Heart Valve Disease

About Heart Valves Understanding the role of each of the four heart valves can help you learn why you might need to be on the lookout for certain signs and symptoms

New to managing your heart valve condition?

We encourage you to take time to learn how your heart works and how each of the valves function. When you understand the specifics of your condition, you’ll be better equipped to understand the treatment options.

Watch an animation of heart valve anatomy.

We have helpful media and tips from people who have walked the journey to wellness. • Visit heart valves and circulation to get a better understanding of the basics of blood flow. • Understanding the role of each of the four heart valves can help you learn why you might need to watch for certain signs and symptoms. • Additional valve terms and related conditions also can help you broaden your understanding. Valve disease treatment plans can be complex, with many factors determining who might be a candidate for medical therapy or valve repair or replacement. We want to help you be a well-prepared participant in your treatment decisions.

Heart Valves and Circulation Properly Working System

To understand your valve condition or the problems you or your loved one may be facing, it helps to understand the basics of heart valves and circulation.

Heart Chambers and Valves The heart’s job is to pump blood throughout the entire body so every cell can thrive.

Blood always flows through the system in the same pattern: coming from the body, passing through the right side of heart, then out to the lungs to receive oxygen, then passing back through the left side of the heart and traveling out to the body.

What is the purpose of the heart chambers?

A normal heart has two distinct sides and four chambers for circulating blood. • The upper chambers – called the right atrium and the left atrium – collect blood flowing in from the body and in from the lungs. • The lower chambers – called ventricles – collect blood from the atria then forcefully pump it out. o The right ventricle pumps blood to the lungs. o The left ventricle pumps blood through the aorta and out to the entire body.

Watch a blood flow animation.

Why are valves important for circulation and health? Each heart valve has two functions: • To open correctly so blood can empty from the chamber • To close properly so blood flows forward

When the valves and chambers fail to move blood properly, symptoms eventually may develop and require critically important treatment.

Learn more about the roles of your heart valves.

Roles of Your Four Heart Valves

To better understand your valve condition and what your health care provider will discuss, it helps to know the role each heart valve plays in healthy blood circulation. Every part of the circulatory system must work together to deliver blood, oxygen and nutrients to all tissues.

What role does each play in healthy circulation? The four valves in order of circulation are: 1. Tricuspid Valve o Has three leaflets or cusps. o Separates the top right chamber (right atrium) from the bottom right chamber (right ventricle). o Opens to allow blood to flow from the right atrium to the right ventricle. o Prevents the back flow of blood from the right ventricle to the right atrium.

Related valve problems include: tricuspid atresia, tricuspid regurgitation, tricuspid stenosis

2. Pulmonary Valve (or Pulmonic Valve)

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Watch a heart valve anatomy animation.

o Has two leaflets. o Separates the right ventricle from the pulmonary artery. o Opens to allow blood to be pumped from the right ventricle to the lungs (through the pulmonary artery) where it will receive oxygen. o Prevents the back flow of blood from the pulmonary artery to the right ventricle.

Related valve problems include: pulmonary valve stenosis, pulmonary valve regurgitation

3. Mitral Valve o Has two leaflets. o Separates the top left chamber (left atrium) from the bottom left chamber (left ventricle). o Opens to allow blood to be pumped from the lungs to the left atrium. o Prevents the back flow of blood from the left ventricle to the left atrium.

Related valve problems include: mitral valve prolapse, mitral valve regurgitation, mitral valve stenosis

4. Aortic Valve o Has three leaflets, unless it's abnormal from birth, i.e., bicuspid aortic valve. o Separates the left ventricle from the aorta. o Opens to allow blood to leave the heart from the left ventricle through the aorta and the body. o Prevents the backflow of blood from the aorta to the left ventricle.

Related valve problems include: aortic regurgitation (also called aortic insufficiency), aortic stenosis

Essentials for properly working valves • The valve is properly formed and flexible. • The valve should open all the way so the blood can pass through. • The valve should close tightly so no blood leaks backwards into the chamber. Heart Valve Terms and Related Conditions If you or someone you love has a potential heart valve problem, a team of health care providers may perform several tests to confirm the diagnosis and look for other possible related conditions.

As you prepare for your visit with a specialist, or begin the testing for a diagnosis, here are some terms and related conditions you may find helpful.

The following measures and tests are used to evaluate heart valve conditions.

Echocardiogram An echocardiogram is a test that uses high-frequency sound waves (ultrasound) to make pictures of your heart. The test is also called echocardiography.

An echocardiogram looks at your heart’s structure and checks how well your heart functions.

Measuring the Valve Gradient The valve gradient is the difference in pressure on each side of the valve. When a valve is narrowed (a condition called stenosis), the pressure on the front of the valve builds up as blood is forced through the narrow opening. This causes a larger pressure difference between the front and back of the valve. The valve gradient can be used to determine the severity of the valve disorder.

A leaking or regurgitating valve can also affect the pressure in both the heart chambers as well as surrounding blood vessels.

Measuring the Valve Area The valve area is the size of the open valve. This is done using measurements during an echocardiogram. The valve area is in square centimeters and can be used to determine the severity of the valve disorder.

Understanding Ejection Fraction The ejection fraction describes how well the heart can pump blood. A normal ejection fraction is 50% to 70%. This means that between 50% and 70% of the blood in the heart is pumped out with each heartbeat. When that number falls, especially below 40%, it can indicate a significant problem with the heart muscle. Learn more about ejection fraction.

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Ejection Fraction Measurement and Heart Failure

Checking Your Heart Muscle’s Response to Your Valve Condition When the heart muscle has trouble moving blood through the chambers due to valve disease, it may respond by thickening, called hypertrophy. The heart’s chambers may also enlarge. A significantly enlarged chamber or a very thickened heart muscle may be a sign of valve disease or other heart conditions.

Related Conditions Because healthy heart valves are critically important to a healthy circulatory system, a heart valve problem can either be the cause or the effect of several other related problems. Taking a few minutes to learn more about these conditions can help you become better prepared to understand the diagnostic process and manage your condition. • Arrhythmias • Heart failure • High blood pressure • Stroke • Aneurysm (in nearby arteries such as the aorta)

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To fully understand your valve condition or the problems you or your loved one may be facing, it helps to understand the basics of heart valves and circulation.

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Heart Valves Are for Life

Heart Valve Problems and Causes

Any heart problem can seem overwhelming at first, but there are many treatment options available.

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View our heart valve animations library.

If you’re seeking to better understand a heart valve problem, you may want to learn more about the possible link between a heart murmur and valve disease. Not all heart murmurs lead to problems, so it’s good to understand why some are considered "innocent murmurs."

Find articles and helpful media to educate those affected by valve disease: • If your valve is too narrow or doesn’t allow enough blood to flow through it, the stenosis section will help you learn more and why it develops. • Mitral valve prolapse affects many people. Although it can be mild and not have any symptoms, in some people the valve starts to leak and can cause symptoms. • Leaky valves are often referred to as “regurgitant valves” or by the condition known as valve regurgitation. • Although many valve problems develop because of age-related factors, sometimes valve conditions develop due to illnesses, such as rheumatic fever (PDF)(link opens in new window) and infective endocarditis.

Understanding Heart Valve Problems and Causes Many heart valve problems are first identified by the presence of a murmur, or sound that can be heard by listening to the heartbeat with a stethoscope. A murmur may sound like a “whooshing” noise as blood flows from one chamber to the next, or it may sound like an extra click when a valve allows back flow. Some murmurs are harmless. Others can indicate an underlying problem with the valve. If a murmur is detected, here are some possible causes.

Murmurs may indicate valve problems including: • Stenosis: a narrowing or stiffening of the valve that prevents enough blood supply from flowing through • Regurgitation: when valves allow blood to flow backward into the chamber • Prolapse: a valve that has improperly closing leaflets • Atresia: a valve that is improperly formed or missing

Understanding your heart valve problem: Which solution may be right for you?

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Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Causes of Valve Problems The causes of valve problems can often be linked to birth defects, related to age or caused by another condition.

Congenital defects (abnormalities present at birth): • Aortic valve stenosis • Ebstein’s anomaly • Pulmonary valve stenosis • Bicuspid aortic valve

Aging and age-related valve disease include: • Degenerative valve disease – Over time valves can slowly degenerate. This most commonly affects the mitral valve. For example, mitral valve prolapse, a condition that affects 2% to 3% of the population, may eventually lead to mitral valve regurgitation and require treatment. • Calcification due to aging – Sometimes calcium can accumulate on the heart's valves, most commonly affecting the aortic valve, and can lead to aortic stenosis. • Mediastinal radiation therapy (radiation to the chest) – Studies have shown childhood cancer survivors who had radiation therapy have an increased chance of valve disease later in life.

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Related illnesses and conditions that can cause valve problems: • Infective endocarditis • Injury • Rheumatic fever (PDF)(link opens in new window)

These conditions can cause one or more of the heart valves to leak blood backward into the heart chambers or fail to open fully. This makes your heart work harder and lessens its ability to pump blood. Although valve problems can potentially be severe and life- threatening, most valve conditions are also highly treatable.

Heart Murmurs and Valve Disease Play without Auto-PlayPlay Video Text

Understanding Heart Murmurs, Aortic and Mitral Valve Problems

What causes heart murmurs? Abnormal heart murmurs in adults are usually related to defective heart valves. Abnormal heart murmurs in adults may be related to: • Valve calcification • Endocarditis • Rheumatic fever (PDF)

Some heart murmurs, called innocent murmurs, may occur in children. They are not considered to be serious and may be caused by: • Congenital heart disease including valve abnormalities • Holes in the septum of the heart

Heart murmurs related to valve problems should receive follow-up care.

Not every murmur is associated with valve disease. Murmurs can also be caused by conditions that may temporarily increase blood flow such as: • Exercise • Pregnancy • Fever • Hyperthyroidism • Anemia • Rapid growth spurts in children

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Diagnosing the Cause: Types of Heart Murmurs Your health care provider will investigate the root cause of the heart murmur. Clues about the cause can be based on the loudness, location and quality of the murmur. Loudness is graded from 1 to 6. A grade of 1 is very faint, heard only with a special effort. A grade 6 is extremely loud and can be heard with a stethoscope even without touching the chest.

