What is Heart Valve Disease?

Heart valve disease occurs when a valve doesn't work right. A valve may not open all the way. Or, a valve may have problems closing. If this happens, blood doesn't move through the heart's ch ambers the way it should.

If a valve doesn't open all the way, less blood moves through to the next chamber. If a valve doesn't close tightly, blood may leak backward. These problems may mean that the heart must work harder to pump the same amount of blood. Or, blood may back up in the lungs or body because it's not moving through the heart as it should.

Problems Opening (stenosis)

Stenosis occurs when a valve doesn't open fully. The valve may have become hardened or stiff with calcium deposits or scarring. So, it's hard to push open. Blood has to flow through a smaller opening, so less blood gets through the valve into the next chamber.

Problems Closing (insufficiency or regurgitation)

Insufficiency (also called regurgitation) results when the valve doesn't close tightly. The valve's supportive structures may be loose or torn. Or, the valve itself may have stretched or thinned. Blood may then leak back the wrong way through the valve.

How do I know if I have heart valve disease?

Your heart doctor can tell if you have valve disease by talking to you about your symptoms, performing a physical exam and sometimes, diagnostic tests. When you have valve disease, you may notice the following symptoms:

•  Shortness of breath or difficulty catching your breath
• You may notice this most when your are active (doing your normal daily activities) or when you lie down flat in bed. You may need to sleep propped up on a few pillows to breathe easier
• Weakness or dizziness - You may feel too weak to carry out your normal daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.
• Discomfort in your chest - This may feel like a pressure or weight in the chest with activity or going out in cold air.
• Palpitations - This may feel like a rapid heart rhythm, irregular heart beats, skipped beats or a flip-flop feeling in your chest.
• Swelling of your ankles, feet or abdomen - This is called edema. Swelling may occur in your belly, which may cause you to feel bloated.
• Quick weight gain - A weight gain of three to five pounds in one day is possible.

Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

Symptoms do not always relate to how serious your valve disease is. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet diagnostic tests may show your valve leak is not significant. These symptoms may cause you to worry, but they are not dangerous or life-threatening, and may not require treatment at all.

 Tests to diagnose valve disease may include:

• Echocardiography 
• Transesophageal echocardiography
• Cardiac Catheterization (cardiac cath or angiogram)
• Radionuclide scans
• Magnetic resonance imaging (MRI)

What causes heart valve disease?

Valve problems may be caused by:

• infections such as rheumatic fever, or infective endocarditis
• birth defects, calcification,
• certain medications such as Fen-Phen.

Defective valves may cause congestive heart failure and infections (infective endocarditis ).

What is heart valve surgery?

Heart valve surgery is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breast bone (sternum). Your blood is routed away from your heart to a heart-lung bypass machine. This machine keeps the blood circulating while your heart is being operated on.

Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical):

• Natural valves are from human donors (cadavers).
  • Modified natural valves come from animal donors. (Porcine valves are from pigs, bovine are from cows.) These are placed in synthetic rings.These valves don't last as long as mechanical valves.
• Artificial valves are made of metal.

If you receive an artificial valve, you will need to take life-long medication, an anticoagulant, (sometimes called a "blood thinner") to prevent blood clots. Natural valves rarely require life-long medication.

Minimally lnvasive Valve Surgery

During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means your diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can only be decided once surgery has begun. Your surgeon will talk with you about his or her plans for surgery and any other procedures you may need.

Repairing a Valve

During valve repair, a ring may be sewn around the opening of the valve to tighten it. Other parts of the valve may be cut, shortened, separated, or made stronger to help the valve open and close right.

Replacing a Valve

If a valve can't be repaired, it may be replaced with a prosthetic valve. Two kinds of prosthetic heart valves are available:

Your doctor will talk with you about choosing the best valve for you. Factors weighed include your age, your occupation, the size of your valve, how well your heart is working, your heart's rhythm, your ability to take an anticoagulant, and how many new valves you need.