About

The University of Utah Health Care Cardiovascular Valve Clinic offers the most advanced diagnostic and treatment services available for patients with heart valve disease. Cardiovascular surgeons, imaging specialists, and cardiologists team up to provide better treatment options for patients with heart valve conditions, including catheter-based valve replacement and heart defect repair. Patients have access to several specialists at one time, which will expedite their care and help determine the optimal treatment plan for each individual.

Diagnosis & Treatment Options

Heart valve disease involves the dysfunction of one or more of the four heart valves, which keep blood flowing in the correct direction through your heart. To diagnose this condition, a doctor may use diagnostic tests, like chest x-rays and magnetic resonance imaging (MRI). Once your condition is diagnosed, your physician will choose a treatment that may include medication or surgery. Medication can treat the symptoms of heart disease, and valve surgery involves a doctor repairing or replacing your heart valve.

The valve clinic provides solutions for the most complex valve diseases, such as aortic stenosis and mitral regurgitation, even to patients who previously had no options. For patients with severe aortic valve stenosis, we offer transcatheter aortic valve replacement (TAVI or TAVR) as a treatment option. Any patient with a heart murmur is a candidate for treatment.

Treatments

Heart Valve Diseases

What are heart valves?

The heart consists of four chambers--two atria (upper chambers) and two ventricles (lower chambers). There is a valve through which blood passes before leaving each chamber of the heart. The valves prevent the backward flow of blood. They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The four heart valves include the following:

  • Tricuspid valve. Located between the right atrium and the right ventricle.

  • Pulmonary valve. Located between the right ventricle and the pulmonary artery.

  • Mitral valve. Located between the left atrium and the left ventricle.

  • Aortic valve. Located between the left ventricle and the aorta.

How do the heart valves function?

As the heart muscle contracts and relaxes, the valves open and close, letting blood flow into the ventricles and out to the body at alternate times. The following is a step-by-step illustration of how the valves function normally in the left ventricle:

  • After the left ventricle contracts, the aortic valve closes and the mitral valve opens to allow blood to flow from the left atrium into the left ventricle.

  • The left atrium contracts and more blood flows into the left ventricle.

  • When the left ventricle contracts, the mitral valve closes and the aortic valve opens so blood flows into the aorta and out into the systemic circulation to the rest of the body.

What is heart valve disease?

Heart valve disorders can arise from two main types of malfunctions:

  • Regurgitation (or leakage of the valve). The valve(s) does not close completely, causing the blood to flow backward through the valve. The heart is forced to pump more blood on the next beat, making it work harder.

  • Stenosis (or narrowing of the valve). The valve(s) opening becomes narrowed, limiting the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force in order to move blood through the narrowed or stiff (stenotic) valve(s).

Heart valves can develop both malfunctions at the same time (regurgitation and stenosis). Also, 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. Heart valve problems are one cause of heart failure.

What are the symptoms of heart valve disease?

Mild heart valve disease may not cause any symptoms. The following are the most common symptoms of heart valve disease. However, each individual may experience symptoms differently. Symptoms may vary depending on the type of heart valve disease present and may include:

  • Chest pain

  • Palpitations caused by irregular heartbeats

  • Fatigue

  • Dizziness

  • Low or high blood pressure, depending on which valve disease is present

  • 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 your doctor for a diagnosis.

What causes heart valve damage?

The causes of heart valve damage vary depending on the type of disease present, and may include the following:

  • A history of rheumatic fever, a condition characterized by painful fever, inflammation, and swelling of the joints. Rheumatic fever is now rare in North America due to effective antibiotic treatment.

  • Damage resulting from a heart attack

  • Damage resulting from an infection

  • Changes in the heart valve structure due to the aging process

  • Congenital birth defect

  • Syphilis, a disease characterized by progressive symptoms if not treated. Syphilis is a sexually-transmitted infection. Symptoms may include small, painless sores that disappear, followed by a skin rash, enlarged lymph nodes, headache, aching bones, loss of appetite, fever, and fatigue.

  • Myxomatous degeneration, an inherited connective tissue disorder that weakens the heart valve tissue.

The mitral and aortic valves are most often affected by heart valve disease. Some of the more common heart valve diseases include:

Heart valve disease

Symptoms and causes

Bicuspid aortic valve

Mitral valve prolapse (also known as click-murmur syndrome, Barlow's syndrome, balloon mitral valve, or floppy valve syndrome)

Mitral valve stenosis

Aortic valve stenosis

Pulmonary stenosis

This congenital birth defect is characterized by an aortic valve that has only two flaps (a normal aortic valve has three flaps). If the valve becomes narrowed, it is more difficult for the blood to flow through, and often the blood leaks backward. Symptoms usually do not develop during childhood, but are often detected during the adult years.