The location, duration and loudness of the murmur can help your health care provider determine which heart valve is involved as well as the severity.

Other tests may be done to decide if the murmur needs further investigation including: • Chest X-ray • Electrocardiogram (ECG) • Echocardiogram • Cardiac catheterization

As with most conditions, heart murmurs and any underlying problems can vary in severity and risk.

Seeking a Qualified Health Care Provider or Specialist Any time a murmur is suspected to be associated with a valve problem that may need treatment or repair, it’s wise to look for a qualified health care provider with experience diagnosing and treating your condition. A specialist who regularly manages valve disease can assess your condition and offer treatment options.

"Innocent" Heart Murmur

If a murmur is detected, follow-up tests may be recommended. Although some heart murmurs indicate heart valve problems, others are considered harmless. These are “innocent” murmurs.

What are innocent heart murmurs? Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart's chambers and valves or through blood vessels near the heart. They

166 | P a g e can be common during infancy and childhood and often disappear by adulthood. They're sometimes known as "functional" or "physiologic" murmurs.

Some harmless murmurs require additional tests such as an electrocardiogram (ECG) or echocardiogram (echo) to rule out the possibility of a problem.

Are innocent heart murmurs normal? Innocent murmurs are common in healthy infants, children and adolescents. Innocent murmurs also may disappear and then reappear. Read more about childhood heart murmurs.

Innocent murmurs don’t require medication, don’t create cardiac symptoms and don’t mean there is a heart problem or disease.

Most innocent murmurs disappear when a child reaches adulthood, but some adults still have them. When a child's heart rate changes, such as during exercise, excitement or fear, the innocent murmur may become louder or softer.

Download our printable information sheet: What Are Innocent Heart Murmurs? (PDF)

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Heart Murmurs and Valve Problems

Problem: Heart Valve Stenosis Play without Auto-PlayPlay Video Text

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Valve Stenosis: When a Heart Valve is Too Narrow

About Valve Stenosis Stenosis is the term for a valve that is narrowed and doesn’t open properly. The flaps of a valve may thicken, stiffen or fuse together. As a result, the valve cannot fully open. The heart then has to work harder to pump blood through the valve, and the body may suffer from a reduced supply of oxygen.

Causes of Valve Stenosis All types of heart valve disease are more common with age, although some may be caused by congenital heart defects. For example, a type of malformed aortic valve is a bicuspid aortic valve. About 1% to 2% of the population is born with an abnormal bicuspid valve, which means instead of having three flaps that open for blood flow, two are fused together. This causes blood to pass through a smaller, restricted opening.

Watch a video explaining a bicuspid valve(link opens in new window).

Learn about the different types of stenosis: • Aortic stenosis • Tricuspid stenosis

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• Pulmonary stenosis • Mitral stenosis

Outlook for People with Valve Stenosis Most valve conditions are very treatable with medications and procedures or surgery. However, medical procedures and surgery have risks that should be discussed with your health care provider. It’s important to weigh your options carefully because untreated heart valve problems can lead to serious, life-threatening conditions.

Aortic Stenosis Overview Play without Auto-PlayPlay Video Text

Learn about Bicuspid Aortic Valves and Mitral Valve Prolapse

What is aortic valve stenosis?

Aortic stenosis is one of the most common and serious valve disease problems. Aortic stenosis is a narrowing of the aortic valve opening. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.

Watch an animation of aortic valve stenosis.

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Although some people have aortic stenosis because of a congenital heart defect called a bicuspid aortic valve, this condition more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Does aortic stenosis always produce symptoms? No. Many people with aortic stenosis, or AS, don't experience noticeable symptoms until the amount of restricted blood flow becomes greatly reduced.

Symptoms of aortic stenosis may include: • Chest pain • Rapid, fluttering heartbeat • Trouble breathing or feeling short of breath • Feeling dizzy or light-headed, even fainting • Difficulty walking short distances • Swollen ankles or feet • Difficulty sleeping or needing to sleep sitting up • Decline in activity level or reduced ability to do normal activities

It may be important to note the person suffering from AS may not complain of symptoms. However, if you or your family members notice a decline in routine physical activities or significant fatigue, it’s worth a visit to your health care provider to check for reduced heart function.

Infants and children who have aortic stenosis due to a congenital defect may exhibit symptoms such as: • Fatigue upon exertion • Failure to gain weight • Poor or inadequate feeding • Breathing problems

How does aortic stenosis progress or cause increasing problems? In addition to the symptoms of aortic stenosis, which may cause a patient to feel faint, weak, or lethargic, the wall of the left ventricle also may show muscular thickening because the ventricle must work harder to pump blood through the narrow valve opening into the aorta.

The thickened wall takes up more space inside the lower heart chamber that allows less room for an adequate amount of blood to be supplied to the body. This may lead to heart failure. Appropriate treatment can help reverse or slow down the progress of this disease.

Who's at risk for aortic stenosis? Aging people Aortic stenosis mainly affects older people as a result of scarring and calcium buildup in the valve cusp (flap or fold). Age-related AS usually begins after age 60, but often doesn’t show symptoms until ages 70 or 80.

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AS in the young The most common cause of aortic stenosis in young people is a birth defect where only two cusps grow instead of the normal three. This is called a “bicuspid aortic valve.”

Another cause may be that the valve opening doesn't grow along with the heart. This makes the heart work harder to pump blood to the restricted opening. Over the years the defective valve often becomes stiff and narrow because of calcium build-up.

What treatments are advisable for people with aortic stenosis? If there are no symptoms or if symptoms are mild, the best course of action could be regular follow up and monitoring to see if any symptoms develop or worsen.

However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options.

Possible treatments may include medications, valve repair or valve replacement. It’s important to discuss options with your health care provider to ensure you receive the most effective treatment possible.

Understanding your heart valve problem: Which solution may be right for you?

Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Additional resources: • Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF)(link opens in new window) | Spanish (PDF) • Patient guide: Understanding Your Heart Valve Problem (PDF)(link opens in new window) | Spanish (PDF)

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Problem: Mitral Valve Stenosis

What is mitral valve stenosis? Mitral stenosis is a narrowing of the mitral valve opening. Mitral stenosis restricts blood flow from the left atrium to the left ventricle.

Watch a mitral valve stenosis animation.

What problems can result from untreated or advanced mitral valve stenosis? Mitral stenosis causes reduced blood flow through the narrowed valve opening from the left atrium to the left ventricle. As a result, the volume of blood bringing oxygen from the lungs is reduced. This can make you feel tired and short of breath. The volume and pressure from blood remaining in the left atrium increases which causes the left atrium to enlarge and fluid to build up in the lungs.

What causes mitral valve stenosis? Mitral stenosis can be caused by congenital heart defects, mitral valve prolapse, rheumatic fever, lupus and other conditions. Rheumatic fever (PDF) is a childhood illness that sometimes occurs after untreated strep throat or scarlet fever.

Rheumatic fever is rare in high-income countries such as the United States but remains a concern in some low- and middle-income nations.

Two conditions not related to valve stenosis that can mimic it by producing the same symptoms are: • Myxoma (a benign tumor in the left atrium) • Nearby blood clot that reduces blood flow through the mitral valve

Is mitral valve stenosis treatable? Although medications can’t fix a valve defect, they can help with symptoms. Your health care provider may prescribe diuretics to reduce fluid accumulation in the lungs, blood thinners* to prevent clots from forming, or drugs to control the heart rhythm if those

172 | P a g e are indicated. The mitral valve can usually be repaired or replaced with surgery, or a minimally invasive procedure.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Problem: Tricuspid Valve Stenosis

What is tricuspid valve stenosis? Tricuspid stenosis is a narrowing of the tricuspid valve opening. Tricuspid stenosis restricts blood flow between the upper (atrium) and lower (ventricle) part of the right side of the heart.

What problems can result from untreated or advanced tricuspid valve stenosis? After several years, the right atrium can become enlarged because blood flow through the narrow tricuspid valve opening is restricted. An enlarged atrium can affect the pressure and blood flow in the nearby chambers and veins.

The pressure in the right ventricle could be lower because the amount of blood entering from the right atrium is reduced. This could result in less blood circulating through the lungs to get oxygen.

Who's at risk for tricuspid stenosis? Many cases are caused by infective endocarditis or by rheumatic fever (PDF)(link opens in new window), which has become rare in the United States. Rarely, tricuspid stenosis may be caused by birth defects or tumors of the heart.

What are the symptoms of tricuspid stenosis? Symptoms are usually mild but include palpitations, a fluttering discomfort in the chest, swelling in the legs, cold skin and fatigue. Medical management usually includes drug treatment and regular echocardiograms to monitor the valve. If severe enough, tricuspid stenosis may be treated with surgical repair or replacement.

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Valve Stenosis: When a Heart Valve is Too Narrow

Problem: Pulmonary Valve Stenosis

What is pulmonary valve stenosis? Pulmonary stenosis, also called PS, is caused by a narrowing of the pulmonary valve opening. PS restricts blood flow from the lower right chamber (ventricle) to the pulmonary arteries, which deliver blood to the lungs. It’s most commonly the result of a congenital heart defect. However, rarely PS can develop as a result of infections such as rheumatic fever (PDF)(link opens in new window) or carcinoid syndrome.

Who's at risk for pulmonary stenosis? Pulmonary stenosis, which is rare among adults, is usually caused by a birth defect, also called a congenital heart defect. Moderate to severe PS is most often diagnosed during childhood due to the loud heart murmur associated with the condition.

What are the symptoms? If PS is mild, there probably won't be any noticeable symptoms. If it's moderate or severe, you may experience some of the following: • Heart murmur • Low tolerance for exercise • Fatigue

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• Fainting • Shortness of breath • Chest pain or palpitations

What are the treatments and probable outcomes? Treatment is needed when the pressure in the right ventricle is high (whether or not there are symptoms). High pressure in the ventricle can lead to enlargement of the heart and heart failure.

