When a heart valve doesn’t open all the way or has problems closing, it affects the flow of blood through the heart's chambers. This is called heart valve disease. In stenosis, a hardened or scarred valve becomes increasingly hard to push open. Blood has to flow through a smaller opening, so less blood goes through the valve to the next chamber. In insufficiency, or regurgitation, a valve doesn’t close tightly enough and blood leaks back the wrong way through the valve.
During heart valve surgery, one or more valves will be replaced, repaired, and if possible and medically advisable, replaced. Three types of prosthetic (artificial) valves are available to replace the malfunctioning aortic valve:
- Mechanical valves made of metal or plastic and covered with polyester knit fabric, so they can be sewn into place
- Biological valves can be heterograft valves, made from bovine or porcine tissue, or homograft valves from a human donor
At Marin General Hospital, our surgeons typically use biological valves. Mechanical valves are durable, but tend to promote clotting, which requires patients to take anticoagulants for the rest of their lives. (This is less of a concern if the patient is already taking anticoagulants for other reasons).
Aortic Valve Replacement
The aortic valve is located between the left ventricle and the aorta, which provides oxygenated blood to the body. Aortic valve replacement is most commonly performed for aortic stenosis, when the heart valve does not open fully, but may also be necessary for excessively leaky valves. Causes may include the aging process, childhood rheumatic fever, an infection known as endocarditis, or a common congenital birth defect.
Mitral Valve Repair
The mitral valve allows blood to flow from the left atrium to the left ventricle. Mitral valve repair is usually performed to correct a leaking valve. This can be due to the aging process, rheumatic fever, infection, coronary artery disease, or a congenital abnormality. The majority of mitral valve repairs are performed for degenerative disease.
Mitral Valve Replacement
Not all mitral valves can be repaired. If repair is not possible, or medically advised, the mitral valve can be surgically replaced with a mechanical or biological valve.
Tricuspid Valve Repair
The tricuspid valve is located between the right atrium and the right ventricle. Damage to the tricuspid valve can be caused by a dilated right ventricle, pulmonary hypertension, congenital abnormalities, rheumatic fever, and other conditions. Some consider tricuspid valve repair to be the most challenging valve repair surgery, and it is actually more difficult than tricuspid valve replacement. Depending on the individual case, the procedure may involve the implantation of a device called an annuloplasty ring to support the mitral valve and allow it to maintain the appropriate diameter of opening.
Tricuspid Valve Replacement
Tricuspid valve replacement is used to treat tricuspid valve stenosis, tricuspid valve regurgitation, or a combination of the two called myxomatous valve disease. The replacement valve can be a biological, homograft, or mechanical valve.
Heart surgery is an open procedure that entails a significant recovery process as well as rehabilitation. If more than one valve needs repair or replacement, combination surgeries may be performed on a case-by-case basis. Many patients who need bypass surgery have an enlarged heart, which tends to pull the mitral valve apart. Bypass surgery can also serve as an opportunity to fix a leaky mitral valve.