This disease is characterized by the bulging of one or both of the mitral valve flaps during the contraction of the heart. One or both of the flaps may not close properly, allowing the blood to leak backward. This may result in a mitral regurgitation murmur.

Often caused by a past history of rheumatic fever, this condition is characterized by a narrowing of the mitral valve opening, increasing resistance to blood flow from the left atrium to the left ventricle.

This type of valve disease occurs primarily in the elderly and is characterized by a narrowing of the aortic valve opening, increasing resistance to blood flow from the left ventricle to the aorta.

This condition is characterized by a pulmonary valve that does not open sufficiently, causing the right ventricle to pump harder and enlarge.

How is heart valve disease diagnosed?

Heart valve disease may be suspected if the heart sounds heard through a stethoscope are abnormal. This is usually the first step in diagnosing a heart valve disease. A characteristic heart murmur (abnormal sounds in the heart due to turbulent blood flow across the valve) can often indicate valve regurgitation or stenosis. To further define the type of valve disease and extent of the valve damage, doctors may use any of the following diagnostic procedures:

  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.

  • Echocardiogram (echo). A noninvasive test that uses sound waves to evaluate the heart's chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over the heart.

  • Transesophageal echocardiogram (TEE). A diagnostic procedure that involves passing a small ultrasound transducer down into the esophagus. The sound waves create an image of the valves and chambers of the heart on a computer monitor without the ribs or lungs getting in the way.

  • Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An X-ray can show enlargement in any area of the heart.

  • Cardiac catheterization. This diagnostic procedure involves the insertion of a tiny, hollow tube (catheter) through a large artery in the leg or arm leading to the heart in order to provide images of the heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

What is the treatment for heart valve disease?

In some cases, the only treatment for heart valve disease may be careful medical supervision. However, other treatment options may include medication, surgery to repair the valve, or surgery to replace the valve. Specific treatment will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • The location of the valve

  • Your signs and symptoms

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment varies, depending on the type of heart valve disease, and may include one, or a combination of, the following:

  • Medication. Medications are not a cure for heart valve disease, but in many cases are successful in the treatment of symptoms caused by heart valve disease. These medications may include:

    • Medications such as beta-blockers, digoxin, and calcium channel blockers to reduce symptoms of heart valve disease by controlling the heart rate and helping to prevent abnormal heart rhythms.

    • Medications to control blood pressure, such as diuretics (medications that remove excess water from the body by increasing urine output) or vasodilators (medications that relax the blood vessels, decreasing the force against which the heart must pump) to ease the work of the heart.

  • Surgery. Surgery may be necessary to repair or replace the malfunctioning valve(s). Surgery may include:

    • Heart valve repair. In some cases, surgery on the malfunctioning valve can help alleviate symptoms. Examples of heart valve repair surgery include remodeling abnormal valve tissue so that the valve functions properly, or inserting prosthetic rings to help narrow a dilated valve. In many cases, heart valve repair is preferable, because a person's own tissues are used.

    • Heart valve replacement. When heart valves are severely malformed or destroyed, they may need to be replaced with an entirely new replacement valve. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves, which can consist of metal, plastic, or another artificial material.

Another treatment option that is less invasive than valve repair or replacement surgery is balloon valvuloplasty, a nonsurgical procedure in which a special catheter (hollow tube) is threaded into a blood vessel in the groin and guided into the heart. The catheter, which contains a deflated balloon, is inserted into the narrowed heart valve. Once in place, the balloon is inflated to stretch the valve open, and then removed. This procedure is sometimes used to treat pulmonary stenosis and, in some cases, aortic stenosis. There are also some special cases where a new valve can be inserted through the groin into the heart and opened up with a balloon like a stent. This is called total aortic valve replacement. 

Cardiologists

Rodney S. Badger, M.D.

Rodney S. Badger, M.D., is a board-certified physician specializing in cardiology. He graduated from Stanford University in 1976 and attended the University of California, San Diego, completing his M.D., in 1980. He then completed his residency in internal medicine and his fellowship in cardiology, both at the ... Read More

Specialties:

Cardiology, Interventional Cardiology, Valvular Heart Disease

Locations:

Basin Clinic (801) 585-7676
Redstone Health Center (435) 658-9262
South Jordan Health Center (801) 585-7676
University Hospital (801) 585-7676

David A. Bull, M.D.

