Many different things may damage the heart valves: Infection, rheumatic fever, some medications, inflammation, aging, and congenital defects.

Regardless of the cause, there are only two types of problems:

    1) Stenosis (narrowing)
    2) Regurgitation (back-leakage)

Or both may occur in combination

ULTRASOUND
Trans-Thoracic Echocardiogram (TTE).  This common, no-risk test provides pictures of the moving heart, heart chamber function, valve anatomy and disease, and the flow patterns of the valves. Imaging is from the chest skin surface.

TRANS-ESOPHAGEAL ECHO (TEE). Provides superior images but requires sedation and probe placement.

CARDIAC CATHETERIZATION. Provides direct internal pressure measurement from catheters placed from the groin area.

PREVENTION
Rheumatic Fever (RF) can be prevented by early treatment of “strep throat” and RF recurrence is reduced by daily antibiotics in patients with increased strep exposure.

Bacterial endocarditis is a dreaded infection of the heart valves. Patients with abnormal valves should be treated with antibiotics before any dental procedures (including routine cleaning).

MEDICINES
Medicines are helpful in reducing symptoms, preventing rhythm disturbances, reducing stroke risk (coumadin), and reducing fluid retention (diuretics).

For patients with valve regurgitation (back-leakage), ACE / ARB medications (a common blood pressure medicine) actually reduce the natural progression of heart damage (remodeling) and can prevent heart failure and decrease the need for surgery.

Severe valve obstruction (stenosis) is a mechanical problem and usually requires a physical or mechanical treatment like surgery or balloon dilation. Medications may help with symptoms but usually can’t change the course of this type of valve disease.

OPEN HEART SURGERY

VALVE SPARING PROCEDURES
In some patients, surgery can repair the valve and avoid the placement of an artificial valve. Mitral valve opening (comissurotomy) is the best known sparing procedure.

TISSUE VALVE REPLACEMENT
Artificial valves composed of tissue (bovine, porcine, homograft) are more natural and may not require anti-coagulants after surgery.

MECHANICAL VALVE REPLACEMENT
Modern mechanical valves are made of metal or “space age” materials and have excellent performance and durability. All require life-long anticoagulant therapy with coumadin.

All modern valve surgery is “open heart” and requires the use of a heart-lung machine during surgery.

BALLOON VALVULOPLASTY
Narrowed valves can be opened by stretching, splitting, or cutting. In the early days of heart surgery, artificial valves were not available. Some types of narrowed valves responded to physical force to open the scarred edges during surgery. 20 years ago, techniques were developed to stretch open these obstructed valves with balloon-tipped catheters which were placed through small skin incisions in the groin. These treatments could therefore avoid open heart surgery in some patients.

PULMONIC VALVE STENOSIS BALLOON VALVULOPLASTY
Patients with congenital pulmonic valve stenosis are born with narrowing of the pulmonic valve. Opening of the valve is indicated when the obstruction is severe.

In patients without complicating features or other congenital problems, balloon valvuloplasty is the first treatment of choice due to very good results and very low complications. Most patients have mild residual obstruction and some valve regurgitation.

AORTIC VALVE STENOSIS BALLOON VALVULOPLASTY
The best treatment for severe aortic valve stenosis is surgery and valve replacement.

While balloon treatments for mitral and pulmonic valves are comparable with surgery, aortic valves do not respond as well and are more likely to re-narrow with time. This difference is due to the different disease process causing narrowing.

AORTIC VALVE STENOSIS BALLOON VALVULOPLASTY
Aortic balloon valvuloplasty is a palliative procedure which can double the valve opening and thereby reduce symptoms.

Re-narrowing occurs in 40-50% of patients within 6 months. Repeat valve dilation can be performed.

Therefore, aortic valvuloplasty is best suited for patients with severe aortic stenosis, significant symptoms: who are not good candidates for valve replacement surgery (due to age or other conditions).

MITRAL VALVE STENOSIS MITRAL BALLOON VALVULOPLASTY
Mitral valve narrowing (stenosis) causes mechanical obstruction to flow from the lungs resulting in heart failure, arrhythmia, and risk of stroke.

Physical opening of the valve by replacing the valve or preferably repairing the valve by separating the fused edges is the treatment of choice.

Opening the edges of the mitral valve leaflets which have scarred together is called commissurotomy. Although originally done by stretching the valve with a finger (closed commissurotomy), modern techniques involve cutting the fused edges during open heart surgery using the heart-lung machine.

Since opening the edges of the mitral valve can be done by physical stretching with a finger or a device, it follows that a balloon placed through the valve could do the same job.

Over 20 years ago, methods were developed to place balloons through the mitral valve using catheters placed through the skin in the groin.

These catheters were advanced up the major vein leading to the heart and through the atrial divider. Inflation of these balloons opened or “split” the fused edges of the narrowed mitral valve. The balloons could then be removed without the need for surgery or long recovery.

Balloon valvuloplasty or surgical commissurotomy is indicated when 1) the valve is severely narrowed, moderate symptoms are present, pulmonary artery pressures are elevated, and the valve is suitable (without severe thickening or calcification or valve regurgitation).

Many studies comparing surgical and balloon treatments have shown equivalent improvement in valve size, lowering of abnormal pressures, and improvement in symptoms. The cost and risk of the balloon treatment are lower than surgery. The chance of re-narrowing seems the same for both treatments.

20 year experience
-- 1000 tran-septal catheterizations
-- 500 aortic, pulmonic, mitral, Ross procedure balloon treatments
Excellent surgical collaboration
Extensive TTecho, TEE, and intra-cardiac echo experience