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Heart Valve Disease Patient Guide Overview

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Heart Valve Disease Patient Guide Overview Heart Valve Disease Patient Guide Overview The heart is a powerful muscle that pumps between To schedule an 1,500 and 2,000 gallons of blood daily in adults. This appointment, call one-way circulation is possible thanks to valves — thin 410-328-7877 Cardiovascular Medicine membranes attached to the heart that open and close, 410-328-5842 regulating blood flow and causing that well-known Cardiac Surgery “lubbdubb” sound with each heartbeat. When working For more information, properly, a heart beats 100,000 times a day. But when visit us online at umm.edu/heart the valves become damaged or diseased, the smooth flow of blood is disrupted. To understand the role of the valves, it is important to recognize that the heart supports two separate circula- tions. The left side of the heart takes oxygen-rich blood from the lungs and pumps it to the rest of the body. The right side of the heart drains oxygen-poor blood from the rest of the body and sends it to the lungs for recycling. The valves exist to help that flow go in the correct direction. UNIVERSITY OF MARYLAND HEART & VASCULAR CENTER WE HEAL, WE TEACH, WE DISCOVER, WE CARE THERE ARE FOUR HEART VALVES: HEART VALVE DISEASE Tricuspid valve: The tricuspid valve is located on the Heart valve disease can occur when heart valves no right side of the heart between the reservoir chamber longer function as they should. While some valve (atrium) and the right-sided pumping chamber, known issues don’t cause symptoms or harm one’s health, as the right ventricle (RV). It allows blood to fill the others can strain and eventually damage the heart. RV without going backward to the rest of the body. There are two main conditions associated with valve Pulmonary valve: Also located on the right side of disease: valvular regurgitation and valvular stenosis. the heart, the pulmonary valve separates the lungs Valvular regurgitation, a leaky valve, occurs when from the right heart. When the right-sided pumping leaflets (tissue flaps) do not close completely, caus- chamber squeezes, the pulmonary valve opens, ing blood to leak backward across the valve. This kind allowing blood to go to the lungs and then closes of regurgitation is most common in the mitral valve to prevent blood from returning to the right-sided (known as mitral valve regurgitation), although it can pumping chamber. occur in the other three valves, as well. Mitral valve: The mitral valve, located on the left side “Because the valve is leaking, to get five gallons of of the heart, closes off the left atrium from the main blood to go forward, the heart has to do the equiva- pumping chamber of the heart. It allows the left lent work of pumping 10 gallons,” says James Gammie, atria to fill maximally with oxygen-rich blood from MD, Professor of Surgery and Chief of Cardiac Surgery the lungs, then opens to allow the main pumping at the University of Maryland School of Medicine and chamber to fill maximally with blood. When the main co-director of the University of Maryland Heart and pumping chamber is squeezing blood to the rest of Vascular Center. “The heart is always working overtime.” the body, the mitral valve closes, preventing the blood Valvular stenosis occurs when the leaflets become from going backwards to the lungs. stiffer or fuse together. This narrows the valve’s Aortic valve: The aortic valve, also located on the opening and reduces the amount of blood flow. If the heart’s left side, closes off the main pumping chamber narrowing is severe, not enough blood flows forward. of the heart (left ventricle) from the rest of the body. The left ventricle fills with oxygenated blood and once filled, squeezes. This squeezing closes the mitral valve and opens the aortic valve, allowing the blood to leave the heart and reach the rest of the body via the aorta (the blood vessel that acts as the main highway out of the heart). The aortic valve then closes, allowing the main pumping chamber to fill anew. Image sources: umm.edu/health/medical/ency/articles/double-inlet-left-ventricle (A.D.A.M.) umm.edu/health/medical/ency/articles/heart-murmurs-and-other-sounds (A.D.A.M.) University of Maryland Heart & Vascular Center | Heart Valve Disease | umm.edu/heart 2 2 Heart valve disease can be: • Structural: Structural changes can occur to the valves over time and due to aging. Parts of the Congenital: Congenital valve disease can develop valve can dilate, while leaflets can become stiff before birth and most often affects the aortic or and calcified. The papillary muscles, which are pulmonary valves. These valves may be the wrong attached to these mitral and tricuspid valve size or have malformed leaflets (tissue flaps). Types leaflets, can also stretch or tear. of congenital valve disease include: • Caused by other heart diseases: Diseases and • Bicuspid