How Is Heart Valve Disease Treated?

The goals of heart valve disease treatment are to:

• Prevent, treat, or relieve the symptoms of other related heart conditions.
• Protect your valve from further damage.
• Repair or replace faulty valves when they cause severe symptoms or become life threatening. Man-made or biological valves are used as replacements.

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay complications for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.

Prevent, Treat, or Relieve the Symptoms of Other Related Heart Conditions

To relieve the symptoms of heart conditions related to heart valve disease, your doctor may ask you to quit smoking and follow a healthy eating plan low in salt, cholesterol, and fat.

Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) eating plans. TLC is for people who have high blood cholesterol. DASH is for people who have high blood pressure (or for anyone who wants to follow a healthy eating plan).

Your doctor also may ask you to limit physical activities that make you unusually short of breath and fatigued (tired). He or she also may ask that you limit competitive athletic activity, even if the activity doesn't leave you unusually short of breath or fatigued.

Your doctor may prescribe medicines to help prevent or treat other related heart conditions, such as heart failure, high blood pressure, irregular heartbeats, coronary artery disease (CAD), and life-threatening blood clots. Heart valve disease can cause these conditions or worsen them.

People who have heart valve disease are commonly prescribed medicines to:

• Treat heart failure. Heart failure medicines widen blood vessels and rid the body of too much fluid.
• Lower blood pressure or blood cholesterol levels.
• Prevent irregular heartbeats.
• Thin the blood and prevent clots (for people who have man-made valves). These medicines also are prescribed for mitral stenosis or other valve defects that make you prone to developing blood clots.

Protect Your Valve From Further Damage

If you've had previous heart valve disease and now have a man-made valve, you may be at increased risk for a heart infection called endocarditis. This infection can worsen your heart valve disease. Even if you don't yet have symptoms of a valve problem, you're at increased risk for this infection.

To help prevent this serious infection, floss and brush your teeth and see a dentist regularly. Gum infections and tooth decay can cause endocarditis.

Let your doctors and dentists know if you have a man-made valve or if you've had endocarditis before. They may give you antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.

Repair or Replace Heart Valves

Your doctor may recommend repairing or replacing your heart valve(s), even if you do not yet have symptoms of heart valve disease. This can prevent lasting damage to your heart and sudden death.

Having heart valve repair or replacement depends on a number of factors, including:

• How severe your valve disease is.
• Your age and general health.
• Whether you need heart surgery for other conditions, such as bypass surgery to treat CAD. Bypass surgery and valve surgery can be done at the same time.

When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk for endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.

However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic or pulmonary valves often have to be replaced.

Repairing Heart Valves

Heart valves can be repaired by:

• Separating fused valve flaps
• Removing or reshaping tissue so the valve can close tighter
• Adding tissue to patch holes or tears or to increase the support at the base of the valve

Heart surgeons do most heart valve repair surgeries. Cardiologists do some repair surgeries using cardiac catheterization. Although catheterization procedures are less invasive, they also may not work as well for some patients. You and your doctor will decide whether repair is appropriate and the best procedure for doing it.

Balloon valvuloplasty. Heart valves that don't open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy.

During the procedure, a balloon-tipped tube is threaded through your blood vessels and into the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.

You're awake during the procedure, which usually requires an overnight stay in the hospital.

Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can still worsen over time. You may need medicines to help with symptoms or surgery to repair or replace the faulty valve.

Balloon valvuloplasty has a shorter recovery time than surgery. For some patients who have mitral valve stenosis, it may work as well as surgical repair or replacement. For these reasons, balloon valvuloplasty usually is preferred over surgical repair or replacement for these people. Balloon valvuloplasty doesn't work as well as surgical treatment for adults who have aortic valve stenosis.

Balloon valvuloplasty often is used in infants and children. In these patients, valve stenosis is caused by a congenital defect that can be repaired by a one-time procedure.

Replacing Heart Valves

Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made valve or a biologic valve.

Biologic valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so no medicines are needed to stop the body from rejecting the valve.

Man-made valves are more durable than biologic valves and usually don't have to be replaced. Biologic valves usually have to be replaced after about 10 years, although newer biologic valves may last 15 years or longer.

Unlike biologic valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk for endocarditis.

You and your doctor will decide together whether you should have a man-made or biologic replacement valve. If you're a woman of childbearing age or if you're athletic, you may prefer a biologic valve so you don't have to take blood-thinning medicines. If you're elderly, you also may prefer a biologic valve, as it will likely last for the rest of your life.

Other Approaches for Repairing and Replacing Heart Valves

Some newer forms of heart valve repair or replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery are usually 3 to 5 days, compared to 5 day stays for traditional heart valve surgery.

New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2 to 4 weeks versus 6 to 8 weeks for traditional surgery.

Some cardiologists and surgeons are exploring procedures that use cardiac catheterization to thread clips or other devices in a tube through your blood vessels and into the faulty valve in your heart. The clips or devices are used to reshape the valve and stop the backflow of blood. It's not yet known how effective these procedures are.

The Ross operation is a surgical procedure to treat faulty aortic valves. During this operation, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. The pulmonary valve is then replaced with a pulmonary valve from a deceased human donor.

This is more involved surgery than typical valve replacement, and it has a greater risk of complications.

The Ross operation may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isn't required. But in some patients, one or both valves fail to work properly within a few years of the surgery. Experts continue to debate the usefulness of this procedure.

Serious risks from all types of heart valve surgery vary according to your age, health, the type of valve defect(s) you have, and the surgical procedure(s) performed.