Valvular Heart Disease

Do I have Valvular Heart Disease?

Valvular heart disease is characterized by a defect or damage of one of the heart valves.  The heart has four valves: the mitral, aortic, tricuspid or pulmonary valve.

The mitral and tricuspid valves control the flow of blood between the upper and lower chambers of the heart (the atria and the ventricles). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve controls the blood flow between the heart and the aorta and the blood vessels to the rest of the body.

Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become narrow and hardened and are unable to open fully (stenotic) or unable to close completely (incompetent). The most commonly affected valves are the aortic valve and the mitral valve. The most commonly diagnosed heart valve conditions are aortic stenosis, mitral regurgitation, mitral stenosis, aortic regurgitation and less commonly tricuspid regurgitation/stenosis.

When the heart valves start to fail, they can cause symptoms of shortness of breath, fatigue, chest pain and even congestive heart failure. 

At the Queen’s Medical Center, we offer minimally invasive alternatives such as TAVR and MitraClip to help patients with valvular heart disease. Patients will meet a team of specialists in our valve clinic who all work in partnership to determine a unique treatment plan for every patient.

What is Aortic Valve Stenosis?

Aortic valve stenosis is the narrowing of your aortic valve opening that prevents the valve from opening fully, reducing normal blood flow and increasing the work load of the left ventricle, in order to pump sufficient amount of blood from the heart into the aorta and rest of your body. This will cause the left ventricle to thicken, enlarge, and eventually weaken, leading to heart failure and other problems.

It can be caused by a birth defect, rheumatic fever, radiation therapy, or more commonly by progressive build-up of calcium (mineral deposits) within the valve.

Risk factors of aortic valve stenosis include: older age, certain acquired heart conditions from birth, such as a bicuspid aortic valve, history of infections that can affect the heart, or presence of diabetes, high cholesterol, high blood pressure, chronic kidney disease, and history of radiation therapy to the chest.

The severity of aortic valve stenosis ranges from mild to severe. Symptoms will generally develop when the valve narrowing is severe. Although, some people with severe aortic valve stenosis may not experience symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

• Abnormal heart sound or murmur
• Chest pain or tightness with activity
• Dizziness, lightheadedness or fainting with activity
• Shortness of breath and/or fatigue, especially with activity
• Heart palpitations

The heart-weakening effects of aortic valve stenosis may lead to heart failure, and may cause progressive fatigue, shortness of breath, and/or swelling of the ankles/feet.

The definitive treatment of aortic valve stenosis is only achieved by replacing the damaged aortic valve, either by open heart surgery or minimally invasive Transcatheter Aortic Valve Replacement (TAVR).

Queen’s Heart Cardiovascular Interventional & Surgical Services is the premier program in Hawaii to offer Transcatheter Aortic Valve Replacement (TAVR).

When should I see a doctor?

If you have a heart murmur, your doctor may recommend that you visit a heart doctor (cardiologist). If you are experiencing any of the above mentioned symptoms, see your doctor.

What is Mitral Valve Regurgitation?

Mitral Valve Regurgitation, also known as mitral incompetence or mitral insufficiency, is a condition where your mitral valve fails to close tightly, allowing blood to flow backward in your heart. As it progresses, so will the amount of blood leaking back into the upper left chamber of the heart, each time the left ventricle contracts, reducing the amount of blood that needs to move forward to the rest of your body, making you feel tired or out of breath.

The severity ranges from mild to severe. Mild mitral regurgitation may not have any symptoms. As the condition progress, the patients may experience palpitations, especially when lying on the left side. If the regurgitation is severe, increased pressure may result in congestion (or fluid build-up) in the lungs and the heart may enlarge to maintain forward flow of blood, causing heart failure. This may cause fatigue, shortness of breath, coughing, and/or swelling of the ankles/feet.

What is the treatment for mitral regurgitation?

Treatment of mitral valve regurgitation depends on how severe the condition is, or whether there are present symptoms. Definitive treatment requires heart surgery to repair or replace the damaged valve.

Patients that have symptomatic severe mitral regurgitation that are too sick for open heart surgery, may undergo minimally invasive catheter-based procedure for the treatment of their condition.

If left untreated, severe mitral valve regurgitation can cause heart failure or heart rhythm problems (arrhythmias).

The Queen’s Heart Cardiovascular Interventional & Surgical Services is the premier program in Hawaii to offer Transcatheter Mitral Valve Repair (TMVR) with the Mitraclip™. This procedure is a minimally invasive catheter-based procedure for patients with symptomatic, degenerative and functional Mitral Regurgitation (MR) who may be too sick for surgery.