What Are the Pros and Cons of Each Type of Heart Valve?
Mechanical heart valves. The advantage to mechanical heart valves is their
sturdiness. They are designed to last for many years. There are also drawbacks.
Due to the artificial material involved, people who receive these valves will
need to take life-long blood-thinner medication (anticoagulants) to prevent
clots from forming in the mechanical valve. These clots can increase the risk
for a stroke. Also, some people report a valve ticking sound that is usually not
bothersome. It is the sound of the valve leaflets opening and closing.
Biological heart valves. The advantage of biological heart valves is that
most people do not need to take life-long blood thinners, unless they have other
conditions (such as atrial fibrillation) that warrant it. Biologic valves,
traditionally, were not considered as durable as mechanical valves, especially
in younger people. Previously available biologic valves usually needed to be
replaced after about 10 years. However, some studies show that some biologic
valves may last at least 17 years without decline in function. This represents a
new milestone in the durability of biologic valves.
Homograft heart valves. Homografts are ideal heart valves for aortic valve
replacement, especially when the aortic root is diseased or there is infection.
The heart's natural anatomy is preserved and patients do not need to take
life-long blood thinners. However, the limited availability is a drawback in
some settings.
Introduction to Heart Valve Surgery
Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuloplasty).
What Happens During Traditional Heart Valve Surgery?
During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.
What Happens During Minimally Invasive Heart Valve Surgery?
Minimally invasive heart valve surgery is a type of surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay.
Your surgeon will review your diagnostic tests prior to your surgery to determine if you are a candidate for minimally invasive valve surgery.
Often, the surgeon and cardiologist (heart doctor) will use transesophogeal echo (an ultrasound transducer probe that is passed down the throat) to help determine the functioning of the valve before and after surgery.
What Is Heart Valve Repair Surgery?
The mitral valve is the most commonly repaired heart valve, but the aortic, pulmonic, and tricuspid valves may also undergo some of these repair techniques.
If your valve can be repaired, your surgeon will perform any of the following types of valve repair procedures.
Commissurotomy. Fused valve leaflets, or flaps, are separated to widen the valve opening.
Decalcification. Calcium deposits are removed to allow the leaflets to be more flexible and close properly.
Reshape leaflets. If one of the leaflets is floppy, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. This procedure is called quadrangular resection.
Chordal transfer. If a leaflet of the mitral valve has prolapse (floppy; lacking support), the chordae are transferred from one leaflet to the other. Then, the leaflet where the chordae was removed is repaired by quandrangular resection (see above).
Annulus support. If the valve annulus (the ring of tissue supporting the valve) is too wide, it may be reshaped or tightened by sewing a ring structure around the annulus. The ring may be made of tissue or synthetic material.
Patched leaflets. The surgeon may use tissue patches to repair any leaflets with tears or holes.
The advantages of heart valve repair surgery include:
decreased need for life-long blood thinner (anticoagulant) medication
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
Aortic valve stenosis is an abnormal narrowing of the aortic valve of the heart. The causes of aortic stenosis are wear and tear of the valve in the elderly, congenital, or scarring or scarring of the aortic valve from rheumatic fever. Symptoms include angina, fainting, and shortness of breath. Treatment is dependant upon the severity of the condition.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
A heart murmur is the sound generated when blood flow within the heart is not smooth. Causes of heart murmurs can be functional, congenital, or caused heart valve conditions. Symptoms of a heart murmur may be none, or may include chest pain, shortness of breath, and arm, leg, and ankle swelling. Treatment of a heart murmur depends on the cause.
Endocarditis, a serious infection of one of the four heart valves is caused by growth of bacteria on one of the heart valves; leading to an infected massed called a "vegetation." The infection can be caused by having bacteria in the bloodstream after dental work, colonoscopy, or other similar procedures. Endocarditis symptoms include fever, fatigue, weakness, chills, aching muscles and joints, night sweats, edema in the legs, feet, or abdomen, malaise, shortness of breath and small skin lesions. Treatment for endocarditis is generally aggressive antibiotic treatment.
Balloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty (PTCA), was introduced in the late 1970's. PTCA is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This allows more blood and oxygen to be delivered to the heart muscle.
PTCA, is now referred to as percutaneous coronary intervention, or PCI, as this
term includes the use of balloons, stents, and atherectomy devices. Percutaneous
coronary intervention is accomplished with a small balloon catheter inserted into an artery in the groin or arm, and advanced to the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery. When successful,
percutaneous coronary intervention can relieve chest pain of angina, improve the prognosis of
individuals with unstable angina, and minimize or stop a heart attack without having the patien...
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