aortic valve disease: The bicuspid aortic health conditions like coronary artery disease, heart valve has only two leaflets instead of three. The attacks, aortic aneurysms, syphilis and high blood missing leaflet can cause the valve to be stiff or pressure can also lead to heart valve disease. to leak. • Pulmonary atresia: The heart either lacks a function- DIAGNOSING VALVE DISEASE ing pulmonary valve or has a hole between its two Doctors at the University of Maryland Heart and bottom chambers and lacks a connection to the Vascular Center use the most advanced technology to lung’s blood vessels. diagnose heart valve disease and determine the next steps in patients’ treatments. After a physical exam, • Pulmonary stenosis: The pulmonary valve is thick doctors perform one or more of the following tests with a smaller-than-normal opening. Blood doesn’t and procedures: flow properly through the valve and into the lungs. Cardiac MRI: Uses a magnet and radio waves to • Tricuspid atresia: The tricuspid valve doesn’t make images of the heart and provide more detailed develop, preventing blood returning to the right information about the valves. atrium from flowing into the right ventricle. 3D transesophageal electrocardiography (TEE): Acquired: Acquired valve disease can occur when Uses a throat probe to create highly detailed images problems develop in normal, healthy valves. Common in three dimensions. A special contrast solution causes are infections or illnesses like rheumatic fever, provides extra clarity and definition. which is caused by an untreated bacterial infection, or endocarditis, which occurs when bacteria enters Cardiac CT Angiography: Uses CT scans to create the bloodstream and attaches to an area of the heart. reconstructions of the heart and valves, and allows for Men over age 65 and women over age 75 are also appropriate sizing of catheter based aortic valves. at greater risk for acquired valve disease. Types of Echocardiography: Uses sound waves to study acquired valve disease include: motion of the heart valves. • Aortic stenosis: A narrowing of the aortic valve Cardiac catheterization: Uses a tiny, hollow tube opening, restricting blood flow from the left (catheter), inserted through an artery in the arm, leg ventricle to the aorta. If left untreated, this or wrist and threaded to the heart to show whether disease can lead to congestive heart failure. backflow is occurring and how fully a valve opens. Aortic stenosis may also occur in infant and children due to a congenital defect. CARDIOGENETIC TESTING • Mitral regurgitation: Leakage of blood backward The University of Maryland Heart and Vascular through the mitral valve when the left ventricle Center is one of a few centers in the region to provide contracts due to leaflets not closing effectively. cardiogenetic testing. The testing, performed by a This can increase blood pressure in the left atrium specially-trained group of geneticists and cardiolo- and in the veins running from the lungs to the heart. gists, can help families take the needed steps to prevent cardiac emergencies. University of Maryland Heart & Vascular Center | Heart Valve Disease | umm.edu/heart 3 3 TREATMENTS VALVE REPAIR Cardiologists treat heart valve disease through either Our surgeons are committed to repairing valves to medication and lifestyle changes; or through surgery preserve a patient’s own heart tissue and restore to repair or replace the valves. valve function. MEDICINES Mitral Valve Repair In general, valvular disease is a mechanical problem, The mitral valve is the most commonly repaired of requiring a mechanical solution. Medications and all four heart valves. Heart muscles also function lifestyle changes can treat symptoms of heart valve better over the long term with repairs rather than disease and even reduce the risk of additional prob- mitral valve replacements, and there is also less risk of lems, but do not appear to change the natural history stroke, bleeding and infection during repair procedures. of heart valve disease. Overall, people with heart Our surgeons take a range of approaches when valve disease should maintain a healthy weight, stop repairing the mitral valve, including: smoking, maintain regular physical activity and eat a heart-healthy diet made up of fruits, vegetables, • Sewing in a new ring of plastic, cloth or tissue to whole grains, fat-free or low-fat dairy products and support the valve’s circular frame (annulus). fish high in omega-3 fatty acids, like salmon and tuna. • Trimming off the diseased portion of a valve leaflet Doctors may also prescribe one or more of the and closing the defect. following medicines: • Reconstructing leaflets and using sutures to • Angiotensin converting enzyme (ACE) inhibitors: support the valve. Opens blood vessels more fully, helps reduce high blood pressure and slows heart failure • Replacing a leaflet using tissue surrounding the heart (pericardium).
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