Treatment Guide Heart Valve Disease Heart valve disease refers to any of several condi- TABLE OF CONTENTS tions that prevent one or more of the valves in the What causes valve disease? .................................. 2 heart from functioning adequately to assure prop- er circulation. Left untreated, heart valve disease What are the symptoms of heart valve disease? ....... 5 can reduce quality of life and become life-threat- How is valve disease diagnosed? ............................ 6 ening. In many cases, heart valves can be surgi- What treatments are available? .............................. 8 cally repaired or replaced, restoring normal func- What are the types of valve surgery? ...................... 9 tion and allowing a return to normal activities. What can I expect before and after surgery? .......... 13 Cleveland Clinic’s Sydell and Arnold Miller How can I protect my heart valves? ...................... 17 Family Heart & Vascular Institute is one of the largest centers in the country for the diagnosis and treatment of heart valve disease. The decision to prescribe medical treatment or proceed with USING THIS GUIDE surgical repair or replacement is based on the Please use this guide as a resource as you examine your type of heart valve disease you have, the severity treatment options. Remember, it is every patient’s right of damage, your age and your medical history. to ask questions, and to seek a second opinion. To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE About Valve Disease The heart valves How the Valves Work Heart valve disease means one of the heart valves isn’t working properly because The heart has four valves — one for of valvular stenosis (narrowing of the valves) or valvular insufficiency (“leaky” valve). each chamber of the heart. The valves keep blood moving through the heart These conditions cause the heart to work harder to pump the right amount of blood in the right direction. through the body. It is possible to have valvular stenosis and valvular insufficiency in The mitral and tricuspid valves are one or more valves. located between the atria (upper If you have valve disease, you will need treatment. Many patients with valve disease chambers of the heart). can have surgery to repair or replace the diseased valve(s). The treatment causes the The aortic and pulmonic valves are valve to work normally again and then you can return to your normal activities. Without located between the ventricles (lower treatment, valve disease can reduce your quality of life and become life-threatening. chambers of the heart) and the major blood vessels leaving the heart. Leaflets What causes valve disease? The valves are made of strong, thin A person can be born with valve disease (congenital) or develop a problem later in life flaps of tissue, called leaflets. The leaflets open to let blood move forward (acquired). Common causes of acquired valve disease include infection (such as rheu- through the heart during half of the matic fever and infective endocarditis) and changes to the valve that develop over time. heartbeat. They close to keep blood from flowing backward during the Congenital valve disease other half of the heartbeat. The leaflets in the mitral and tricuspid Congenital valve disease develops before birth. Common problems that cause this type valves are supported by: of valve disease are abnormal valve size, leaflets that are not properly formed, and Annulus: tough, fibrous ring attached abnormal leaflet attachment. Congenital valve diseases include bicuspid aortic valve to the leaflets that helps support and disease and mitral valve prolapse. maintain the proper shape of the valve Bicuspid aortic valve disease is a type of congenital valve disease that affects the aortic Chordae tendineae: tough, fibrous valve. The valve has two leaflets instead of three. At least 25 percent of patients with strings this disease have a larger than normal aorta above the valve. The valve may not open Papillary muscles: part of the inside fully (stenosis) or may not close tightly (regurgitation). The condition affects about 2 walls of the ventricles percent of the population. The chordae tendineae and papillary muscles keep the leaflets stable to Mitral valve prolapse (MVP) is a type of valve disease caused by weaker than normal prevent blood from flowing backward. connective tissue in the mitral valve. The condition causes the leaflets of the mitral valve to flop back into the left atrium when the heart contracts. The tissues of the valve also become abnormal and stretchy. This causes the valve to leak. Normal aortic valve - three leaflets Mitral valve prolapse affects about 1 to 2 percent of the population. Men and women have the same risk of MVP. The condition usually isn’t a reason for concern. Only a small percentage of patients with MVP eventually need surgery. If the prolapse becomes Bicuspid aortic valve severe or is associated with torn chordae or flail leaflets (floppy and lacking support), it - two leaflets could lead to a bad leak, and surgery may be needed. The valve may not open fully (stenosis) All patients with MVP should ask their doctor if they need to take precautions to pre- or may not close vent endocarditis. tightly (regurgitation). 2 To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE How the Valves Work Blood flow through the heart The four valves open and close to let blood flow through the heart. The illustration below shows how the blood flows through the heart and describes how each valve works to keep blood moving. Open tricuspid and Closed tricuspid and Open pulmonic and Closed pulmonic and mitral valves mitral valves aortic valves aortic valves Blood flows from the When the right ventricle As the right ventricle begins When the right ventricle fin- right atrium into the right is full, the tricuspid valve to contract, the pulmonic ishes contracting and starts ventricle through the open closes and keeps blood from valve is forced open. Blood is to relax, the pulmonic valve tricuspid valve, and from flowing backward into the pumped out of the right ven- snaps shut. This keeps blood the left atrium into the left right atrium when the ventri- tricle through the pulmonic from flowing back into the ventricle through the open cle contracts (squeezes). valve into the pulmonary right ventricle. mitral valve. When the left ventricle is artery to the lungs. When the left ventricle fin- full, the mitral valve closes As the left ventricle begins ishes contracting and begins and keeps blood from flow- to contract, the aortic valve to relax, the aortic valve ing backward into the left is forced open. Blood is snaps shut. This keeps blood atrium when the ventricle pumped out of the left ventri- from flowing back into the contracts. cle through the aortic valve left ventricle. into the aorta. The aorta di- vides into many arteries and provides blood to the body. This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body. The four normally working heart valves make sure that blood always flows freely in one direction and that there is no backward leakage. To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. 3 CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE Acquired Valve Diseases Acquired valve diseases include problems that develop with valves that were once normal. Acquired disease can be the result of infection, such as infective endocar- ditis and rheumatic fever. It can also be caused by changes in the valve structure, such as stretching or tearing of the chordae tendineae or papillary muscles, fibro- calcific degeneration or dilatation of the valve annulus. Sometimes the cause of acquired valve disease is unknown. INFECTION Both infective endocarditis and rheumatic fever can lead to valve disease. Infective endocarditis is a major infection and can be life-threatening. Germs attack the heart valve and may cause the valve to leak. Rheumatic fever may cause the valve leaflets to become inflamed. The leaflets may stick together and become scarred, rigid, thickened and shortened. One or more of the valves (most commonly the mitral valve) may become stenotic (narrowed) or leaky. How does infective endocarditis develop? Infective endocarditis (also called bacterial endocarditis) is an infection of the heart valves or the heart’s inner lining (endocardium). It occurs when germs (especially bacteria, but occasionally fungi and other microbes) enter the blood stream and attack the lining of the heart or the heart valves. Bacterial endocarditis causes growths or holes on the valves or scarring of the valve tissue. This often causes a leaky heart valve. Bacterial endocarditis can be deadly if it is not treated. How does rheumatic fever develop? Rheumatic fever is usually the result of an untreated streptococcal infection, such as strep throat. The use of penicillin to treat strep throat can prevent this disease. It occurs most often in children between the ages of five and 15, and it can take years for symptoms of valve disease to develop. The valve itself is not infected when you have rheumatic fever. Instead, the body pro- duces antibodies to fight the infection, and they react with the heart valves, causing inflammation and eventual scarring. 4 To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE Structural Valve Disease Structural valve diseases include stretching or tearing of the chordae tendine- ae or papillary muscles, fibro-calcific degeneration or dilatation of the valve annulus. What are the symptoms of heart valve disease? When the heart valves begin to fail, the heart beats harder to make up for the reduced blood flow.