A growing number of people require treatment for heart valve disease. Heart valve disease happens when the heart’s valves do not work the way they were intended. Your heart valves are located between the four heart chambers and maintain one-way blood flow through the heart. The four heart valves – the tricuspid valve, the mitral valve, the pulmonary valve and the aortic valve – ensure that blood flows freely in a forward direction with no backward flow or leakage. The tricuspid and mitral valves are situated between the upper and lower chambers and the pulmonary and aortic valves are at the exits from the ventricles.

Valve stenosis. Heart valves that no longer open fully are described as “stenotic” or hardened valves. The condition is diagnosed when the valve flaps or leaflets become rigid, thickened or fused together, narrowing the valve opening and restricting blood flow through the valve. A heart valve with stenosis does not allow enough blood to flow through to other heart chambers or to the body. All four valves can be stenotic: aortic stenosis, mitral stenosis, tricuspid stenosis or pulmonic stenosis.

Valve insufficiency. Valve insufficiency occurs when a heart valve does not close tightly, causing some blood to leak backwards through the valve. Incompetent valves are unable to keep blood flowing through the heart in one direction. Blood leaking back through an incompetent valve is commonly known as regurgitation. The problem may include a condition in which the valve pushes flow backward with the leaking blood. This is called valve prolapse.

Regurgitation or stenosis makes the heart work much harder. This extra work may cause your heart muscle to grow to accommodate the added demands, and an overworked, enlarged heart may begin to fail over time. In such cases, valve repair or replacement surgery can return the heart muscle to its original workload and size.

Causes of Heart Valve Disease
The causes of heart valve disease may be congenital (born with defective valves) or acquired. Such diseases as rheumatic fever and bacterial endocarditis can damage heart valves, causing scarring. The aging process and coronary artery disease also are sources of heart valve problems. While many people lead normal lives in spite of heart valve disease, a minor defect can progress over time and become a condition requiring treatment. Medical treatment with drugs and lifestyle changes often are sufficient in treating heart valve disease. Despite attentive medical care, however, diseased heart valves sometimes require surgical attention. Your doctor will discuss the options with you.

Symptoms of Heart Valve Disease
People with heart valve disease may experience one or more of these symptoms:

• Problems with breathing during mild exertion or while resting
• Wheezing or coughing with exercise
• Palpitations, the sensation of fluttering or fast pounding in the chest
• Quickly fatigued
• Weakness or dizziness
• Swelling of ankles and hands
• Discomfort, pressure or pain in the chest
• Physician-diagnosed heart murmur

The diagnosis of Heart Valve Disease
Valve disease can be diagnosed by listening to your heart. When blood flows through a diseased valve, a whooshing sound – a murmur – is heard. With stenosis, the sound may be rough, short and low-pitched while with valve insufficiency or incompetence, the sound may be higher-pitched, softer and longer. In either event, your cardiologist may order a series of diagnostic tests. An electrocardiogram (ECG) and chest X-ray can provide information about heart size and activity. A further, more definitive diagnostic tool is the echocardiogram, a noninvasive and painless procedure using sound waves to produce images of the heart. The echocardiogram allows the doctor to see your heart valves opening and closing in rhythm with your heartbeat and ventricles contracting and relaxing, helping to identify possible heart or valve abnormalities. If additional information is necessary and/or surgery is considered, a cardiac catheterization – or angiogram – procedure is requested. Through a thin tube or catheter inserted in your artery and guided to your heart, a chemical dye is injected. The dye then appears on a x-ray, which permits the physician to see an image of the inside of the heart in order to determe blood flow and valve performance.

When Treatment Calls for Surgery
Even with attentive medical care, diseased heart valves can require surgical attention. Aortic and mitral valves most often call for repair or replacement due to valve disease. In some instances, the patient’s own valve can be repaired to allow it to function in a normal way. Others require valve replacement.

During heart valve replacement surgery, one or more diseased heart valves may be replaced. If this operation is indicated for you, your diseased valve will be removed and a substitute valve implanted. Substitute heart valves are referred to as prosthetic valves. There are two types of prosthetic valves: tissue (biologic) and mechanical. However, tissue valves more closely resemble the natural valves they replace and are well tolerated by the body generally without special medications. Tissue valves are less durable than mechanical valves and may require replacement during a patient's lifetime. Mechanical valves are made of hard, durable materials that have been proven safe for use in the human body. Although mechanical valves last longer than tissue valves, they require that patients take daily medication to prevent blood clots from forming around the valve, potentially leading to complications. The ATS Open Pivot® Heart Valve is a mechanical heart valve.

One method of heart valve repair involves restoring the valve to normal function by removing damaged or malformed tissue and surgically reconstructing the valve. An advantage of this method is that the patient’s own valve tissues are used, thus precluding long-term anticoagulation therapy. The ATS Simulus™ Annuloplasty Ring and the ATS Simulus Band are both devices used in heart valve repair.

Ultimately, the decision of whether to repair or replace a heart valve depends on the type and severity of the valve’s malfunction. The surgeon frequently does not know exactly what will be needed until surgery takes place and he or she is able to look at the valves and surrounding structures.

Following Surgery
After heart valve replacement or repair surgery, you will be encouraged to return to your normal daily routine with advice from your health care team. Most patients feel better after their operation because the symptoms of their heart valve disease have been relieved. Your doctor will prescribe a program of recovery that includes diet, exercise and medication. If you are the recipient of a mechanical heart valve, you will be informed about regular anticoagulation medication to keep your blood from clotting and your mechanical heart valve functioning well.