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Valve Surgery | Baylor Dallas

Valve Surgery

Heart valve disease occurs when heart valves fail to open and close properly. If this condition is left untreated, valve disease may lead to arrhythmias and congestive heart failure.

In addition to medication, valve disease treatment options include open heart and minimally-invasive surgical procedures using smaller incisions which usually means less pain and quicker healing time. Valve repair and valve replacement are common surgeries. The surgeon will decide to repair or replace a heart valve based on whether the valve is diseased, whether it is narrowed or leaky, and the degree of any calcium buildup.

At the Center for Valve Disorders, part of Baylor Heart and Vascular Services at Dallas, a multidisciplinary team of interventional cardiologists, cardiothoracic surgeons, and imaging specialists on the medical staff diagnose and treat patients with valve disease.

Aortic valve surgery

Heart physicians on the medical staff at the Center for Valve Disorders perform a wide range of open-heart and minimally-invasive surgical procedures to address aortic valve disorders.

Aortic valve repair

Medication and valve repair are also treatment options for aortic valve conditions along with valve replacement. Valve repair is usually open-heart surgery, where physicians attempt to fix a malfunctioning valve depending on the extent of valve leakage or calcium buildup. Surgery is not commonly performed on a patient with a diseased aortic valve.

Aortic valve replacement

Traditionally, valve replacement was considered open-heart surgery. A surgeon would remove an entire defective valve, such as an aortic valve, and sew in a new one. However, with the advent of minimally-invasive valve replacement surgery today, physicians use smaller incisions usually resulting in less pain and quicker healing time than open procedures.

Mitral valve surgery

The mitral valve, one of the heart’s four valves, connects the left atrium to the left ventricle. Within the mitral valve are flaps, called leaflets, which open and close to allow or restrict blood flow in only one direction. The opening of the flaps allows blood to flow from the left atrium to the left ventricle. In turn, the flaps close to prevent the backflow of blood into the left atrium.

When the mitral valve does not work properly, your heart must worker harder resulting in an enlarged, weakened heart. There are three types of mitral valve disease: mitral valve prolapse, mitral stenosis, and mitral regurgitation.

Mitral valve prolapse

Mitral valve prolapse is the most common valvular disorder in the United States, occurring in 2 percent to 3 percent of the population. Mitral valve prolapse occurs when the mitral valve flaps are unable to properly close, and instead one or both flaps bulge upward into the left atrium. In most cases, this condition is harmless and affected persons are unaware they are living with the condition.

The most common cause of mitral valve prolapse is myxomatous valve disease, when the valve flaps are abnormally stretchy. Some connective tissue disorders, such as Marfan syndrome, can also cause a person to develop this condition. Most people do not have symptoms, but an abnormal heartbeat may be detected during a physical examination. Common symptoms include chest pain, shortness of breath, irregular heartbeat, anxiety, and fainting. If you are presented with these symptoms, advanced diagnostic testing may include an echocardiography (ECHO) or cardiac magnetic resonance imaging (MRI).

Mitral valve prolapse may not always involve treatment. For those with worsening or severe symptoms, medical management, mitral valve repair surgery, or mitral valve replacement surgery may be recommended.

Mitral stenosis

Mitral stenosis is the narrowing or blockage of the mitral valve, resulting in decreased blood flow to the left ventricle. The most common cause of mitral stenosis is rheumatic fever, a rare disease in the United States resulting from untreated strep throat or scarlet fever. Rheumatic fever may cause thickening, scarring, and calcification of the mitral flaps.

The most common signs and symptoms of mitral stenosis are shortness of breath, fatigue, irregular heartbeat, swollen feet or legs, and chest pain, with more advanced cases causing right-sided heart failure. Decrease in the size of the mitral opening increases the patient’s risk of developing atrial fibrillation, an irregular heart rate, and arterial thromboembolism, a blood clot that blocks blood flow in an artery.