David Bull, MD, is a member of the Thoracic Oncology Program, a joint effort between Huntsman Cancer Institute and the University of Utah Hospitals and Clinics. The program was developed to offer consultation, diagnosis, and treatment for all chest cancers. Bull is a professor in the Department of Surgery, Divis... Read More

Specialties:

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

Locations:

University Hospital (801) 581-5311

Collin G. Cowley, M.D.

Collin Cowley, MD is an Associate Director of the Division of Pediatric Cardiology at the University of Utah. In this role he oversees the clinical programs and the quality assurance efforts in both the inpatient and outpatient settings. Dr. Cowley provides general cardiology care to children and select adults ... Read More

Specialties:

Pediatric Cardiology, Valvular Heart Disease

Locations:

PCH Outpatient Services at Riverton (801) 213-3599
Pediatric Cardiology (801) 213-3599

Christopher J. McGann, M.D.

Christopher J. McGann, M.D., has appointments in both the Cardiology Division and Radiology Department at the University of Utah, where he has been a faculty member since 2002. He currently serves as the Section Chief of General Cardiology and the Director of Cardiovascular Imaging. He received his medical degre... Read More

Specialties:

Body Imaging, Cardiac Imaging, Cardiology, Echocardiography, General Cardiology, Nuclear Medicine, Valvular Heart Disease

Locations:

University Hospital (801) 587-0555

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

Dr. McKellar is a native of Salt Lake City and received his Bachelor of Arts from the University of Utah and his Doctor of Medicine from the George Washington University School of Medicine. He completed his General Surgical and Cardiothoracic Surgical training at the Mayo Clinic in Rochester, Minnesota in a com... Read More

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

Locations:

A location has not yet been added by this physician.

Jack H. Morshedzadeh, M.D.

Jack Morshedzadeh. M.D., has appointments in the Division of Cardiology and in the Department of Radiology at the University of Utah. He serves as the Medical Director of the Cardiovascular Medicine Unit and Cardiac Critical Care Unit. He is also the Director of the Cardiovascular Disease Fellowship Program. He... Read More

Specialties:

Cardiac Imaging, Cardiology, Echocardiography, General Cardiology, Nuclear Medicine, Preventive Cardiology, Valvular Heart Disease

Locations:

Redwood Health Center (801) 213-9990
University Hospital (801) 587-0555

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

Amit Patel, MD, MS, is an associate professor in the Division of Cardiothoracic Surgery at the University of Utah School of Medicine and Director of Clinical Regenerative Medicine and Tissue Engineering at the University of Utah. His clinical interests include heart surgery for coronary disease, valve repair and... Read More

Specialties:

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

Locations:

University Hospital (801) 587-7946

Craig H. Selzman, M.D.

Dr. Craig Selzman is an Associate Professor of Surgery in the Division of Cardiothoracic Surgery at the University of Utah who specializes in the care of patients requiring heart surgery. He earned his undergraduate degree at Amherst College and medical degree at Baylor College of Medicine. He received his Gener... Read More

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

Locations:

University Hospital (801) 587-9348

Brigham R. Smith, M.D.

Dr. Brigham Smith is an Interventional Cardiologist with expertise and training in both intracoronary and structural cardiac procedures. Clinical interests and responsibilities include invasive management of acute heart attacks, invasive evaluation and management of heart failure, invasive assessment of valvula... Read More

Specialties:

Cardiology, Interventional Cardiology, Valvular Heart Disease

Locations:

South Jordan Health Center (801) 585-7676
University Hospital (801) 585-7676

Anwar Tandar, M.D.

Anwar Tandar, M.D., is an Associate Professor of Medicine with an appointment in the Cardiology Division at the University of Utah. He has been on faculty at the University of Utah since 2011and is the Co-Director of the Valve Clinic Program and the TAVR Program. He received his medical degree from Sriwijaya Uni... Read More

Specialties:

Cardiology, Interventional Cardiology, Valvular Heart Disease

Locations:

Blanding Family Practice (801) 585-7676
Cardiovascular Clinic (801) 585-7676
South Jordan Health Center
University Hospital (801) 585-7676

Brent D. Wilson, M.D., Ph.D.

Brent D. Wilson, M.D., Ph.D., has appointments in the Division of Cardiology and in the Department of Radiology at the University of Utah. He serves as Director of the Cardiovascular Center, Director of the Echocardiography Laboratory, and Director of Cardiology Clinical services. He has been on faculty at the U... Read More

Specialties:

Body Imaging, Cardiac Imaging, Cardiology, Echocardiography, General Cardiology, Nuclear Medicine, Valvular Heart Disease

Locations:

University Hospital (801) 587-0555