HEART VALVE DISEASE
The heart consists of 4 chambers. The 2 upper chambers are called the right and left atria. The 2 lower chambers are the right and left ventricles. Within the chambers of the heart, there are 4 heart valves. These valves function as one-way doors for the flow of blood through the heart and to the rest of the body. To see a video of heart valves functioning normally, click here.
A heart valve may be abnormal from birth, and because of this, it may deteriorate over time. Valves may also fail due to infection, rheumatic fever, injury and aging. Sometimes valves fail due to unknown causes. The most commonly affected valves are the aortic, mitral and tricuspid. The diagnosis of heart valve disease is made with an echocardiogram and/ or cardiac catheterization.
Valves can fail in two ways. They may fail to open completely, making it more difficult for blood to pass through the valve. These valves are stenotic. Some heart valves may also fail to close completely, allowing blood to leak back through the valve when it should not. These valves are regurgitant, or incompetent. Some patients have valves that are both stenotic and regurgitant.
If left untreated, some diseased valves will lead to heart failure and premature death. Some patients with heart valve disease will have valve surgery recommended. For the best outcome, it is important that surgery by performed before the heart is permanently damaged, sometimes even before symptoms occur.
HEART VALVE SURGERY
There are 2 major types of valves available for heart valve replacement:
The first type of valve is mechanical, or prosthetic, and is made with totally artificial material. It is designed to last a lifetime but requires taking blood thinners to prevent blood clot formation. 
The second type of valve is bioprosthetic, and is one taken from a pig or cow. These valves will last at least 12 – 15 years in appropriate patients. The use of long term blood thinners is not required. - In rare instances, a cadaver aortic valve may be used to replace a diseased aortic valve.
Aortic Valve Surgery – Aortic valves fail because of either stenosis or regurgitation or both. Aortic stenosis develops as a result of either the accumulation of calcium in a normal valve or the deterioration of an aortic valve that was abnormal from birth (bicuspid). Aortic regurgitation usually develops as a result of valve deterioration over time.
Almost all patients needing aortic valve surgery will have aortic valve replacement. The decision of whether to use a mechanical or bioprosthetic valve is determined by the patient’s age, activity and other coexisting diseases.
Mitral Valve Surgery – Mitral valves fail because of either stenosis or regurgitation or both. The most common cause of mitral valve stenosis is rheumatic fever early in life. Mitral valve regurgitation usually develops as a result of leaflet deterioration or heart enlargement.
If patients with rheumatic mitral valve stenosis are treated when the valve leaflets are still flexible, mitral valve repair surgery is often an option. In these patients the primary problem is fusion of the areas between the valve leaflets. Incising through the fused valve leaflets, or commissurotomy, is effective in relieving mitral stenosis. If the valve leaflets are inflexible replacement is necessary, usually with a mechanical valve.
Patients with mitral valve regurgitation are usually candidates for mitral valve repair. Repair usually involves surgical removal of the diseased part of the valve and placement of a ring to tighten the annulus. Occasionally, patients will have valves that will not permit repair. When replacement is necessary, a mechanical valve is usually selected.
For an animation of a mitral valve replacement click here.
Many patients with mitral valve disease will also have atrial fibrillation. For information about atrial fibrillation, click here.
Heart valve surgery requires the use of the heart-lung machine. The most common incision is through the breastbone, but other less invasive incisions may also be used. Patients usually spend 2 nights in the surgical intensive care unit (SICU) and are discharged after 4 – 5 days. Patients usually resume driving and light work after 1 month, and unrestricted activity after 2 months.
If you’d like to discuss heart valve surgery with one of the best heart surgeons in New Orleans, please contact Dr. Pigott.