Diagnostic testing, such as electrocardiogram (EKG), chest x-ray, and echocardiography (ECHO), may be completed to determine diagnosis and severity. Treatment of mitral stenosis includes medical management, catheter-based procedures, mitral valve repair or replacement surgery, or a minimally invasive approach.

Mitral regurgitation

Mitral regurgitation occurs when the mitral flaps fail to close properly, resulting in blood leakage from the left ventricle backwards into the left atrium. Leakage can increase blood pressure in the left atrium, enlarging the heart. Mitral regurgitation can also lead to increased pressure in the veins leading from the lungs to the heart while severe mitral regurgitation cases may lead to congestion, or fluid build-up, in the lungs.

The most common cause of mitral regurgitation is myxomatous disease, having abnormally stretchy valve flaps. Other causes include coronary artery disease, cardiomyopathy, rheumatic heart disease, and infective endocarditis. Patients may not show symptoms for years. When symptoms develop, most commonly patients experience shortness of breath, fatigue, and irregular heartbeat caused by atrial fibrillation. If you are presented with these symptoms, diagnostic testing may include electrocardiogram (EKG), chest x-ray, echocardiography (ECHO), and cardiac magnetic resonance imaging (MRI).

Treatment for mild regurgitation may include medical management. However, mitral valve repair surgery, mitral valve replacement surgery, or a minimally invasive approach is often recommended to treat patients with mitral regurgitation.

Tricuspid valve surgery

Located between the upper and lower right chambers of the heart — the atrium and the ventricle — the tricuspid valve helps control blood flow, moving it in the appropriate direction. When the right ventricle contracts and blood leaks backward through the tricuspid valve, the condition is called tricuspid regurgitation, and it could lead to enlargement of the right atrium due to increased blood pressure.

Surgical treatment options for tricuspid valve regurgitation include valve repair using minimally-invasive approaches and open-heart surgery.

Minimally invasive valve surgery

Unlike traditional open heart surgery, minimally-invasive procedures offer smaller incisions usually minimizing pain, recovery time, and complications. This patient-friendly approach is available for certain valve procedures such as mitral valve surgery.

Transcatheter Aortic Valve Replacement (TAVR)

One technique for treating heart valve disease is transcatheter aortic valve replacement (TAVR), an advanced treatment option. Unlike open-heart surgery, TAVR is a minimally invasive procedure. Using this approach, a surgeon replaces a damaged aortic valve without removing the old, damaged valve, instead positioning a replacement valve into the aortic valve's place. Similar to a stent put in an artery, the valve is directly delivered with a catheter.

Transluminal balloon valvuloplasty surgery

Transluminal balloon valvuloplasty is a minimally invasive surgery option to repair a stenotic mitral valve, a narrowing or obstruction of the valve that prevents it from opening properly. Balloon valvuloplasty may not be an option for patients with severe coronary artery disease.

Transcatheter mitral valve surgery

Transcatheter mitral valve surgery is a minimally-invasive treatment option for heart patients suffering from mitral regurgitation when the mitral valve closes incompletely during the heart's ventricular contraction. This procedure can be useful in restoring healthy blood flow.

Mitraclip

At the Center for Valve Disorders, surgeons are now performing a new minimally-invasive procedure to treat mitral regurgitation for patients who are at increased surgical risk. The Mitraclip® device, a small clip attached to the mitral valve, allows the valve to close more completely, restoring normal blood flow in the heart.

Surgery for infective endocarditis

Valve conditions may develop due to illnesses, such as infective endocarditis. Also called bacterial endocarditis, this infection is caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. Although it is uncommon, some people with heart conditions have a greater risk of developing it. Treatment usually consists of high doses of intravenous (I.V.) antibiotics initially.

If antibiotics fail to cure the infection and heart valve damage has occurred, surgery may be needed to fix the valve. The type of surgery will vary depending on the location of the infection, the extent of heart and valve damage, and the presence of complications such as heart failure or blood clots.

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