Ongoing follow-up care People with mild pulmonary stenosis can often maintain heart function without getting worse. However, depending on the severity of the stenosis, the valve may be repaired or replaced by surgery, or by a minimally invasive procedure.

Problem: Mitral Valve Prolapse What's mitral valve prolapse?

Mitral valve prolapse, also called MVP, is a condition in which the two valve flaps of the mitral valve don't close smoothly or evenly, but bulge (prolapse) upward into the left atrium. Mitral valve prolapse is also known as click-murmur syndrome, Barlow's syndrome or floppy valve syndrome.

What happens during MVP?

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When the heart pumps (contracts) part of one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur.

Watch an animation of mitral valve prolapse.

Is mitral valve prolapse dangerous? In most cases, it’s harmless. Most people who have the condition are unaware of it and their health isn't affected. However, in some cases treatment is required.

What causes MVP? The most common cause of MVP is abnormally stretchy valve leaflets (called myxomatous valve disease). Mitral valve prolapse occurs in around 2% of the population. A person can be born with the genetic risk of developing MVP. It also can be caused by other health problems, such as some connective tissue diseases.

How's mitral valve prolapse detected? Because most patients with MVP don’t have symptoms, a murmur may be detected during a routine physical exam when listening to the heart with a stethoscope. Common symptoms include bursts of rapid heartbeat (palpitations), chest discomfort and fatigue.

What should I do if a murmur is detected? Even for those who aren’t having symptoms, if a murmur is detected suggesting mitral valve prolapse, an echocardiogram (echo) is usually recommended. The echo uses ultrasound to evaluate the characteristics of the valve cusps and how much blood may be leaking (regurgitation) from the valve when the heart contracts. Other tests may include magnetic resonance imaging (MRI), or an angiogram. The test results and extent of your symptoms will guide your health care provider in determining if further testing is needed.

Does mitral valve prolapse need to be treated? In many instances, having MVP won’t impact your health and requires no treatment. Talk with your health care provider about how to prevent complications from MVP based on your level of risk. If you’re prescribed medication, take it as directed.

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People with an abnormal mitral valve may need mitral valve repair or replacement if: • Symptoms are getting worse • Mitral regurgitation becomes severe • The left ventricle or left atrium of the heart become enlarged • Arrythmias develop • The heart function gets worse

MVP rarely becomes a serious condition. However, in the most serious cases it can cause abnormal heartbeats (arrhythmias) that may eventually become life-threatening.

When mitral valve prolapse is severe enough to cause significant valve leakage, called “regurgitation,” it can lead to serious complications such as heart attack and stroke. This happens because when the valve leaks, it can cause the atrium to enlarge. An enlarged atrium may lead to heart rhythm problems such as atrial fibrillation, which may cause blood clots to form. When clots travel from the heart to the arteries or the brain, it can lead to a stroke or heart attack.

Know the signs and symptoms of heart attack and stroke.

Do people with MVP need to take antibiotics before dental procedures? The use of antibiotics before having a dental procedure is no longer recommended by the American Heart Association for patients with mitral valve prolapse, regardless of whether they have associated symptoms.

Understanding your heart valve problem: Which solution may be right for you?

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Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Additional resources: • Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF)(link opens in new window) | Spanish (PDF) • Patient guide: Understanding Your Heart Valve Problem (PDF)(link opens in new window) | Spanish (PDF)

Problem: Heart Valve Regurgitation Play without Auto-PlayPlay Video Text

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Valve Regurgitation: When a Heart Valve Leaks

What's valve regurgitation?

Regurgitation is the name for leaking heart valves. Sometimes the condition is minor and may not require treatment. At other times valve regurgitation places a strain on the heart. It can cause the heart to work harder and it may not pump the same amount of blood.

Regurgitation occurs when: • Blood flows back through the valve as the leaflets are closing, or • Blood leaks through the leaflets that don't close correctly.

For example: A leaking (regurgitant) mitral valve allows blood to flow in two directions during the contraction. Some blood flows from the ventricle through the aortic valve – as it should – and some blood flows back into the atrium through the defective valve.

A leaking aortic valve allows blood to flow in two directions. Oxygen-rich blood either flows out through the aorta to the body – as it should – or it flows backward from the aorta through the defective valve into the left ventricle when the ventricle relaxes.

Leaking valves can cause the heart to work harder to pump the same amount of blood.

Watch a mitral valve regurgitation animation.

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How does valve regurgitation develop? Valve regurgitation can come on suddenly or it may develop gradually over decades.

Read more about regurgitation and specific valves: • Mitral regurgitation is leakage of blood backward through the mitral valve each time the left ventricle contracts. • Aortic valve regurgitation may stem from a congenital heart defect, complications of an infection or other more rare causes. • Pulmonary or pulmonic regurgitation is more rare and is usually a result of other problems like pulmonary hypertension. • Tricuspid regurgitation is more commonly caused by an enlarged lower chamber on the right side of the heart, but it may also develop in response to other valve problems on the left side of the heart that end up straining the entire system.

What's the treatment for leaking valves? Based on the severity of the problem, leaking valves may require surgical repair or replacement.

Problem: Aortic Valve Regurgitation What's aortic valve regurgitation? Aortic regurgitation is leakage of blood through the aortic valve each time the left ventricle relaxes.

A leaking (or regurgitant) aortic valve allows blood to flow in two directions. Oxygen-rich blood flows out through the aorta to the body — as it should — but some flows backwards from the aorta into the left ventricle when the ventricle relaxes.

What happens during aortic regurgitation? The heart will have to do more work to compensate for the blood leak back into the left ventricle. The walls of the ventricle sometimes thicken (hypertrophy), and a thickened heart muscle is a less effective pump. Eventually, the heart maybe unable to pump enough to meet the body’s need for blood, leading to heart failure.

What are the symptoms of aortic valve regurgitation? Mild aortic regurgitation may produce few symptoms.

People with more severe aortic regurgitation may notice heart palpitations, chest pain, fatigue, or shortness of breath. Other symptoms include difficulty breathing when lying down, weakness, fainting, or swollen ankles and feet.

What causes aortic regurgitation? Common causes of severe aortic regurgitation are weakening of the valve tissue due to aging processes, high blood pressure, bacterial infection of the heart tissue, untreated syphilis or injury.

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How is aortic regurgitation treated? Mild aortic regurgitation may be treatable with medications to reduce blood clotting and reduce the risk of stroke, but surgical repairs or replacement are often needed.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Problem: Mitral Valve Regurgitation Play without Auto-PlayPlay Video Text

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Valve Regurgitation: When a Heart Valve Leaks

What's mitral valve regurgitation?

Mitral regurgitation is leakage of blood backward through the mitral valve each time the left ventricle contracts.

Watch an animation of mitral valve regurgitation.

A leaking mitral valve allows blood to flow in two directions during the contraction. Some blood flows from the ventricle through the aortic valve — as it should — and some blood flows back into the atrium.

What's the problem that results from mitral regurgitation? Leakage can increase blood volume and pressure in the left atrium. The increased pressure can increase pressure in the veins leading from the lungs to the heart (pulmonary veins).

If regurgitation is severe, increased pressure may result in congestion (or fluid build-up) in the lungs.

What are the symptoms of mitral valve regurgitation? Mild mitral regurgitation may not have any symptoms.

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When regurgitation is more severe, a person may have palpitations, often due to atrial fibrillation.

If regurgitation is severe enough, the heart may enlarge to maintain forward flow of blood, causing heart failure (when the heart does not pump enough blood to the body). This may produce symptoms ranging from shortness of breath during exertion, coughing, congestion around the heart and lungs and swelling of the legs and feet (edema).

What conditions may be related to mitral regurgitation? The left atrium tends to enlarge due to the extra blood volume leaking back from the ventricle. An enlarged atrium may develop a rapid and disorganized movement (atrial fibrillation), which reduces the heart’s ability to pump efficiently.

A fibrillating atrium quivers and doesn’t pump efficiently, which increases the risk for blood clots that may cause a stroke.

Another potential complication of mitral regurgitation is pulmonary hypertension.

Treatment for mild mitral regurgitation may include anticoagulation medication. However, surgery to repair or replace is often needed.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Problem: Tricuspid Valve Regurgitation What's tricuspid valve regurgitation?

Tricuspid regurgitation is leakage of blood backwards through the tricuspid valve each time the right ventricle contracts.

What happens during tricuspid regurgitation? As the right ventricle contracts to pump blood forward to the lungs, some blood leaks backward into the right atrium, increasing the volume of blood in the atrium. As a result, the right atrium can enlarge, which can change the pressure in the nearby chambers and blood vessels.

What causes tricuspid regurgitation? Tricuspid regurgitation often results from an enlarged lower heart chamber (right ventricle).

Other diseases also may cause tricuspid regurgitation, most commonly infective endocarditis (valve infection), and less commonly, Marfan syndrome, rheumatoid

183 | P a g e arthritis, rheumatic fever (PDF)(link opens in new window), injury, carcinoid tumors, and myxomatous degeneration.

Tricuspid regurgitation also is associated with the use of the diet drug “Fen-Phen” (fenfluramine and phentermine).

What are the symptoms of tricuspid valve regurgitation? Tricuspid regurgitation may not have symptoms or the symptoms be vague, such as weakness and fatigue. These symptoms develop because the heart is not pumping enough blood to allow the body to receive the needed oxygen.

Other symptoms may include: • Active pulsing in the neck veins • Enlarged liver • Fatigue or weakness • Abdominal swelling • Swelling in the legs, ankles, and/or feet

Treatment options may include:

Treatment may not be required if the symptoms are not bothersome. Any underlying disorder, such as emphysema or pulmonary stenosis, should be treated when possible and symptoms such as swelling can be managed with medications.

