Valvular disease occurs in many forms and can affect any of the four valves of the heart.
The most common forms of valvular disease include aortic stenosis, aortic insufficiency, mitral valve regurgitation, and mitral stenosis.
These conditions are potentially serious impediments to heart function, often hindering or reversing the natural flow of blood through the heart.
To treat valvular disease, surgeons either repair the patient's own valve, or replace that valve with a tissue or mechanical substitute.
Dr. Craig Smith - How does mitral valve repair compare with mitral valve replacement?
The most common valve operation is aortic valve replacement for aortic stenosis.
The aortic valve resides deep within the heart and regulates the blood supply to all of the major vessels of the body.
In aortic stenosis, the aortic valve tightens or narrows, preventing blood from easily flowing through.
Aortic stenosis may manifest itself along with other heart problems such as coronary artery blockages or other valve disease.
Aortic insufficiency may also require aortic valve replacement.
With aortic insufficiency, the aortic valve no longer adequately retains blood, allowing leakage through the valve back into the heart.
Aortic insufficiency can lead to heart failure.
Surgical options for either aortic stenosis or insufficiency include the implantation of a mechanical valve, a tissue valve, or your own valve (the Ross procedure).
The type of valve used typically depends on the severity of symptoms and other individual health concerns, such as age and the use of blood thinners.
The procedure may require a sternotomy (opening of the chest bone) or, in select cases, may be performed through a minimally invasive approach, using a series of small incisions.
Patients who are unable to undergo surgery for aortic valve replacement may be candidates for a minimally invasive approach called transcatheter aortic valve implantation, or TAVI.
This approach is currently under investigation at NewYork-Presbyterian/Columbia in the PARTNER study.
TAVI has been found to be as effective as open surgery, and significantly superior to medical management, as reported in September 2010 and April 2011.
Read more about transcatheter aortic valve replacement here.
The Mitral Valve: Repair and Replacement
What is the Mitral Valve?
The mitral valve separates the left atrium from the left ventricle and regulates the flow of blood between these two chambers.
Mitral Valve Regurgitation: Mitral Valve Leaking
In mitral valve regurgitation, the mitral valve leaks, allowing the backflow of blood through the heart and into the lungs.
This condition can cause shortness of breath, irregular heartbeats, and pain.
What is Mitral Valve Prolapse?
Mitral valve regurgitation is sometimes caused by mitral valve prolapse, a relatively common and benign condition in which the patient has too large a valve leaflet that makes a snapping sound when the valve closes. Depending on the severity of the leakage, mitral regurgitation can be treated by valve repair, rather than replacement.
Mitral Valve Repair
Mitral valve repair offers a very normal life to the patient without the requirement for blood thinners and other interventional therapies often associated with valve replacements. At Columbia, our surgeons now treat mitral valve regurgitation with a minimal access approach known as the "Bow Tie" procedure, which is extremely effective in curing this disorder.
In addition, through the EVEREST II clinical trial, physician-scientists at Columbia are investigating a non-invasive approach using the Evalve clip to treating mitral valve regurgitation. However, some cases of mitral regurgitation do require replacement with a tissue or mechanical valve.
The type of valve replacement chosen depends largely on the severity of the condition and the overall health of the patient.
Learn more about: Bow Tie Procedure | Evalve® Repair System
Dr. Craig Smith - What should I know before I have mitral valve repair or replacement?
Mitral Valve Stenosis
Mitral stenosis, or a constricted mitral valve, is another disorder that sometimes requires mitral valve repair or replacement.
Relatively uncommon, this condition often strikes individuals who had rheumatic heart disease as children.
Options for treatment include comissurotomy, making small incisions to free valve leaflets, or valve replacement.
Tricuspid Valve Replacement
Tricuspid valve surgery is uncommon, and typically only occurs in conjunction with mitral or aortic valve repair or replacement.