Valvular heart disease occurs when the heart valves do not function as they should. They can be too tight, preventing adequate blood flow, or too loose, allowing the blood to leak in the wrong direction.
Causes for valve disease include:
- Advanced age
- Degenerative disease
- Congenital defect
Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.
Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves. When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).
As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body. When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles. This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body.
When the valve no longer functions properly it is necessary to repair or replace it. The primary goal is to perform a valve repair and Mid-Atlantic Cardiothoracic Surgeons are uniquely qualified to perform individualized repairs to improve valve function. Valve repair is the best option for patients with valve regurgitation and for many with valve stenosis because of the following advantages:
- Better survival and outcome statistics
- Better preservation of heart function and anatomy
- Lower risk of complications, such as stroke or endocarditis (infection)
- No need for anticoagulation therapy
- Improved lifestyle
Valve replacement is an open heart procedure performed by a cardiothoracic surgeon to treat valve stenosis and valve regurgitation (or a combination of the two called myxomatous valve disease). The native (original) valve is removed, and a new valve is sewn in its place. The new valve can be a biological, homograft, or mechanical valve.
Biological valves are made from pig tissue (porcine), cow tissue (bovine), or pericardium from other species. The natural tissue is supported by an artificial framework, which gives it structure and allows it to be surgically implanted. Biological tissue valves are also called bioprosthetic valves. They last from 15 to 20 years after implantation, are readily accepted by the body, and usually do not cause blood clotting problems.
- A homograft valve has been donated from another human who has died. After removal from a donated human heart, it is treated with antibiotics, placed in preservative, and frozen under sterile conditions. Homograft valves are sometimes used in the tricuspid position, especially in severe cases of endocarditis.
- Mechanical valves are usually bileaflet valves that are made with non-reactive, well tolerated materials like pyrolite (qualities similar to a diamond) carbon leaflets surrounded with a polyester knit fabric—covered ring. The advantage of mechanical valves is their excellent durability—they do not wear out over time. A huge disadvantage is that blood clots on mechanical valves. Because of this risk, patients with a mechanical heart valve must take anticoagulant medications or "blood thinners" and be routinely tested for its level in their blood for the rest of their lives. Blood clots also pose a serious risk for causing stroke.
Surgeries for Valve Disease include:
- Minimally Invasive Mitral or Aortic Valve Surgery — is performed through a small incision, often using specialized surgical instruments.
- Transcatheter Aortic Valve Replacement — is a cutting edge technology for use in treating aortic stenosis in patients. The procedure resembles a balloon angioplasty, in which a catheter, a long, flexible tube, is threaded through an artery and a balloon device on the end inflates to help open up a narrowing in an artery in the heart.
- Aortic Valve Replacement — is the removal of the valve that sits between the left ventricle and the aorta which carries oxygenated blood to the body.
- Aortic Valve Repair — is nearly exclusively limited to patients with aortic regurgitation (AR) without a component of stenosis. Patients considered for repair are generally young who wish to avoid anticoagulation and would be expected to outlive a tissue valve should replacement be considered. In order to perform this operation, the cusps must be thin and flexible without calcifications.
- Mitral Valve Repair — avoids removal of this valve repairing it instead. Not all valves can be repaired and the procedure can be complicated and lengthy but postoperative care is simpler.
- Mitral Valve Replacement — is the removal of the native valve that sits between the left atrium and the left ventricle and its replacement with a new valve either mechanical or tissue.
- Tricuspid Valve Repair/Replacement — is an open heart procedure performed by a cardiothoracic surgeon to treat tricuspid valve stenosis and tricuspid valve regurgitation (or a combination of the two called myxomatous valve disease).