Surgical valve repair or valve replacement usually corrects the condition. Those with untreated, severe tricuspid regurgitation may face a poor prognosis, either from the valve disease itself or because of the complications from the underlying condition causing the valve problem.

Problem: Pulmonary Valve Regurgitation Pulmonary regurgitation (PR, also called pulmonic regurgitation) is a leaky pulmonary valve. This valve helps control the flow of blood passing from the right ventricle to the lungs. A leaky pulmonary valve allows blood to flow back into the heart chamber before it gets to the lungs for oxygen.

What causes pulmonary regurgitation? The most common causes for a leaky pulmonary valve is pulmonary hypertension.

Less common causes are: • Infective endocarditis • Complications after surgery to repair tetralogy of Fallot • Carcinoid syndrome • Rheumatic fever (PDF)(link opens in new window) and complications after catheterization (rare causes in the United States)

What are the symptoms of pulmonary regurgitation?

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There are usually no noticeable early symptoms. Signs that can be detected during a medical exam include a heart murmur.

Eventually, the right ventricle can become enlarged. Rarely, these conditions can progress to heart failure, which can create more noticeable symptoms such as chest pain or discomfort, fatigue, lightheadedness or fainting.

How is pulmonary regurgitation treated? Treatment is usually focused on the underlying cause that created the valve problem (i.e., pulmonary hypertension). The pulmonary valve very rarely needs to be replaced.

Jen was born with tetralogy of Fallot, and ultimately had valve replacement surgery for her pulmonary valve. Watch Jen share her story:

Heart Valves and Infective Endocarditis What is infective endocarditis?

Infective endocarditis, also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. IE is uncommon, but people with some heart conditions have a greater risk of developing it.

Infective endocarditis refers to infection in the lining of the heart, but also affects the valves. It often affects the muscles of the heart.

View an illustration of endocarditis.

There are two forms of infective endocarditis, also known as IE: 1. Acute IE — develops suddenly and may become life threatening within days 2. Subacute or chronic IE (or subacute bacterial endocarditis) — develops slowly over a period of weeks to several months.

How do people contract infective endocarditis? The infection can be caused by bacteria introduced into the blood stream. Infection can result from many sources, including poor dental hygiene, tooth brushing that causes minor injury to the lining of the mouth or gums, dental procedures, implanted cardiovascular medical devices, chronic skin disorders and infections, burns, infectious

185 | P a g e diseases and more. These bacteria can lodge on heart valves and cause infection of the endocardium.

Why does endocarditis pose a threat to the heart valves? The heart valves are not supplied directly with blood. Therefore, the body’s immune response system, including the infection-fighting white blood cells, can't directly reach the valves through the bloodstream. If bacteria begins to grow on the valves (this occurs most often in people with already diseased heart valves), it is difficult to fight the infection, whether through the body’s own immune system or through medications that rely on the blood system for delivery.

Who's at risk for infective endocarditis? Risk factors for children and young adults include birth defects of the heart such as malformed valves or a hole in the septum, which allow blood to leak from one part of the heart to another.

Risk factors for adults include previous valve surgeries or a heart transplant, calcium deposits in the mitral valve or in the aortic valve, congenital heart defects or a history of endocarditis.

Illicit drug use and IE If the cause of IE is injection of illicit drugs or prolonged use of IV drugs, the tricuspid valve is most often affected. Street drugs, including narcotics, can also affect the mitral or aortic valve.

What are the symptoms of infective endocarditis? The symptoms of acute IE usually begin with fever (102°–104°), chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough, or swelling in the feet, legs or abdomen.

The symptoms of chronic IE may include fatigue, mild fever (99°–101°), a moderately fast heart rate, weight loss, sweating, and a low red blood cell count (anemia).

Treatment usually consists of IV antibiotics. The choice of antibiotic and the length of treatment is based on the type of infection causing the endocarditis.

Prevention for those at risk usually involves awareness of the risks, and preventative antibiotics prior to certain surgical, dental and medical procedures.

Related links: • Dental procedures and infective endocarditis • Download our free IE wallet card (PDF) • Downloadable patient sheet: What is Endocarditis? English (PDF) | Spanish(PDF)

What is Left Ventricular Hypertrophy (LVH)?

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Left ventricular hypertrophy, or LVH, is a term for a heart’s left pumping chamber that has thickened and may not be pumping efficiently. Sometimes problems such as aortic stenosis or high blood pressure overwork the heart muscle. In response to this pressure overload, the inner walls of the heart may respond by getting thicker. These thickened walls can cause the left ventricle to weaken, stiffen and lose elasticity, which may prevent healthy blood flow.

What are the symptoms of LVH?

LVH may be present for many years without any noticeable symptoms. As the condition worsens, symptoms may develop, such as: • Shortness of breath • Fatigue • Chest pain (especially with exercise) • Heart palpitations • Dizziness or fainting

If you are experiencing any of these symptoms, talk to your health care provider right away so that the problem can be identified and treated.

How's Left Ventricular Hypertrophy related to other heart problems? LVH usually happens as a result of other heart problems such as: • High blood pressure • Diabetes • Heart valve problems like stenosis or regurgitation • Arrhythmias • Enlargement of the aorta

It's important to treat the causes of LVH early because it can lead to severe problems such as heart failure, sudden cardiac arrest and ischemic stroke.

How's LVH diagnosed? Because LVH can develop silently over several years without symptoms, it can be difficult to diagnose. However, a routine electrocardiogram or echocardiogram can usually

187 | P a g e diagnose LVH, even before symptoms become noticeable. MRI imaging of the heart can also diagnose LVH.

What are the treatment options for LVH? LVH can often be corrected by treating the underlying problem causing the heart to work too hard. Depending on the type of damage that has occurred, treatment measures may include medications and heart-healthy lifestyle changes to help reduce the pressure in the heart. If LVH is caused by a heart valve problem, surgery may be needed to repair or replace the valve.

Can LVH be reversed? A number of studies point to improved outcomes for people who are treated for LVH.

Visit our Support Network to talk with others and connect with our heart valve ambassadors. We are here to help and encourage you in reaching your treatment goals.

Heart Valve Disease Risks, Signs and Symptoms

What do you need to know about people at risk for valve disease and valve problems? What symptoms do you need to watch for?

Checking for possible symptoms of valve disease is important. It can be a critical part of deciding on the right treatment or the ideal time for valve surgery. Frequently symptoms can worsen gradually over time, making it important for patients to track any changes.

However, people who have valve disease may never notice any symptoms.

It's important to note that symptoms of valve disease, such as chest pain, fatigue, lightheadedness, shortness of breath or syncope can be signs of several conditions. Review the symptoms page to read more about how symptoms can develop gradually.

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Visit risks for valve disease to see what makes a person at increased risk for developing a dangerous heart valve problem.

We have helpful articles and media to help you think through the symptoms and consider whether you may need treatment.

Symptoms of Heart Valve Disease How would I know if I am having symptoms of valve disease? Some people have no symptoms, yet they can still have a valve problem that needs treatment.

Some people suddenly experience very noticeable symptoms. Valve disease symptoms can also develop very quickly if the condition is severe.

For some people, the disease progresses very slowly, and the heart is able to compensate over time so that the symptoms are barely noticeable.

However, the risk and damage may still be significant, so education and awareness about the possible causes for a gradual onset of symptoms is important for patients who may be at risk.

(link opens in new window)

Download our Valve Disease Symptom Tracker (PDF)(link opens in new window) (also available in Spanish (PDF)) so you can track your symptoms over time. A change in symptoms is important to discuss with your health care provider.

Some physical signs of heart valve disease can include: • Chest pain or palpitations (rapid rhythms or skips)

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• Shortness of breath, difficulty catching your breath, fatigue, weakness, or inability to maintain regular activity level • Lightheadedness or fainting • Swollen ankles, feet or abdomen

Symptoms don't necessarily determine the seriousness of a person’s valve problems.

A valve problem can be severe with no symptoms. A valve problem also can be insignificant in terms of leakage, but problematic because of the uncomfortable symptoms. It's important to tell your health care provider any time you notice new or irregular symptoms that may relate to your condition.

Recognizing the Symptoms of Worsening Heart Valve Disease Can you recognize the symptoms of worsening heart valve disease? When heart valve problems are severe, there are often no recognizable symptoms until heart damage has progressed significantly. All too often, patients fail to notice small changes that may be clues that the valve disease is progressing. By the time it’s recognized, the patient may have heart muscle damage, heart failure or death due to sudden cardiac arrest.

However, there's nearly always a long delay between the beginning of heart valve disease and heart problems requiring medical attention. Regular check-ups are key to the proper treatment of any heart valve problems. It's also important to pay attention to changes that may be occurring and to recognize when they may be connected to your heart valve condition.

Know the symptoms of increasing fatigue Know the symptoms, watch for clues: Jeannie's slow change

Jeannie has been aware of her mitral valve prolapse for many years. • She used to feel invigorated during her daily walks and although she had some stiffness in her joints, she always had an energy and vitality about her. • In recent weeks, her grown children have noticed she seems tired all the time and gets short of breath just walking to the car. • Jeannie says she hasn’t really seen any sudden changes in her energy level. But when her daughter suggested Jeannie try the neighborhood walking group, Jeannie realized that it had been quite some time since she has had the energy or stamina to walk for exercise.

Would you notice the need for a heart valve check-up?

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The Importance of Tracking Heart Valve Disease Symptoms

Know the signs of shortness of breath The clues can be subtle: Monty's recliner

Monty is 75 years old, and his doctor had noted his heart murmur several years ago. He recently went to visit his son David for a few days. • Each night Monty would go to bed in the guest bedroom and the next morning David would find him sleeping in the family room recliner. • David asked if he was unable to get comfortable in the bed, and Monty replied that he felt unable to get a deep breath when lying down and the recliner seemed to help. • Monty insists that it’s not a problem, but David wonders if he should urge him to check in with his health care provider.

Would you recognize this behavior as a possible sign of valve disease progression?

