There are 4 valves ensuring the proper flow of blood through the heart. They are called the aortic, mitral, tricuspid, and pulmonary valve. Although it is possible to have problems with any valve or combination of valves, the pulmonary valve rarely causes clinical problems and even more rarely needs surgery for correcting the problem. The other 3 valves can cause problems that are generally related to leakage or blockage. Medicine can help you feel better with these valve problems but as they get worse, surgery may be the only solution. Valve problems do not get better alone or with medicine. In general, it is a mechanical problem that requires a mechanical solution, that is, surgery.
Heart Valve Problems
Here are possible problems that can develop with the different heart valves.
The aortic valve may block or leak. When it is blocked, it is called aortic stenosis. Calcium buildup on the valve prevents it from opening properly and the heart is forced to pump blood out through a small opening instead of a normal sized one. This puts stress on the heart muscle. This calcium buildup is progressive from aging or from an abnormal valve at birth.
When the aortic valve leaks, it is called aortic insufficiency or regurgitation. When the blood leaks back into the heart after being ejected, it also puts strain on the heart.
The mitral valve may be blocked or it may leak. A blockage of this valve is rare – it is called mitral stenosis. This is caused almost always by rheumatic fever that you may have had early in life.
A leaking mitral valve is called mitral regurgitation or insufficiency. This puts strain on the heart since part of the blood that is supposed to be ejected out to the body is pushed backwards in the heart.
A tricuspid blockage is extremely rare. A tricuspid leak is not unusual, but it is often mild, and does not require surgery. This problem is called tricuspid regurgitation or insufficiency.
Solutions for Heart Valve Problems
Here are the possible solutions for heart valve problems when surgery is required.
The aortic valve can sometimes be repaired, leaving your own valve working. It is unusual to be able to repair an aortic valve, but we consider it for some patients with aortic insufficiency. For patients with aortic stenosis and most with aortic insufficiency, a valve replacement is necessary.
The choices for aortic valve replacement are several. The right one for you depends on many factors including age, lifestyle and activity level. Each patient receives counseling and participates in this choice.
Aortic Valve Replacement Options
- Mechanical (metal) Valve
- Stented Tissue Valve - Valves are constructed from a pig valve or the sac around a cow’s heart; they are mounted inside a metal and cloth skeleton for support.
- Stentless Tissue Valve – Valves have little or no cloth and no metal support; they are either a pig valve, a human valve or your own valve transplanted from one position to another where it is needed more (Ross procedure).
The mitral valve can sometimes be repaired, leaving your own valve working. This is preferable over a valve replacement if it is possible. Whenever possible, we favor this technique. If this is not possible, a valve replacement is necessary.
Mitral Valve Repair
There is now evidence that keeping your own valve, whenever possible,
as long as it doesn’t leak, is better than replacing it. We strive to
repair leaking and blocked mitral valves if at all possible. Most
mitral valve problems are related to leakage. This may be due to a
disease called myxomatous mitral valve disease or it may be a mitral
leak caused by coronary artery disease. It may also be due to your
heart being enlarged. The chance of success of repair with a blocked
mitral valve is lower, but this is an uncommon problem.
Whatever
the cause, you should be evaluated for a possible repair if your
cardiologist feels that surgery needs to be considered. The goal of
surgery is to minimize or eliminate the leak by making the valve close
more efficiently. A variety of techniques are used to accomplish this.
Some require remodeling the moving parts of the valve that open and
close. All repairs, however, use a ring sewn around the outer aspect of
the mitral valve, acting as a belt to tighten up the valve. This brings
the moving parts of the valve closer together. There are different
models available from different companies. Some are soft and flexible,
others are rigid. Some are open-ended, others are complete rings. We
favor a flexible, complete ring model for longer lasting results.
Mitral Valve Replacement Options
- Mechanical (metal) Valve
- Tissue Valve – Tissue is either porcine (pig) valve or bovine (cow) valve.
The tricuspid valve can usually be repaired, leaving your own valve working. When this is not possible, a valve replacement is necessary.
Tricuspid Valve Repair
The tricuspid valve can leak or be blocked due to several unusual diseases. Much more common though, is a leak due to stresses placed on the heart from the lungs, leaks in the other valves in the heart, or a weak heart. In most of these cases the tricuspid valve is simply stretched out of shape, so it doesn’t close properly. We strive to repair this situation whenever present by placing a “belt” around the outside of the valve to render it tighter and stop or minimize the leak. This is done with a device called an annuloplasty ring which can be rigid or flexible. It is always covered with a cloth material that facilitates sewing it in place.
Whenever possible, it is better to keep your own tricuspid valve and have it repaired. Results show that this is a better solution for the long term and for heart function. The alternative is a valve replacement which is only considered if repair is not possible.
Tricuspid Valve Replacement
- Mechanical (metal) Valve
- Tissue Valve - Valve is a porcine (pig) tissue valve
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