Heart Valve Disease

Types of Heart Valve Disease

Some people are born with heart valve disease, while others acquire it later in life. Heart valve disease that develops before birth is called congenital heart valve disease. Congenital heart valve disease can occur alone or with other congenital heart defects.

Congenital heart valve disease often involves pulmonary or aortic valves that don't form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.

Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.

Both congenital and acquired heart valve disease can cause stenosis or backflow.

Many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.

Causes of Acquired Heart Valve Disease

Heart conditions and other disorders, age-related changes, rheumatic fever, or infections can cause acquired heart valve disease. These factors change the shape or flexibility of once-normal heart valves. Certain conditions can stretch and distort the heart valves. These conditions include:

• Advanced high blood pressure and heart failure, this can enlarge the heart or the main arteries.
• Atherosclerosis in the aorta. Atherosclerosis is a condition in which a waxy substance called plaque builds up inside the arteries. The aorta is the main artery that carries oxygen-rich blood to the body.
• Damage and scar tissue due to a heart attack or injury to the heart.

Infections, conditions and factors that can cause heart valve disease

Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but serious infection is called infective endocarditis. The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Often, the body’s defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to infective endocarditis.

Many other conditions and factors are linked to heart valve disease. However, the role they play in causing heart valve disease often isn’t clear.

• Autoimmune disorders. Autoimmune disorders, such as lupus, can affect the aortic and mitral valves.
• Carcinoid syndrome. Tumors in the digestive tract that spread to the liver or lymph nodes can affect the tricuspid and pulmonary valves.
• Diet medicines. The use of fenfluramine and phentermine (“fen-phen”) sometimes has been linked to heart valve problems. These problems typically stabilize or improve after the medicine is stopped.
• Marfan syndrome. Congenital disorders, such as Marfan syndrome and other connective tissue disorders, can affect the heart valves.
• Metabolic disorders. Relatively uncommon diseases (such as Fabry disease) and other metabolic disorders (such as high blood cholesterol) can affect the heart valves.
• Radiation therapy. Radiation therapy to the chest area can cause heart valve disease. This therapy is used to treat cancer. Heart valve disease due to radiation therapy may not cause symptoms until years after the therapy.

Rheumatic Heart Disease

Untreated strep throat or other infections with strep bacteria that progress to rheumatic fever can cause heart valve disease. When the body tries to fight the strep infection, one or more heart valves may be damaged or scarred in the process. The aortic and mitral valves most often are affected. Symptoms of heart valve damage often don’t appear until many years after recovery from rheumatic fever.

Today, most people who have strep infections are treated with antibiotics before rheumatic fever occurs. If you have strep throat, take all of the antibiotics your doctor prescribes, even if you feel better before the medicine is gone.

Heart valve disease caused by rheumatic fever mainly affects older adults who had strep infections before antibiotics were available. It also affects people from developing countries, where rheumatic fever is more common.

Diagnosing Heart Valve Disease

Your primary care doctor may detect a heart murmur or other signs of heart valve disease. However, a cardiologist usually will diagnose the condition. Your doctor will listen to your heart and lungs with a stethoscope as you breathe to check for fluid buildup and check for swollen ankles and other signs that your body is retaining water.

Your doctor also may recommend other tests and procedures if you're diagnosed with heart valve disease. For example, you may have cardiac catheterization, stress testing, or cardiac MRI (magnetic resonance imaging). These tests and procedures help your doctor assess how severe your condition is so he or she can plan your treatment.

Following are the additional tests and procedures which may be performed.

Echocardiography (echo) is the main test for diagnosing heart valve disease. Echo uses sound waves to create a moving picture of your heart as it beats. A device called a transducer is placed on the surface of your chest. The transducer sends sound waves through your chest wall to your heart. Echoes from the sound waves are converted into pictures of your heart on a computer screen and can show:

• The size and shape of your heart valves and chambers
• How well your heart is pumping blood
• Whether a valve is narrow or has backflow

Transesophageal echo, or TEE, provides a better image of your heart.

• During TEE, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). From there, your doctor can get detailed pictures of your heart.
• You'll likely be given medicine to help you relax during this procedure.

EKG is simple test detects and records the heart's electrical activity. An EKG can detect an irregular heartbeat and signs of a previous heart attack. It also can show whether your heart chambers are enlarged.