Notice your decline in ability to keep up Denial can delay treatment: Monica's fitness regimen Monica was born with a bicuspid aortic valve, which means the valve may not fully open because it has two flaps instead of three. • Neighbors Monica and Alexis have enjoyed keeping fit together for years. • Although they’ve been consistent running buddies for the last two years, over the last few weeks, Monica just doesn’t seem able to keep up. • Even walking leaves her winded on some days, and Monica berates herself for lagging behind. • Monica knows she has a bicuspid valve, and wonders if that's why she's losing her stride despite her efforts to stay fit.

Would you simply train harder or would you make an appointment with your health care provider?

All three of these situations describe people who are at risk of missing clues of worsening heart valve disease. It can be easy to adjust to a situation little by little as it worsens over time. That's one reason it’s very important for people with heart valve disease to have regular check-ups.

Track Your Symptom Progression

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It’s important to ask yourself about symptoms. When doing so, don't simply think in terms of “yes” or “no”, but consider the degree to which you experience symptoms.

What causes you to become short of breath? Is it walking 3 miles? Or has that walk gotten shorter and shorter over time, and do you now feel breathless after going to the mailbox?

Do you ever feel lightheaded? Do you ever notice a sudden urge to lie down until you feel steady? How often do you have this sensation?

What about chest pain or unusual swelling in the feet or ankles? It’s important to track your symptoms (PDF)(link opens in new window) and remind yourself to review them every 6 months or at least annually. Because most valvular heart problems progress slowly, with good notes you'll probably be able to see evidence of your condition if it begins to worsen.

What if I’m just “out of shape”? It can be hard to separate habits from the mechanics of the heart, which is one important reason you need a health care professional to monitor your progress regularly. Your health care provider will rely on your reports to help them make treatment decisions. The better you are at noticing what's going on, the better you can advocate and participate in building a longer and healthier life.

Download our symptom tracker (PDF) (also available in Spanish (PDF)) and make an appointment with yourself every six months to review and repeat the exercise. You never know when being attentive may save a life.

Risks for Heart Valve Problems

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Who's at risk for heart valve disease?

Although the number of people affected by heart valve disease is considerably smaller than the number of people who have more common conditions, such as high blood pressure and coronary artery disease, heart valve disease has become an increasing problem in recent years due to increased life expectancy.

Valve disease and age Heart valve disease is more common among older people. Today, thanks to improved quality of medical care and increased attention on prevention, people are living longer. As a result, heart valve disease has become a more common problem. As we age, our heart valves can become lined with calcium deposits that cause the valve flaps to thicken and become stiffer.

Valve disease and related health conditions People who have had rheumatic fever (PDF)(link opens in new window) or infective endocarditis are at greater risk for heart valve problems. Heart problems such as heart attack, heart failure, arrhythmia or previous heart valve conditions from birth (congenital heart defects) also can increase the chance for developing valve problems. Childhood cancer survivors who had radiation therapy to the chest also have an increased prevalence of heart valve disease later in life.

Valve disease and health risks Many people live long and healthy lives and never realize they have a mild valve problem. However, left untreated, advanced valve disease can cause heart failure, stroke, blood clots or death due to sudden cardiac arrest.

People who have been diagnosed with a heart murmur, a defect like a bicuspid aortic valve, mitral valve prolapse or a mild form of valve disease should maintain regular check-ups with a health care provider and should be aware of possible symptoms should they start or worsen.

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If surgery is needed to repair or replace a valve, antibiotics might be needed before dental procedures to help protect against infective endocarditis. You should discuss your risk and the recommendations with your health care provider.

Aging people should also be aware of changes that may come on gradually. Not all declines in energy or stamina are related to “the normal problems of getting older.” When the heart fails to pump enough oxygen-rich blood to the body, symptoms may appear. Problems such as fatigue, shortness of breath, chest pain or discomfort and lightheadedness can indicate treatable problems related to the heart.

Do you notice routine activities such as walking faster or taking the stairs have become more difficult? Have you stopped doing enjoyable activities that you used to do with relative ease?

Be sure to take notes on any changes like these and describe them to your health care provider.

Getting an Accurate Heart Valve Diagnosis

You’ll need a careful evaluation to decide the best treatment.

Several tests can provide information about your heart valves and your circulation. Those tests are described as they relate to valve disease in this section.

Diagnostic checks in your health care provider's office Your health care team will use diagnostic criteria to assess your needs and determine the severity of problems you might be having. The first diagnostic measure is usually auscultation, which is listening to your heart and any unusual sounds or murmurs with a stethoscope. Sometimes, you may be asked to change your position or bear down with your abdominal muscles to see if the murmur changes.

Learn more about further diagnostic testing

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The remainder of this section covers what happens beyond listening to your heart in the office. Read more about echocardiography (PDF)(link opens in new window) – the main diagnostic tool for valve problems. Sometimes, the echocardiogram (echo) will provide all the needed information to decide on a treatment plan or to rule out the need for further treatment.

Sometimes, the information from the echo alone doesn’t provide all the information. You may need further testing including an exercise test, chest X-rays, CT scan and sometimes cardiac catheterization.

Read more about these heart valve tests.

Heart Valve Diagnostic Criteria Before seeing your health care professional or consulting a specialist about a possible heart valve problem, you may have been told you have a murmur that needs to be checked. Or you may have experienced a physical symptom or group of symptoms that need further investigating.

Heart valve issues, whether because of stenosis or regurgitation, often produce a heart murmur. A heart murmur can be harmless, known as an innocent murmur, but many heart murmurs will need further investigation.

There are several methods for diagnosing heart valve disease. The most important is the echocardiogram.

Download and print this patient guide: English (PDF) | Spanish (PDF)

To assess your needs and determine the severity of problems you might be having, your health care team will use the following criteria: • Whether you’re having symptoms of valve problems • Appearance of the heart and valves and severity of disease • How well the lower chambers (ventricles) respond to increased pressure • Whether the blood flow to the lungs or body is affected Whether there are changes to heart rhythm • Whether you have any other heart conditions to consider

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To fully understand your heart valve problem, your medical team may want to perform a series of tests to provide a complete picture to better understand your treatment options. • Appearance: Some tests help to provide a picture of what the valve looks like. o Chest X-rays o Cardiac computed tomography • Function: other tests help to determine how well the valve can do its job. • Damage or Strain: Others help to evaluate the entire heart and nearby circulatory organs to see if your valve problem has affected your heart in ways that could place you at increased risk. o Echocardiogram o Exercise Test o Electrocardiogram

Read more about these heart valve tests.

Additional resources:

• Download and print our guide: Understanding a Potential Heart Valve Problem (PDF) (link opens in new window) | Spanish (PDF)

Testing for Heart Valve Problems

Echocardiogram What is an echocardiogram? An echocardiogram (echo) is a test that uses high-frequency sound waves (ultrasound) to make pictures of your heart. The test is also called echocardiography.

Why do I need an echocardiogram? An echocardiogram looks at your heart’s structure and checks how well your heart functions. The test provides information about:

• The size and shape of your heart. • The size, thickness and movement of your heart’s walls. • How your heart moves. • The heart’s pumping strength. • If the heart valves are working correctly. • If blood is leaking backward through your heart valves (regurgitation). • If the heart valves are too narrow (stenosis). • If there is a tumor or other abnormalities around your heart valves.

Exercise Stress Test Why is an exercise test sometimes needed to assess a valve problem? Also called a stress test or treadmill test, exercise testing can provide valuable information in patients with valvular heart disease, especially in those whose symptoms may be difficult to assess.

Your health care provider may use an exercise test in combination with echocardiography, an angiogram and cardiac catheterization.

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Exercise testing helps evaluate changes in blood pressure and symptoms, and the heart’s response to a more challenging workload. Because heart valve symptoms can develop slowly, you may not realize you have limited activity over time or attributed the change to “normal aging.” If you have a heart murmur, your health care provider will note any changes in the murmur that happen during exercise. Read more about exercise testing.

Chest X-ray What’s a chest X-ray?

A chest X-ray is a picture of the heart, lungs and bones of the chest. A chest X-ray can show the heart’s overall shape, but it can't show the inside structures of the heart.

Why is it done on someone with a valve condition?

A chest X-ray shows the location, size and shape of the heart, lungs and the blood vessels. This can provide clues to a valve problem that include an enlarged or thickened heart and calcium deposits on the valve. Read more about chest x-ray procedures.

CT Scan What’s a CT Scan?

The CT scan captures multiple X-ray images to create a cross-sectional image of the heart and lungs. Like an MRI, this test sometimes takes clearer pictures. Unlike MRI imaging, the CT scan uses about the same amount of X-ray as is needed for an angiogram.

Although an echocardiogram, including transesophageal echocardiography and transthoracic echocardiography is now the standard tool for assessing valvular heart disease, there are times when its effectiveness is limited in some patients. A CT scan creates images of the valve anatomy and allows for evaluation of the severity of stenosis and regurgitation. A CT scan also can determine whether there are valvular lesions or nearby tumors affecting the function. Read more about CT scans.

Cardiac Catheterization How does cardiac catheterization help diagnose valve disease?

Although cardiac catheterization is most often used to look at the blood flowing to the heart muscle, it also can provide important information about narrowed heart valves, leaky heart valves or blood that is not flowing through the heart as it should.

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View an illustration of cardiac catheterization.

For valve disease patients, a cardiac catheterization can: • Measure blood pressure within the heart and oxygen in the blood • Evaluate heart muscle function for moving blood through each chamber • Help determine the best course of treatment

Cardiac catheterization is a “minimally invasive” procedure and isn’t necessary for every person who has a cardiac murmur or valve problem, but it can provide additional information when other tests may be inconclusive. Read more about cardiac catheterization.

Understanding Your Heart Valve Treatment Options

Recovery statistics are very good for people who receive proper treatment.

Some people live long and full lives with mild valvular problems and never need surgery. But once a heart valve begins to affect the heart’s ability to pump blood, it's likely to require a repair or replacement.

Treatment for valve disease will include a plan to: 1. Protect your heart from further damage.

