Heart valve disorders

Stenosis means narrowing. The stiffening of heart valves can narrow the size of the valve opening. This restricts blood flow. In severe cases, the valve opening can become so narrow that the rest of the body may not receive enough blood flow. There are four heart valves and each valve can narrow with different consequences:

• Aortic valve stenosis: Narrowing restricts blood flow from the heart to the body, leading to heart strain and inefficiency.
• Mitral valve stenosis: Narrowing reduces blood flow from the left atrium to the left ventricle, causing fatigue and lung fluid buildup.
• Tricuspid valve stenosis: If this valve narrows, blood can't move properly from the right atrium to the right ventricle, affecting blood pressure and lung circulation.
• Pulmonary valve stenosis: Narrowing here restricts blood flow to the lungs, reducing the ability to pick up oxygen and deliver it to the rest of the body. (This is a relatively rare condition.)

Prolapse is a condition when the valve flaps slip out of place or form a bulge. This can lead to poor or uneven closure of the heart valve. As a result of the prolapsed valve, blood may leak backwards through the valve and one-way blood flow may be disrupted. Again, different affected valves have different consequences:

• Mitral valve prolapse: In mitral valve prolapse, the valve fails to close evenly and results in bulging. Bulging of the valve into the atrium during contraction leading to the heart working harder and making it less efficient to pump blood.
• Tricuspid, pulmonary and aortic valve prolapse: Less common, these valves also fail to close properly, causing blood leakage.

Regurgitation can happen when the valve doesn’t close properly and allows blood to flow backwards. This can lead to blood leaking backward through the valve (called regurgitation). This disruption of the one-way blood flow in the heart puts a strain on your heart, reduces its pumping efficiency, and limits its ability to supply your body with oxygen-rich blood.

• Tricuspid valve regurgitation: This is when leaking blood causes your heart to work harder to move the blood through this valve. Over time, if this condition becomes serious, it can cause blood flow problems.
• Pulmonary valve regurgitation: This causes a mix of oxygen-rich and poor blood, reducing oxygen supply to the body.
• Mitral valve regurgitation: In mitral valve regurgitation, you have backward leakage which reduces blood flow to the body and may lead to lung congestion.
• Aortic valve regurgitation: This results when oxygen-rich blood leaks backward from the aorta into the left ventricle with each heartbeat. Backward flow strains the heart, increasing the risk of heart failure.

An angiogram provides detailed images of the heart's blood vessels. It helps your care team look for the presence and severity of any damage to the heart.

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An X-ray is a non-invasive diagnostic procedure that is used to take images of the inside of the body. X-rays are done in the Radiology Clinic.

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An electrocardiogram (ECG or EKG) is a test that checks how your heart is functioning. It measures the electrical activity of the heart.

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Cardiac stress tests help diagnose and manage heart conditions. They tell us how the heart functions during physical activity. There are different ways to administer this test, depending on your situation. Most of the time, we will monitor heart activity as patients exercise on a treadmill. Sometimes medication is used to simulate exercise.

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An echocardiogram (Echo) uses sound waves (ultrasound) to create a picture of your heart. This shows the shape, texture and movement of your heart valves. It also shows the size of your heart chambers and how well they are working.

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Cardiac CT, or Cardiac Computed Tomography provides detailed images of the heart and its blood vessels using X-rays and computer technology. Cardiac MRI, or Cardiac Magnetic Resonance Imaging produces detailed images of the heart using powerful magnets and radio waves.

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This option preserves heart tissue. The team can repair the valve and/or insert clips or other devices to improve how the valve works.

Some valves are too damaged to repair. You may receive either a mechanical valve or a biological valve:

• Mechanical valve: These valves are made of carbon or metal, and are designed to last for life. They increase the risk of blood clots, though, so patients need to take blood thinners for life.
• Biological valve: These are made of human, cow or pig tissue. They last one to two decades and then need to be replaced. Typically, patients do not need to take blood thinners.

Heart valve surgery is open-heart surgery. It is done through the breastbone, into the chest. Your problematic valve will be repaired if possible but it will be replaced if it is too damaged. The surgical staff will discuss all of those issues with you in advance. This is a major operation that can last two hours or longer. Recovery can often take several weeks.

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Depending on the valve, there are a number of non-surgical valve replacement options. Transcatheter Aortic Valve Implantation or TAVI is for the treatment of aortic stenosis. For the TAVI procedure, rather than opening your chest, the surgeon threads a thin and flexible wire through your blood vessels towards the heart. Then, they place a small artificial valve onto a tiny balloon which securely positions the new valve in place. This procedure, pioneered at St. Paul's Hospital, is now performed routinely around the world.

If you have a mitral or tricuspid valve problem and it is determined by your team that surgery is not an option for you, the Transcatheter Edge to Edge Repair (TEER) or other replacement therapies may be discussed with you.

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To help with communicating with your health care team, we offer interpretation services 24-hours-a-day. Please ask your care team to place a request if you need an interpreter including a sign language interpreter.

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We offer pastoral care services to support you and your loved ones. Our professional staff, including chaplains from different faiths, are here to accompany you, provide counselling, and create spaces for reflection, prayer, and meditation.

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We strive to offer you the best and most compassionate care possible. If we succeed, please let us know. If we fall short of our goal “How you want to be treated,” please also let us know.

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