Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's "Your Guide to Lowering Your Blood Pressure With DASH" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Your doctor may ask you to limit physical activities that make you short of breath and 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 tired.
Your doctor may prescribe medicines to:
If you've had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.
One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on many factors, including:
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 of IE 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 and pulmonary valves often have to be replaced.
Heart surgeons can repair heart valves by:
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.
Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.
Balloon valvuloplasty. Heart valves that don't fully open (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 (val-VOT-o-me).
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to 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 a hospital.
Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. Thus, for these people, balloon valvuloplasty often is preferred over surgical repair or replacement.
Balloon valvuloplasty doesn't work as well as surgery for adults who have aortic valve stenosis.
Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.
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 or biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won't need medicines to stop your body from rejecting the valve.
Man-made valves last longer than biological valves and usually don't have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer.
Unlike biological 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 of IE.
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
If you're a woman of childbearing age or if you're athletic, you may prefer a biological valve so you don't have to take blood-thinning medicines. If you're elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
Some newer forms of heart valve repair and 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 usually are 3–5 days, compared with 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—2–4 weeks versus 6–8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring catheter procedures that involve threading clips or other devices through blood vessels to faulty heart valves. The clips or devices are used to reshape the valves and stop the backflow of blood.
People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery. Researchers are still studying this treatment method.
Doctor also may use catheters to replace faulty aortic valves. This procedure is called transcatheter aortic valve implantation (TAVI).
For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. At the end of the catheter is a deflated balloon with a folded replacement valve around it.
Once the replacement valve is properly placed, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.
A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.
Catheter procedures may be an option for patients who have conditions that make open-heart surgery too risky. Only a few medical centers have experience with these fairly new procedures.
Doctors also treat faulty aortic valves with a procedure called the Ross operation. During this operation, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. Your 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 well within a few years of the surgery. Experts continue to debate and study 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 procedures used.
Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To find clinical trials that are currently underway for Heart Valve Disease, visit www.clinicaltrials.gov.
November 18, 2013
Valve repair or replacement offers similar outcomes for severe heart valve disease
Repair or replace? Consumers often ask this question when considering faulty cars, appliances, or other equipment. A new clinical study has now addressed this question for a serious medical decision: how to treat ischemic mitral regurgitation (IMR), a condition in which blood backflows into the heart because the mitral valve becomes leaky after a heart attack. The study compared the two surgical options –re-tightening the leaky mitral valve or replacing it with a prosthetic –and found no significant differences in patient outcomes after a year.
November 20, 2013
Gary H. Gibbons
New NHLBI Program Trains Scientists to Bring More Science Out of the Lab and into the Patient Care Marketplace
The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.