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2. Assess your need for medication to help manage symptoms. 3. Repair the valve problem if needed. 4. Communicate steps for management, self-care and the importance of follow-up care.

Generally, once it's determined that a diseased heart valve needs treatment, the available choices are valve repair or replacement:

• Valve repair — preserves the patient’s valve and leaflets. Sometimes repairs require a minor surgical procedure and other times repairs need a more extensive surgery. Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation. • Valve replacement — may include open heart surgery or a minimally invasive procedure such as TAVR (or TAVI).

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Additional resources:

Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF) | Spanish (PDF)

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Patient guide: Understanding Your Heart Valve Problem (PDF) | Spanish (PDF)

Options and Considerations for Heart Valve Surgery

Is it possible to treat valve diseases with medications alone? Most valve conditions can't be treated with medication alone. However, sometimes the problem isn’t severe enough to require surgical repair or valve replacement, but it’s bothersome enough to cause symptoms or risks. In these cases, a condition might be effectively managed for a while with medication.

Medications may be prescribed to: 1. Reduce unpleasant symptoms from milder forms of the disorder. 2. Maintain heart rhythm if a related arrhythmia is present. 3. Lower the patient’s risk for clotting and stroke.

Heart valve disease is usually progressive. The outlook for those who receive no treatment can be poor. But many who do receive treatment go on to live very full and healthy lives, especially when their cardiovascular risks are otherwise low.

What happens if I don’t treat my condition or ignore recommendations?

Valve disease isn’t a condition that can be ignored. You may feel fine and not notice any problems for years. But once you begin to experience symptoms such as angina (chest pain), syncope (fainting or sudden loss of consciousness) and dyspnea (breathing difficulty or discomfort), life expectancy and quality of life can decline. Once valve disease such as aortic stenosis becomes severe, without treatment only half of people live two years and only 20% live five years.

Evidence is also clear that with proper treatment, most people enjoy an improvement in health and quality of life.

Understanding your heart valve problem: Which solution may be right for you?

Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

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What are the risks associated with valve disease treatment? As with all surgeries, there are risks. Because every patient is different, your doctor and your health care team will discuss your treatment options and recommend the best option for you.

People who have damaged, repaired or replaced heart valves are at increased risk for developing an infection of the valve (infective endocarditis).

Is it true that dental work can increase risks for people with heart valve problems?

It depends. The American Heart Association does not recommend antibiotics before dental procedures, except for patients at the highest risk of endocarditis. If a person has had heart valve surgery, but has not had a heart valve replaced, the cardiologist or

201 | P a g e surgeon will decide if antibiotics are needed. Read more about the antibiotic prophylaxis guidelines for infective endocarditis.

Medications for Heart Valve Symptoms

How do medications help people with valve problems? People who are diagnosed with heart valve disease may be prescribed medications to help relieve symptoms and decrease the risk of further problems.

Can I take medications instead of having a valve procedure? Although medications can serve a very important purpose, there is no medication that will stop a valve from leaking. Likewise, there's no medication that will open a valve that's too constricted.

Still, there are times when the medication is determined to be the best course of action. This decision may be most appropriate for someone whose valve condition is very mild or for a person for whom surgery is not an option.

When should heart valve repair or replacement be considered over medications? If you valve disease progresses, surgical treatment may be necessary. Your health care team can help you understand and evaluate options for heart valve repair or valve replacement surgery.

Below are some of the types of medications that heart valve patients may be prescribed.

Medication Class Purpose for a Valve Disease Patient

ACE inhibitors and Vasodilator: Opens blood vessels more fully and can help reduce ARBs high blood pressure and slow heart failure.

Anti-arrhythmic Helps restore a normal pumping rhythm to the heart. medications

Antibiotics Can help to prevent the onset of infections.

Anticoagulants Reduces the risk of developing blood clots from poorly circulating (*blood thinners) blood around faulty heart valves. Blood clots are dangerous because they can lead to stroke.

Beta-blockers Can reduce the heart's workload by helping the heart beat slower. Some patients find them helpful for reducing palpitations.

Diuretics ("water Reduces amount of fluid in the tissues and bloodstream which can pills") lessen the workload on the heart.

Vasodilators Can lower the heart's work by opening and relaxing the blood 202 | P a g e vessels.

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Additional resources: • Print our medicine chart to help you keep track (PDF). Also available in Spanish (PDF). • Answers by Heart sheet: How do I manage my medicines (PDF)? • Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Options for Heart Valve Repair The goal of heart valve surgery is to correct the valve disorder, reduce or eliminate symptoms, lengthen life and improve the quality of life.

Repair or Replace? It's generally best to repair a valve and preserve a person’s own heart tissue when possible. However, when the tissue is too damaged, a replacement valve may be used from another human heart, an animal or a manufactured mechanical valve.

Repair Procedure: Balloon Valvuloplasty

View an animation of valvuloplasty.

For many people, valve tightness can be relieved during a procedure called balloon valvuloplasty. It's done as part of a cardiac catheterization, which is less invasive than general surgery or open heart surgery.

In a balloon valvuloplasty, a small catheter holding an expandable balloon is threaded into the heart and placed into the tightened valve. Next, the balloon is expanded to stretch open the valve and separate the leaflets.

In some cases the valve cannot be successfully treated by balloon valvuloplasty, and a different surgical treatment is needed to open the valve and allow better blood flow.

Treatment results can vary depending on the experience and training of your medical care teams. Hospitals can become very proficient at managing care around certain conditions. When a valve problem is complex, it is very important to choose an experienced team to do the repair.

How do I find a provider experienced in treating valve disease?

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Treatment may require you to visit a highly specialized cardiologist or surgeon. Your family practitioner or general cardiologists may refer you to a valve disease specialist who focuses almost exclusively on heart valve problems and repair.

Print our pre-surgery checklist: Facing and Recovering from Major Surgery (PDF)

This checklist is also available in Spanish (PDF).

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Options for Heart Valve Replacement

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Valve Replacement The aortic valve and the mitral valve are the most commonly replaced valves. Pulmonary and tricuspid valve replacements are fairly uncommon in adults.

Replacing a narrowed valve: The most common surgical procedure for aortic stenosis, or narrowing of the aortic valve, is aortic valve replacement. Mitral stenosis is another condition that may require valve replacement or repair.

Replacing a leaky valve: Aortic regurgitation (sometimes referred to as aortic insufficiency) is another common valve problem that may require valve replacement. Regurgitation means that the valve allows blood to return backward through the valve and into the heart instead of moving it forward and out to the body. Aortic regurgitation can eventually lead to heart failure.

Mitral regurgitation may also require a valve replacement. In this condition, the mitral valve allows oxygenated blood to flow backward into the lungs instead of continuing through the heart as it should. People with this condition may experience shortness of breath, irregular heartbeats and chest pain.

Surgical options for valve replacement include: • Mechanical valve — a long-lasting valve made of durable materials • Tissue valve (which may include human or animal donor tissue) • Ross Procedure — “Borrowing” your healthy valve and moving it into the position of the damaged valve aortic valve and replacing the “borrowed” valve with a new valve. • TAVI/TAVR procedure — Transcatheter aortic valve implantation/transcatheter aortic valve replacement • Newer surgery options

The procedure chosen will depend on the valve that needs replacement, the severity of symptoms and the risk of surgery. Some procedures may require long-term medication to guard against blood clots.

You have options when choosing a heart valve. Survivor Robert Epps shares the factors that influenced his own heart valve choice:

Types of Replacement Heart Valves Play without Auto-PlayPlay Video Text

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Treatment Options for Heart Valve Replacement

If you need to have a heart valve replacement, you have several choices to consider when discussing your heart valve options with your medical professional. The type of valve and surgical approach have an impact on both your short-term recovery and longer-term quality of life.

Replacement valve’s durability and performance The ideal replacement valve offers excellent valve function and works in coordination with the entire circulatory system to protect each part from damage. Your medical professional may refer to this as “excellent hemodynamic performance.”

Replacement valve’s risks and medication requirements The ideal replacement valve also offers long-term durability without significantly increasing the risk of dangerous blood clots.

*Blood thinner medications can lower your risks of a clot-related stroke or embolism (traveling clot). Clot-risks are higher for people with mechanical valves. People on blood thinners must be carefully monitored because blood that's too thin could increase the risk of bleeding.

Patients and their medical professionals should discuss treatment options and share in the decision-making process to choose the most appropriate treatment.

View illustrations of mechanical and tissue valves.

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Possible choices include: Manufactured Mechanical Valve These valves are made of strong, durable materials. They are the most long-lasting type of replacement valve. Most will last throughout a patient’s life.

Patients who receive a manufactured valve will almost always require a blood-thinning medication for the rest of their lives. The blood thinner will keep clots from forming, which is critical because clots can lodge in the valve flaps or hinges and cause a malfunction. Clots can also break off and form into an embolism (traveling clot), which may move through the bloodstream and lodge into a vessel where it may lead to problems such as heart attack or stroke.

Donor Valve Implantation Human donor valves are often used for someone suffering from a condition that affects the valve, such as infective endocarditis. A donor valve can be expected to last 10 to 20 years.

Tissue Valve Tissue valves are created from animal donors’ valves or animal tissue that's strong and flexible. Tissue valves can last 10 to 20 years, and usually don't require the long-term use of medication. For a young person with a tissue valve replacement, the need for additional surgery or another valve replacement later in life is highly likely.

For each surgery in which the valve must be replaced, careful considerations should be given to durability of the valve, medication options and risks. If you need a valve procedure, heart valve centers of excellence are recommended. The centers are located throughout the country and must meet very high standards of care.

You have options when choosing a heart valve. Survivor Robert Epps shares the factors that influenced his own heart valve choice:

Newer Heart Valve Surgery Options

Less Invasive Options for People with Severe Aortic Stenosis

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One important reason to track any possible valve disease-related symptoms and get regular check-ups – especially as we age – is to ensure any developing valve problems can be identified and treated as soon as possible.

