or animal tissue. Some valves may have some artificial parts to help give the valve support and to aid placement. There are three types of tissue valves: pig tissue (porcine), cow tissue (bovine), and human (allografts or homografts). Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.

You and your doctor will decide which type of valve is best for you.

Jonathan S. Allan, PA-C, M.S.

Locations

Huntsman Cancer Hospital
University Hospital	(801) 581-5311

Specialties: Cardiothoracic Surgery, Physician Assistant

David A. Bull, M.D.

Locations

University Hospital

(801) 581-5311

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Esophageal Surgery, Heart Transplant, Lung Cancer, Lung Transplant, Valvular Heart Disease

Phillip T. Burch, M.D.

Locations

Primary Children's Medical Center

(801) 662-5577

Specialties: Cardiothoracic Surgery, Pediatric Cardiothoracic Surgery

Shamus R. Carr, M.D., FACS

Locations

Huntsman Cancer Hospital	(801) 587-4470
University Hospital	(801) 581-5311

Specialties: Barrett's Esophagus, Bronchoscopy surgery, Cardiothoracic Surgery, Esophageal Diseases, Gastroesophageal Reflux Disease (GERD), Lung Cancer, Minimally Invasive Gastrointestinal Surgery, Therapeutic Endoscopy

Jessica M. De St Jeor, B.S.

Specialties: Cardiothoracic Surgery

Aaron W. Eckhauser, M.D., M.S.C.I

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Peter J. Gruber, M.D., Ph.D.

Locations

Primary Children's Medical Center

(801) 662-5566

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Kyle Gubler, PA-C

Specialties: Cardiothoracic Surgery, Physician Assistant

Terri M. Hancock, DNP, ACNP-BC

Locations

University Hospital

(801) 581-5311

Specialties: Acute Care Nurse Practitioner, Cardiothoracic Surgery

Aditya K. Kaza, M.D.

Locations

Primary Children's Medical Center

(801) 662-5566

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Antigoni Koliopoulou, M.D.

Specialties: Cardiothoracic Surgery

Ganesh S. Kumpati, M.D.

Locations

University Hospital	(801) 581-5311
Veterans Administration Medical Center	(801) 582-1565

Specialties: Cardiothoracic Surgery

Thomas Lewis, PA-C

Locations

University Hospital

(801) 231-2200

Specialties: Cardiothoracic Surgery, Physician Assistant

Stephen McKellar, M.D., M.Sc.

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Minimally Invasive Lung & Esophageal Surgery, Valvular Heart Disease

Amit N. Patel, M.D., B.S., M.S.

Locations

University Hospital

(801) 587-7946

Specialties: Cardiothoracic Surgery, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Valvular Heart Disease

Craig H. Selzman, M.D.

Locations

University Hospital

(801) 587-9348

Specialties: Adult Congenital Heart Disease, Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Surgical Ventricular Restoration, Valvular Heart Disease