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 4 chambers--2 atria (upper chambers) and 2 ventricles (lower chambers). Blood passes through a valve as it leaves 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 4 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 explanation of blood flow through the heart.

  • The left and right atrium contract once they are filled with blood. This pushes open the mitral and tricuspid valves. Blood is then pumped into the ventricles.

  • The left and right ventricles contact. This closes the mitral and tricuspid valves preventing back blood flow. At the same time, the aortic and pulmonic valves open to let blood be pumped out of the heart.

  • The left and right ventricles relax. The aortic and pulmonic valves close preventing backward blood flow into the heart. The mitral and tricuspid valves then open to allow forward blood flow within the heart to fill the ventricles again.

What is heart valve disease?

Heart valve disorders can arise from 2 main types of problems:

  • Regurgitation (or leakage of the valve). When the valve(s) do not close completely, it causes blood to flow backward through the valve. This reduces forward blood flow and can lead to volume overload in the heart.

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

Heart valves can develop both regurgitation and stenosis at the same time. Also, more than one heart valve can be affected at the same time. When heart valves fail to open and close properly, the effects on the heart can be serious, possibly hampering the heart's ability to pump enough blood through the body. Heart valve problems are one cause of heart failure.

What are the symptoms of heart valve disease?

Mild to moderate heart valve disease may not cause any symptoms. These are the most common symptoms of heart valve disease:

  • 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)

  • Leg swelling

Symptoms of heart valve disease may look like other medical problems. Always see 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:

  • Changes in the heart valve structure due to aging

  • Coronary artery disease and heart attack

  • Heart valve infection

  • Birth defect

  • Syphilis (a sexually-transmitted infection)

  • 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

With this birth defect, the aortic valve has only 2 leaflets instead of 3. If the valve becomes narrowed, it is harder for the blood to flow through, and often the blood leaks backward. Symptoms usually don't until the adult years.

With this defect, the mitral valve leaflets bulge and don't close properly during the contraction of the heart. This lets blood to leak backward. This may result in a mitral regurgitation murmur.

With this valve disease, the mitral valve opening is narrowed. It is often caused by a past history of rheumatic fever. It increases resistance to blood flow from the left atrium to the left ventricle.

This valve disease occurs mainly in the elderly. It causes the aortic valve opening to narrow. This increases resistance to blood flow from the left ventricle to the aorta.

With this valve disease, the pulmonary valve does not open sufficiently. This forces the right ventricle to pump harder and enlarge. This is usually a congenital condition.

How is heart valve disease diagnosed?

Your doctor may think you have heart valve disease if your 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 mean 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 tests:

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

  • Echocardiogram (echo).  This noninvasive test 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. This is the best test to evaluate heart valve function.

  • Transesophageal echocardiogram (TEE).This test 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. This 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 test involves the insertion of a tiny, hollow tube (catheter) through a large artery in the leg or arm leading to the heart 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). This test 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, your doctor may just want to closely watch the heart valve problem for a period. However, other options include medicine, or surgery to repair or replace the valve. Treatment varies, depending on the type of heart valve disease, and may include:

  • Medicine. Medicines are not a cure for heart valve disease, but treatment can often relieve symptoms. These medicines may include:

    • 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 (remove excess water from the body by increasing urine output) or vasodilators (relax the blood vessels, decreasing the force against which the heart must pump) to ease the work of the heart.

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

    • Heart valve repair. In some cases, surgery on the malfunctioning valve can help ease symptoms. Examples of heart valve repair surgery include remodeling abnormal valve tissue so that the valve works 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 a new valve. Replacement valves may be either tissue (biologic) valves, which include animal valves and donated human aortic valves, or mechanical valves, which can consist of metal, plastic, or another artificial material. This usually requires heart surgery. But, certain valve diseases such as aortic valve stenosis or mitral valve regurgitation may be managed using non- surgical methods.

Another treatment option that is less invasive than valve repair or replacement surgery is balloon valvuloplasty. This is a non-surgical procedure in which a special catheter (hollow tube) is threaded into a blood vessel in the groin and guided into the heart. At the tip of the catheter is a deflated balloon that 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.

Cardiologists

David A. Bull, M.D.

Patient Rating:

4.8

4.8 out of 5

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, Division of Cardiothoracic Surgery; progra... Read More

Daniel A. Cox, D.O.

Dr. Dan Cox is a pediatric and adult congenital cardiologist who specializes in diagnosing and treating people with congenital heart problems at all ages. He received his undergraduate degree from The George Washington University and medical degree from the Des Moines University College of Osteopathic Medicine. He completed a combined pediatric and... Read More

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 combined, integrated training program. ... Read More

Jack H. Morshedzadeh, M.D.

Patient Rating:

4.8

4.8 out of 5

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 has been on faculty at the Universit... Read More

Amit N. Patel, M.D.

Patient Rating:

4.9

4.9 out of 5

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 replacement, heart failure, aortic s... Read More

Craig H. Selzman, M.D.

Patient Rating:

4.9

4.9 out of 5

Dr. Craig Selzman is a Professor of Surgery and Chief of 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 General and Cardiothoracic Surgery training... Read More

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 valvular heart disease, coronary stent impla... Read More

Specialties:

Cardiology, Interventional Cardiology, Valvular Heart Disease

Locations:

Castle Country Clinic (801) 585-7676
South Jordan Health Center (801) 585-7676
Uintah Basin Medical Center (801) 585-7676
University Hospital
Cardiovascular Center
(801) 585-7676

Anwar Tandar, M.D.

Patient Rating:

4.6

4.6 out of 5

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 University in Indonesia in 1994. He comp... Read More

Specialties:

Cardiology, Interventional Cardiology, Valvular Heart Disease

Locations:

Blanding Family Practice (801) 585-7676
Memorial Hospital of Sweetwater County
Cardiovascular Clinic
(801) 585-7676
University Hospital
Cardiovascular Center
(801) 585-7676

Frederick G. Welt, M.D.

Frederick Welt, M.D. is Associate Chief of Cardiovascular Medicine at the University of Utah School of Medicine and Director of the Cardiac Catheterization Laboratory. He is a professor of medicine and member of the Interventional Cardiology faculty.Dr. Welt most recently served as the Director of Interventional Cardiology at Brigham and Women's Ho... Read More

Specialties:

Cardiology, Interventional Cardiology, Transcatheter Aortic Valve Replacement (TAVI or TAVR), Valvular Heart Disease

Locations:

Basin Clinic (801) 585-7676
Evanston Regional Hospital
Cardiovascular Outreach Care
(801) 585-7676
University Hospital
Cardiovascular Center
(801) 585-7676

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

Patient Rating:

4.7

4.7 out of 5

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 University of Utah since 2006. Dr. W... Read More

Irene Cheong, DNP, APRN, FNP-C, GNP

Irene received her doctorate degree in nursing practice from the University of Utah in 2014. Prior to joining the Cardiology Clinic, she practiced as an independent clinician at Health Clinics of Utah providing primary care for patients from all ages and with diverse healthcare needs. Before becoming a nurse practitioner, she worked at the inpatien... Read More

Specialties:

Cardiology, Family Nurse Practitioner, General Cardiology, Heart Failure, Interventional Cardiology, Valvular Heart Disease

Locations:

Redstone Health Center (801) 585-7676
Uintah Basin Medical Center (801) 585-7676
University Hospital
Interventional Cardiology
University Hospital
Cardiovascular Center
(801) 585-7676