Medications can be prescribed to increase the heart’s ability to pump blood which may help compensate for a valve that isn’t working correctly. However, a diseased heart valve is a mechanical problem that can’t be fixed with medication alone. Surgery is often needed to repair or replace the damaged valve. Untreated valve disease may lead to decreased heart function and limit future treatment options. It’s important to discuss any symptoms with your health care provider.

Watch an animation of TAVR.

What if open-heart surgery is too risky for me? There’s good news if you or someone you love needs a new heart valve and you have been told open-heart surgery is too risky. People with severe aortic valve tightness may be good candidates for a less invasive replacement called a transcatheter aortic valve replacement (TAVR), also called transcatheter aortic valve implantation (TAVI).

This minimally invasive procedure is similar to placing a stent inside an artery. A catheter, a thin wire or tube, is threaded through an artery to the diseased valve and a new valve is placed inside the old valve. Some implanted valves are “spring-loaded” and expand themselves. Others are expanded using a balloon. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the replacement valve takes over the job of regulating blood flow.

The TAVR procedure is performed using one of two approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve: • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Although minimally invasive procedures are not without risks, they provide beneficial treatment options to people who would not have been considered for valve replacement. A patient’s experience with TAVR may be comparable to a coronary angiogram in terms of recovery. You’ll likely have a shorter hospital stay after TAVR compared to surgical valve replacement.

Are there other types of minimally invasive repairs or replacement options? Yes. There are other minimally invasive valve surgery techniques including video- assisted surgery, robotic-assisted surgery or surgeries performed with an endoscope.

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It’s certainly advisable to get a second opinion about valve repair and replacement options.

What are the benefits and considerations for a TAVR or other minimally invasive procedure? Benefits of minimally invasive treatment options may include: • Lower risk of infection • Less trauma to the chest and heart muscle tissue • Reduced length of hospital stay • Decreased recovery time

Of course, everyone wants less pain and a shorter recovery time. But everyone also wants the best possible outcome and the longest, healthiest life as a result. Those factors along with a person’s age, health history, type and severity of the valve problem and overall health will factor into selecting the best surgical option for any patient.

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Visit our interactive treatment options guide.

Why doesn't everyone get a minimally invasive procedure? Your goal — and your provider’s goal — is to get the best and safest treatment possible for you. That means tailoring the treatment to your heart, your valve disease, your age, your general health and other factors unique to you. Because we’re all different, not everyone with the same kind of valve disease needs the same kind of repair, the same kind or size of replacement valve, or the same approach.

Be sure to download our surgery checklist (PDF)(link opens in new window) (also available in Spanish (PDF)) and recovery tracker (PDF)(link opens in new window) (also available in Spanish (PDF)) to help you prepare for the possible experience as you begin the journey toward feeling better.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

Is there financial assistance available for people in need of TAVR or TAVI valve replacement? TAVR is approved and available for qualifying patients receiving Medicare and Medicaid. More information is available on the Centers for Medicare & Medicaid Services (CMS) website(link opens in new window). Learn more about health care laws and government programs seeking to provide affordable coverage at the HealthCare.gov website(link opens in new window). The Heart Valve CareLine can help you navigate the insurance and medical world as it relates to your diagnosis.

What is TAVR?

What is a TAVR? (Also called TAVI) During this minimally invasive procedure a new valve is inserted without removing the old, damaged valve. The new valve is placed inside the diseased valve. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Valve-within-valve — How does it work? Somewhat similar to placing a stent in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

How is TAVR or TAVI different from standard valve replacement?

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Watch an animation of TAVR.

This procedure is available for people with symptomatic severe aortic stenosis at low, intermediate or high risk for standard valve replacement surgery.

What is involved in a TAVR procedure? Usually valve replacement requires an open-heart procedure with a “sternotomy”, in which the chest is surgically separated (opened) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

While TAVR is not without risks, it provides beneficial treatment options to people who may not have been considered for valve replacement. A patient's experience with a TAVR procedure may be similar to a coronary angiogram in terms of recovery. You will likely spend less time in the hospital after TAVR compared to surgical valve replacement.

The TAVR procedure is performed using one of two approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve: • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Who's a good candidate for this type of valve surgery? The procedure is available to patients in all risk categories.

TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

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Is there financial assistance available for people in need of TAVR or TAVI valve replacement? TAVR is approved and available for qualifying patients receiving Medicare and Medicaid. More information is available on the Centers for Medicare & Medicaid Services ;(CMS) website. Learn more about health care laws and government programs seeking to provide affordable coverage at the HealthCare.gov website(link opens in new window). The Heart Valve CareLine can help you navigate the insurance and medical world as it relates to your diagnosis.

Ross Procedure

What is the Ross Procedure? The Ross Procedure is often very effective for treating damaged aortic valves. The aortic valve handles all the blood being pumped back out to the body. The patient’s pulmonary valve is similarly shaped and can usually be “swapped out” with the damaged aortic valve.

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What happens to the missing pulmonary valve after the swap? It's replaced with a donor valve.

Why does the Ross Procedure work? The pulmonary valve is usually under less stress because the right pumping chamber doesn't need to generate as much force to push blood to the lungs. A replacement valve can be more likely to succeed in the pulmonary position because demand on this valve is less.

Even after the pulmonary valve is moved into the aortic valve position, it can continue to grow normally in a child who is not fully grown. It also can handle the high volume of blood flow from the lower pumping chamber out to the body. There is generally no need for long-term medication either. Studies show that this procedure is effective for long- term wellness.

Understanding your heart valve problem: Which solution may be right for you? Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.

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Recovery and Healthy Living Goals for Heart Valve Patients

Recovery statistics are very good for people who receive proper treatment. Even for very strong people, fear can sometimes paralyze us into inaction. But valve surgery is very likely to provide a positive outcome, so planning your recovery is key.

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Read these articles and handouts, and cheer yourself on as you reach your healthy living goals.

Here's what you'll find in this section:

• The key to clear communication with your health care professional about your condition, whether or not you need surgery. • We'll talk about your surgery goals and what to expect from recovery and follow up. • Helpful tips on how to plan and prepare for surgery. • What goals and milestones you might notice after your repair.

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Factors Affecting Recovery from Heart Valve Surgery

Heart Valve Awareness: Seek Clarity About Your Risks

Choosing the best treatment option for you based on your individual values, preferences and life planning is very important. That’s why it’s essential that you’re involved in the decision-making process along with your health care team.

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What if I'm told I don’t need treatment now but I may need it later?

Anyone with a congenital heart defect such as a bicuspid valve, a prolapsed or leaky valve, mitral valve prolapse, a stiffened valve, a previous heart valve surgery, and some people with heart murmurs should faithfully schedule and attend all follow-up appointments so the condition can be monitored.

When a valve has problems, a health care professional will need to carefully track the outflow of blood, possible damage to the other heart chambers and blood vessels, any symptoms you may notice and the pressure around the valve.

Clarify Your Potential for Risks

If you have a potential heart valve problem or a repaired or replaced heart valve, be sure you communicate with your medical professional to get answers to the following questions: • Do I have any restrictions regarding exercise and how long should I keep my heart rate elevated? • Should I pay careful attention to how high my heart rate climbs during exercise? • What symptoms should I be sure to document if I notice them? • Are there any types of medical emergencies for which I am at higher risk because of my valve problem? • How important is regular follow-up care for this condition? • How often should I be rechecked? • Do I need to keep track of my own scheduling or does your office help me remember when I am due for my next appointment?

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Download and print this patient guide: English (PDF) | Spanish (PDF)

If your valve problems remain manageable without noticeable symptoms or causing damage to your heart, your medical professional may feel it’s working “well enough”. They may advise there is little cause for concern and to focus on healthy lifestyle choices. You and your health care professional may decide that your best option is to keep your valve and continue to monitor your condition.

However, if you begin noticing symptoms such as chest pain or discomfort, lightheadedness, feeling faint, or noticing that you're short of breath, your heart valve function may be getting worse. If your heart is having to work harder than it should, it may be time to consider your replacement and repair options.

Your medical professional will help you determine the best option for you.

Helpful resources:

• Heart Valve Disease Symptom Tracker (PDF)(link opens in new window) | Spanish (PDF) • Pre-surgery Checklist: Facing and Recovering from Major Surgery (PDF)(link opens in new window) | Spanish (PDF)

Heart Valve Surgery Goals When a person is considering heart valve replacement or repair, it can be helpful to know the overall goals of the procedure and how the success and your return to wellness will be tracked. Here are some of the goals for any valve surgery.

Goal 1: Lengthen and improve the quality of life. The odds are very good that valve repair or replacement will lengthen life and improve health and quality of life. Most valve patients can expect to return to their full activity level. Although not all valve conditions are life-threatening, it could be a mistake to

217 | P a g e assume the condition is insignificant. Some valve disease problems can lead to an increased risk of death if treatment recommendations are not followed. Some valve disease problems can lead to a significantly increased risk of death. If you’ve been told that you require valve treatment, it shouldn’t be ignored or postponed indefinitely. If finances are keeping you from receiving surgical treatment that you need, there are studies and government initiatives to help make the procedure affordable. Learn more about health care laws and government programs seeking to provide affordable coverage at the HealthCare.gov website(link opens in new window).

Goal 2: Maintain an adequate supply of oxygen-rich blood flowing through your heart. To feel energized and healthy, we all need a good supply of blood carrying oxygen and nutrients to our body. A damaged valve can reduce the heart’s ability to pump blood, but a valve replacement or repair can restore your heart’s ability to serve the needs of the rest of the body.

Goal 3: Reduce the possibility of damaging your heart and blood vessels. A diseased valve can harm the entire surrounding area of tissue and muscle required for pumping blood. Your medical team will want to help you select a treatment plan that will offer the best long-term strategy. They will evaluate the condition and function of each part of your hemodynamic system, which refers to all the functional parts that work together to pump blood. They will measure the pressure on your valves before and after surgery by measuring the jet velocity (pressure on the valve) and ejection fraction (amount of blood pumped out).

