Heart Valve Disease and Surgery

What is the role of the heart valves?
The four heart valves play a critical role in the organ’s function by regulating blood flow through the heart and preventing blood from flowing the wrong way. The heart consists of four chambers, two upper atria and two lower ventricles. Two valves — a one-way inlet valve and a one-way outlet valve — are located in each ventricle (lower heart chamber). In the right ventricle, the tricuspid valve is the inlet valve, receiving blood from the right atrium, and the pulmonary valve is the outlet valve, sending blood to the lungs via the pulmonary arteries. The mitral valve is the inlet valve for the left ventricle — receiving oxygenated blood from the left atrium from the lungs — and the aortic valve is the outlet valve, which opens into the aorta.

What is valvular disease?
Each valve has a set of flaps that open and close fully when working properly. However, some people are born with abnormal heart valves, which don’t function as they should. Others develop valvular disease from infections such as rheumatic fever and infective endocarditis, coronary heart disease, aging or other diseases such as Marfan syndrome. Some people may suffer from mitral valve prolapse, a type of valve disease in which the valve leaflets and chordae are abnormally shaped and do not close properly (the mitral valve has two leafets, which are connected to the inside of the left ventricle by chordae tendoneae, which help open and close the valve). Mitral valve prolapse may be inherited or caused by other conditions.

There are two types of valvular heart disease:

  • In valvular stenosis, the valves are stiff and don’t open completely. Over time, they can become more hardened, and if they are too narrow, they can restrict heart function and blood flow to the body.
  • In valvular regurgitation, the valves do not close properly or completely, and blood flows backwards or regurgitates.

What are the symptoms of heart valve disease?
Symptoms can include unusual tiredeness or fatigue, shortness of breath, chest pain during exertion, passing out, dizziness, irregular heartbeat and swelling of the ankles, feet and sometimes the abdomen. Over time, heart valve disease can cause heart failure.

How is heart disease treated?
People with slightly damaged valves may not require any treatment except medications and close follow-up with their physicians. They may need to take antibiotics before a dental or surgical procedure to reduce the risk of valve infection. When treatment is needed, medicines and lifestyle changes often can be used to relieve symptoms and delay complications. However, eventually, surgery may be needed to repair or replace a malfunctioning heart valve.

What expertise do Washington University heart surgeons offer?
A high volume of valve surgeries are performed at Barnes-Jewish Hospital by Washington University heart surgeons. These surgeons have a high skill level, resulting in excellent clinical outcomes and death rates that are consistently below the national average.

What are the treatment options for valve disease?
Whenever possible, Washington University heart surgeons perform valve repair instead of replacement. Valve repair is most common for mitral and tricuspid valves. Surgeons repair primary mitral valve disease — as opposed to replacement — in about 75% of patients.

Repair is technically more complex than replacement, but it allows patients to avoid taking blood thinners and the possible complications of prosthetic valves. In addition, the need for reoperation is low after valve repair, even after 10 to 15 years.

Many valve procedures also can be performed through minimally invasive incisions. In minimally invasive valve procedures, a much smaller incision (three to four inches long) is made on the side of the chest under the right breast.

Washington University heart surgeons perform minimally invasive valve repairs and replacements routinely. They are the only surgeons in the region to offer the entire spectrum of minimally invasive surgical techniques to repair valves.

Who is a candidate for minimally invasive surgery?
Minimally invasive surgery is not just for low-risk patients. At Barnes-Jewish Hospital, anyone needing an isolated valve repair may be a candidate for minimally invasive surgery, and even double valve replacements can be done with minimally invasive techniques.

The potential advantages of minimally invasive surgery include less pain and bleeding and a shorter recovery time. In addition, a smaller incision produces a much less noticeable scar. For example, in patients undergoing minimally invasive mitral valve repair, a three- to four-inch incision is made under the right breast (mini-thoracotomy). With this approach, the sternum does not need to be divided.

In addition, isolated aortic valve replacement may be performed through a partial or mini-sternotomy, which requires a smaller (three- to four-inch) incision in the upper part of the sternum.

Resources
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