• Valvular Heart Disease


    Illustration of heart valve systemHeart valve disease can reduce the pumping efficiency of the heart and eventually cause heart failure. The heart contains four valves that permit the one-way flow of blood through the heart and lungs. One or more of these valves can be damaged by disease. This damage can result in stenosis (valve narrowing), regurgitation, insufficiency (valve leaking) or a combination of stenosis and regurgitation. Some causes of valve disease include:

    • Bicuspid aortic valve - a congenital deformity that predisposes to calcification and malfunction of the valve over many years
    • Calcific degeneration - typically a "wear and tear" calcification seen in mid to later life
    • Myxomatous degeneration (mitral valve prolapse) - a floppy valve that does not close properly, leading to leakage
    • Infection (rheumatic fever, bacterial endocarditis)
    • Coronary artery disease and heart attack
    • Cardiomyopathy (either ischemic or viral) - an enlargement or malfunction of the heart muscle where the mitral valve attaches, resulting in leakage
    • Radiation (many years after successful treatment for cancer)
    • Marfan syndrome and other connective tissue disorders

    In adults, the most commonly affected valves are the aortic and mitral valves, and less commonly, the tricuspid and pulmonic valves. When valvular heart disease progresses to a point where the heart can no longer pump effectively, symptoms occur and may include: fluid retention, irregular heartbeat, angina (chest pressure), shortness of breath, and fainting spells. At this point, the damaged valve(s) must be repaired or replaced.


    Cardiothoracic surgeon Torin Fitton, MDAt Lahey Clinic, patients with valvular heart disease are evaluated and treated through a coordinated effort by nationally recognized clinicians and surgeons who are experts in their respective specialties. Cardiologists with expertise in cardiac imaging and the treatment of heart rhythm disorders work with a team in the cardiac catheterization laboratories and cardiovascular surgeons to diagnose and treat all types of heart valve disease.

    In cooperation with the American Heart Association, Lahey cardiologists have contributed to the publication of national guidelines for the management of patients with heart valve disease. Cardiologists are also involved in a variety of research programs directed at improving the quality of life for patients. State-of-the-art care from Lahey's team of nationally recognized cardiologists reduces complications and morbidity, and thus, improves the survival of patients with heart valve disease.


    This procedure uses balloon angioplasty to dilate diseased heart valves in order to improve blood flow between the heart chambers. A catheter with a collapsed balloon at the tip can be inserted into an artery or vein in the leg under a local anesthetic and conscious sedation. This catheter is then advanced into the heart and across the narrowed valve, and the balloon is expanded to open the valve. Valvuloplasty may be performed on either the mitral valve or the aortic valve.

    Symptoms including shortness of breath or chest discomfort may lead your physician to investigate the possibility of performing valvuloplasty on you. Following the procedure, patients are generally discharged by the following day.

    Heart Valve Surgery

    Valvular surgery includes both repair and replacement procedures.


    Repair surgery is most commonly performed on the mitral and tricuspid valves. This surgery may involve:

    • Commissurotomy (enlargement of a narrowed valve to a more normal size)
    • Annuloplasty (insertion of a Dacron ring to tighten the valve)
    • Leaflet repair (repair of the valve leaflet itself or its supporting structures)

    In certain situations associated with aneurysms, a leaking aortic valve may be preserved instead of replaced.


    Homograft valve (donated human valve)When a valve is too badly damaged for repair, valve replacement is performed using one of three general types of replacement valves:

    • Mechanical valves (made of carbon, metal alloy and fabrics)
    • Bioprosthetic valves (made from animals such as cows and pigs)
    • Homograft valves (donated human valves)

    What are the differences between these replacement valves?

    The major difference between mechanical and biological valves relates to durability and the need for anticoagulation. Any replacement valve can fail prematurely or unexpectedly, but this is rare. The majority of replacement valves will behave reliably and in a predictable pattern.

    Mechanical valves are the most durable type of replacement valve, typically lasting a lifetime. However, they are slightly more prone to blood clot buildup on the valve apparatus, which could cause the valve to malfunction or produce a blood clot that could travel to another part of the body. This tendency for blood clot development can be greatly reduced by prescribing an anticoagulant, a medicine that reduces the ability of blood to clot. Anticoagulants are taken daily, and the dose is adjusted based on periodic blood testing.

    Bioprosthetic valves, on the other hand, usually do not require anticoagulation long-term unless the patient has certain chronic heart rhythm abnormalities. A daily aspirin is usually sufficient to prevent blood clots from forming. However, over the course of 12 to 15 years, these valves may begin to wear out and in some cases another operation may be required to replace them. Patient age at the time of valve surgery influences the longevity of bioprosthetic valves - these valves last longer in older patients. Thus, bioprosthetic valves generally make good sense in older patients who have bleeding tendencies, as well as in any other patients who cannot take anticoagulants.

    Because the longevity of bioprosthetic valves is significantly reduced in patients under the age of 50, mechanical valves are typically most appropriate for younger patients. However, for younger patients requiring aortic valve replacement and for whom anticoagulation is undesirable, an aortic homograft valve may be best. These valves do not normally require Coumadin and usually last longer than bioprosthetic valves, although they too will ultimately wear out and need to be replaced.

    All types of valves are well-tolerated by the body and will not be "rejected." However, they are foreign materials, and are therefore prone to infection. Any necessary, major dental work - especially involving abscessed teeth or gums - should be performed before surgery. After your valve surgery, be certain to let your dentist and all other physicians know that you have an artificial heart valve so they can give you antibiotics before performing certain invasive procedures, operations, or dental work.

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