Goal 4: Reduce as many unpleasant symptoms as possible. Your health care team will help you feel as good as possible during your procedure and after your recovery.

Goal 5: Give you the best possible option for returning to a healthy and active life. Your providers will weigh your risks for surgery with the possibility of your return to a healthy and active lifestyle. Depending on your heart health, your overall health, your age and your ability to heal after surgery, they will help you choose a plan that provides as full a recovery as possible.

Goal 6: Achieve recovery milestones. Your health care team can also help you determine your return to health by helping to identify milestones such as sitting up alone, walking short distances, self-care and bathing, incision healing, walking longer distances, driving, and within a few weeks, returning to work and engaging in all activities.

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Download our Recovery Milestones checklist: English (PDF) | Spanish (PDF)

Heart Valve Surgery Recovery and Follow Up

What to expect after heart valve surgery The normal recovery time is usually four to eight weeks, and may beshorter after minimally invasive surgeries.

Immediately after surgery People are usually practicing very basic self-care and are encouraged to get up, to breathe deeply, and to resume eating, drinking and walking as soon as possible after surgery.

Days and weeks following surgery During this phase, people can expect to gradually regain energy and return to their normal activity level.

Hear from Allison, who shares her journey of recovering from heart valve repair surgery. Support from friends and family was key to her recovery, and she urges everyone to know the symptoms of heart disease and take action.

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Allison: From My Heart to Yours: Valve Surgery Recovery Part 2

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Surgery Recovery Checklist:English (PDF) |Spanish (PDF)

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Follow-up care You'll most likely be checked within four to six weeks following surgery for a postoperative visit. After that, it's critical to have regular check-ups by your heart specialist. Clarify with your health care provider what symptoms would warrant a phone call or an additional recheck. Whenever you have questions or concerns or if you experience any unusual symptoms or changes in your overall health, it never hurts to call and ask your provider.

Jen describes the recovery process after her heart valve replacement surgery. She was comforted by friends and family, and noticed soon after that she had more energy.

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Jen's Story: Recovering from Heart Valve Surgery

How can diet and exercise help in my recovery? Two important parts of recovery and continuing health are a good diet and a regular exercise routine.

If your doctor has recommended a particular diet, it's important that you follow it. If a special diet hasn't been recommended, balanced, heart-healthy nutrition can speed healing and lessen fatigue. Weight control is also important for your heart health; excess weight increases the heart's workload and slows recovery.

Nutrition: During recovery and beyond, make sure to eat a variety of fruits, vegetables, whole grains, breads, lean meats including fish and low-fat dairy products. Foods high in saturated fats, sugar and sodium should be limited. Avoid trans fat. And limit red and processed meats. In general, a low-fat, low-cholesterol, high-fiber diet is best. After a valve replacement, don't use supplemental calcium without approval from your health care provider.

Taking care of your body means watching what you put into it. Survivor Robert Epps talks about eating for a healthier heart:

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A Patient's Perspective on Eating Healthier Food

Physical Activity: During your recovery, find out what pace is right for you as you work your way toward a physically active lifestyle. Under your provider's guidance, you should gradually build up your physical activity level. Before you begin a new strenuous activity, make sure it’s OK. Find out if you have any guidelines to follow concerning your heart rate or level of exertion. To improve overall cardiovascular health, follow a regular exercise program that includes at least 150 minutes per week of moderate-intensity physical activity (such as brisk walking).

Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF) | Spanish (PDF)

Make Your Winning Post-Surgery Recovery Plan Patients preparing for a major surgery – such as heart valve surgery – are often focused on their most important objective: life. The good news is that heart valve survival rates are incredibly high. If your health care provider has recommended you have heart valve surgery, you can and should begin planning now for recovery and wellness after your surgery. Download our helpful checklist (PDF)(link opens in new window) now and keep it handy during your preparation.

"When I left the hospital, I had to ask my husband to tie my shoes. I didn’t realize before my surgery that I wouldn’t be allowed to bend over for a while during my recovery. I had a lot of questions, but I didn’t know who to ask or where to find answers." — Liz, Heart Valve Patient

Here are some common recovery considerations, but of course you should always follow your individual health care provider’s instructions, which will be tailored to your needs and precautions.

What should you bring to the hospital? • Loose-fitting pants or shorts. Why? o They are easier to put on and take off. o Loose, stretchy pants can accommodate a catheter if needed during recovery. o Swelling can be common after surgery.

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o Hospital gowns don't offer modesty protection and hall-walking is encouraged during recovery. • Comfortable, slip-on shoes or slippers. • Women may want to consider a special bra. o Post-surgery bras can be helpful, especially for women who usually need substantial support. Keep in mind that raising your arms overhead may not be permitted or comfortable. Consider investing in a special bra with front or shoulder Velcro tabs or hooks. • Something loose and comfortable to wear when it’s time to go home.

Christine's Journey: Mitral Valve Surgery When Christine had mitral valve surgery in 2013, she had many questions – but could find few answers. Here she shares her helpful pre-op pack list for the hospital and some hints for a successful post-op recovery in your room.

What do I need to consider for my recovery at home? • Use our checklist to help you think through: o Managing home tasks o Managing self care o Managing family, work and even pet care routines

"One difficulty I didn’t expect was that I could not do laundry. I could drop a few pieces of lightweight clothing in the washer but lifting the wet laundry to put it in the dryer was a huge no-no. The other challenge was loading and emptying the dishwasher. Again, for me, the bending over was off limits for one, but also the weight of some of the dishes was too much for me to lift right at first." — Liz

How long will my recovery take? • Recovery is unique for each person. It will depend on the type of procedure, your overall health prior to surgery, and any potential complications.

Here’s what one patient had to say about managing her expectations.

"When you are told you’ll be recovering for 4-6 weeks, and then you follow up with 12 more weeks of cardiac rehab, and then you realize that you still feel like you're not recovered, it's not actually because you are not recovered. It is because after a major heart surgery you have a new normal. You just feel differently and you're sporting the scar that shows you have been through a battle. I call it my courage scar. I can do most of the things I used to do, and making that connection to other survivors [helped me continue to] get stronger and to remain hopeful." — Eva, Heart Valve Patient

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Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF) | Spanish (PDF).

Post Surgery Milestones: Managing Your Mood, Expectations and Goals

The Emotions of Recovery Often people who are getting ready for major surgery have a whirlwind of details to juggle. “Who will handle my work responsibilities? Who can check on post-surgery prescriptions? How will the house chores get done?”

Most people don’t stop to think about how they can help themselves feel good emotionally during their recovery. Isn’t a positive outlook normal when things are going how they are supposed to go? For some people, yes. However, depression after a cardiac surgery is not uncommon.

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Up to 25% of patients experience cardiac depression. Although you may think of your moods as being somewhat dependent on how you feel or on your progress, especially after a major surgery, a positive outlook during recovery can improve your physical healing process. There are some proven strategies to help you improve your odds for feeling good during recovery.

Ask your health care team about the possibility of post-surgery depression and symptoms to consider. Make sure you and those who live with you know the symptoms of depression. If you find yourself experiencing a sad or empty mood persistently, a loss of pleasure or interest in hobbies and activities that you normally enjoy, or a consistent feeling of worthlessness or hopelessness, discuss your mood with your doctor. Your provider may be able to prescribe a medication to help you bounce back and warding off the blues can help you heal. However, there are several strategies you can use that don't involve medication.

What can I do to feel as well as I possibly can during recovery? The good news is you can help yourself by: • Practicing habits for emotional health • Setting positive goals • Maintaining realistic expectations • Celebrating progress

Healthy Habits: Move into a Routine One of the most reliable ways to keep your mood stable is to get moving. Exercise whenever your health care provider says you can, even you start out just shuffling down the hospital corridor. After surgery you don’t want to overdo it but encouraging yourself to keep moving at a slow and steady rate will help you recover the right way.

Many people find keeping some sort of routine is very helpful for staying positive during recovery. Routines can include whatever keeps your spirits up, provided you have your health care providers’ OK.

Liz Tatham, a spokesperson for the American Heart Association’s Go Red for Women campaign to raise heart-health awareness and former heart valve replacement patient, says: “One thing I made myself do each day after my

225 | P a g e first week home was to get up each day and change out of my pajamas into actual clothing. Even if I wasn't going anywhere, it helped me develop a daytime routine and a nighttime routine. It also made me feel that I was emotionally going somewhere because I was dressed to take on the day.”

By week three, she started making time for social opportunities. “I had a friend pick me up and take me to lunch outside of the house every Wednesday until I was cleared to drive myself.”

She also advises: “Patients should definitely ask how much and how often they should get up to walk and how much they should increase their walking each week. Before I began cardiac rehab, I had a chart that told me how much I needed to walk and how many times a day. At week two, I started with 5-10 minutes 3-5 times a day. I would check it off the chart, even though I just walked laps within my home. The dog thought it was strange at first, but then he started walking laps with me. I know recovery is different for everyone, but again, if I had not been given such specific instructions, I would not have known how much I could walk or the importance of moving to lower my risk of stroke. I was moving much more than I thought I would be.”

Manage your expectations and celebrate your small milestones.

Learn the facts before you have your procedure so that you’ll know what to expect. The more you celebrate your small victories each day and notice the moments of gratitude, the more positive you will likely feel about your progress.

Download our Recovery Milestones checklist (PDF) and chart your progress toward wellness. This checklist is also available in Spanish (PDF).

Don’t feel defeated if you need help. Some people need help in order to bounce back emotionally. That’s not failure. Success involves caring for yourself and those you love enough to do whatever is needed to rebound.

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Print our pre-surgery checklist: Facing and Recovering from Major Surgery: English (PDF) | Spanish (PDF)

Hear from Allison, who shares her journey of recovering from heart valve repair surgery. Support from friends and family was key to her recovery, and she urges everyone to know the symptoms of heart disease and take action.

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Allison: From My Heart to Yours: Valve Surgery Recovery Part 2

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