Chest X-ray can show whether certain sections of your heart are enlarged, whether you have fluid in your lungs, or whether calcium deposits are present in your heart. A chest x ray helps your doctor learn which type of valve defect you have, how severe it is, and whether you have any other heart problems.

Cardiac Catheterization will be recommended if your signs and symptoms of heart valve disease aren’t in line with your echo results. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Your doctor uses x-ray images to guide the catheter. Through the catheter, your doctor does diagnostic tests and imaging that show whether backflow is occurring through a valve and how fully the valve opens. You'll be given medicine to help you relax, but you will be awake during the procedure. The procedure also can help your doctor assess whether your symptoms are due to specific valve problems or coronary heart disease. All of this information helps your doctor decide the best way to treat you.

A Stress Test can show whether you have signs and symptoms of heart valve disease when your heart is working hard. It can help your doctor assess the severity of your heart valve disease. During stress testing, you exercise to make your heart work hard and beat fast while heart tests and imaging are done. If you can't exercise, you may be given medicine to raise your heart rate.

Cardiac MRI uses a powerful magnet and radio waves to make detailed images of your heart. A cardiac MRI image can confirm information about valve defects or provide more detailed information. This information can help your doctor plan your treatment. An MRI also may be done before heart valve surgery to help your surgeon plan for the surgery.

Treatments for Heart Valve Disease

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can treat symptoms successfully and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.

In addition to heart-healthy lifestyle changes, your doctor may prescribe medicines to:

• Lower high blood pressure or high blood cholesterol.
• Prevent arrhythmias (irregular heartbeats).
• Thin the blood and prevent clots (if you have a man-made replacement valve). Doctors also prescribe these medicines for mitral stenosis or other valve defects that raise the risk of blood clots.
• Treat coronary heart disease. Medicines for coronary heart disease can reduce your heart’s workload and relieve symptoms.
• Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.

Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn’t causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death. The decision to repair or replace heart valves depends on many factors, including:

• The severity of your valve disease
• Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease. Bypass surgery and valve surgery can be performed at the same time.
• Your age and general health

When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they don’t need to take blood-thinning medicines for the rest of their lives.

However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.

Repairing Heart Valves

Heart surgeons can repair heart valves by adding tissue to patch holes or tears or to increase the support at the base of the valve; by removing or reshaping tissue so the valve can close tighter; or, by separating fused valve flaps

Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients. Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure.

Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy.

During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube. You’re awake during the procedure, which usually requires an overnight stay in a hospital.

Balloon valvuloplasty relieves many symptoms of heart valve disease, but may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve. Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. For these people, balloon valvuloplasty often is preferred over surgical repair or replacement.

Balloon valvuloplasty doesn’t work as well as surgery for adults who have aortic valve stenosis. Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.

Replacing Heart Valves

Sometimes heart valves can’t be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won’t need medicines to stop your body from rejecting the valve. You and your doctor will decide together whether you should have a man-made or biological replacement valve.

If you’re a woman of childbearing age or if you’re athletic, you may prefer a biological valve so you don’t have to take blood-thinning medicines. If you’re elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.

Less invasive surgery option to repair and replace heart valves

New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2 to 4 weeks versus 6 to 8 weeks for traditional surgery.

Doctors also may use a catheter to replace faulty aortic valves. This procedure is called transcatheter aortic valve replacement (TAVR). For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. A deflated balloon with a folded replacement valve around it is at the end of the catheter.

Once the replacement valve is placed properly, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.

A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.

Living With Heart Valve Disease

If you have heart valve disease, see your doctor regularly for checkups and for echocardiography or other tests. This will allow your doctor to check the progress of your heart valve disease.

Call your doctor if your symptoms worsen or you have new symptoms. Also, discuss with your doctor whether heart-healthy lifestyle changes might benefit you. Ask him or her which types of physical activity are safe for you.

Call your doctor if you have symptoms of infective endocarditis (IE). Symptoms of this heart infection include fever, chills, muscle aches, night sweats, problems breathing, fatigue (tiredness), weakness, red spots on the palms and soles, and swelling of the feet, legs, and belly.

Take all of your medicines as prescribed.

Make an Appointment with a Cooper and Inspira Cardiac Care Heart Valve Disease Specialist

To learn more about the services available for treating heart valve disease at Cooper or to request an appointment, please call 833.SJHEART (833.754.3278).