Heart Valve Repair and Replacement Surgery

What is a Heart Murmur? An Overview

A heart murmur is a sound caused by abnormal blood flow through the heart. A normal heart sounds like "lub-DUPP" or "lub-DUB." A heart murmur may cause a whooshing or swishing sound.

Not all heart murmurs are associated with symptoms or need treatment. Physicians may discover these innocent, or "benign," heart murmurs during routine exams. Other murmurs indicate there is a heart valve problem that needs treatment. Simple tests are recommended to determine the severity of the murmur and whether or not treatment is indicated.

Learn more about valve replacement at Baptist in these videos and audio recordings. To return to the playlist, click the FLOW button in the upper right corner of the viewer.

Heart Valve Disease May Go Unnoticed

One common cause of an abnormal murmur is a narrowing in one or more of the four valves in the heart. This narrowing, called "stenosis," causes blood to leak backwards into the heart instead of being pumped out of the heart. Stenosis is most often due to accumulation of calcium deposits on the valves that prevent them from opening properly.

Because this calcification is a slow process, symptoms of heart valve disease may not be noticed until the calcium buildup is moderate to severe. Over time, most people tend to decrease their activities so that they do not experience symptoms, and don't recognize that treatment is needed.

However, untreated stenosis in a heart valve can have serious consequences. When the valve is not able to open and close properly because of the build up of calcium, the heart must work harder to push blood through the narrow valve. Eventually the heart's muscles weaken, increasing the person's risk of heart failure and other complications.

People with moderate to severe stenosis may experience symptoms, such as:

• Severe shortness of breath ("dyspnea") leading to gasping, even at rest
• Shortness of breath while lying down, requiring the person to prop up on pillows to sleep
• Chest pain or tightness
• Fainting ("syncope")
• Extreme fatigue or progressing fatigue
• Lightheadedness/dizziness
• Difficulty exercising
• Rapid or irregular heartbeat

Understanding Heart Valve Treatments

To understand how heart valves are treated, it helps to know how they work.

The heart has four chambers: two upper chambers called atria, and two lower chambers called ventricles. Between each chamber is a one-way valve that opens to allow blood in, and closes to keep blood from flowing backwards. These valves between the heart's chambers are called atrioventricular valves. The valve connecting the right atrium and ventricle is the tricuspid valve. The valve connecting the left atrium and ventricle is the mitral valve.

There are also one-way valves located at points where blood exits the heart. Blood exits the heart to the lungs through the right ventricle via the pulmonary valve. Blood exits the heart to the rest of the body through the left ventricle via the aortic valve.

Each valve is made up of flaps of tissue called leaflets. When the leaflets open properly, blood moves through the heart freely. When the leaflets close properly, they form a tight seal that prevents blood from flowing backwards. Faulty valves are those that do not open or close correctly.

Heart Murmurs That Need Treatment: Types of Heart Valve Abnormalities

There are a number of heart valve abnormalities, such as leaky valves, that can cause heart murmurs. In general, "regurgitation" occurs when a valve fails to close properly, allowing blood to leak backwards. "Stenosis" occurs when a valve fails to open properly, restricting blood flow. Heart valve abnormalities include:

Aortic Regurgitation

Aortic regurgitation occurs when the aortic valve, located between the left ventricle and the aorta, doesn't close properly, allowing blood to leak backward through it into the left ventricle. Source: American Heart Association

Aortic Stenosis

Aortic stenosis occurs when the aortic valve, located between the left ventricle and the aorta, does not open fully. This decreases blood flow from the heart to the rest of the body. Source: National Institutes of Health

Hypertrophic Cardiomyopathy (idiopathic hypertrophic subaortic stenosis)

Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood. Hypertrophic cardiomyopathy is often asymmetrical, meaning one part of the heart is thicker than the other parts. The condition is usually inherited. Source: National Institutes of Health

Mitral Regurgitation

Mitral regurgitation occurs when the mitral valve, located between the left atrium and ventricle, does not close properly, causing blood to flow backward into the atrium when the ventricle contracts. This leads to a decrease in blood flow to the rest of the body. Mitral regurgitation is the most common type of heart valve abnormality. Source: National Institutes of Health

Mitral Stenosis

Mitral stenosis occurs when the mitral valve, located between the left atrium and ventricle, does not open properly, restricting blood flow. As a result, less blood flows to the body. The upper heart chamber swells as pressure builds up. Blood may flow back into the lungs. Fluid then collects in the lung tissue, making it hard to breathe. Source: National Institutes of Health

Pulmonary Regurgitation

Pulmonary regurgitation is the backflow of blood into the right ventricle, caused by failure of the pulmonary valve to close completely.

Pulmonary Stenosis

Pulmonary stenosis occurs when the pulmonary valve, located between the right ventricle and pulmonary artery, does not open properly, restricting blood flow from the heart to the lungs. This condition is usually present at birth. Source: National Institutes of Health

Tricuspid Regurgitation

Tricuspid regurgitation occurs when the tricuspid valve, located between the right atrium and ventricle, does not close properly, causing blood to flow backward into the right atrium when the right ventricle contracts. Source: National Institutes of Health

Tricuspid Stenosis

Tricuspid stenosis occurs when the tricuspid valve, located between the right atrium and ventricle, does not open properly, restricting blood flow from the atrium to the ventricle. This condition is often associated with rheumatic fever.

Heart Valve Repair and Heart Valve Replacement Surgery at Baptist

At Baptist, interventional cardiologists and cardiovascular surgeons treat patients with heart valve abnormalities that cause heart murmurs. These physicians use a number of state-of-the art diagnostic tests to determine the underlying cause of your heart murmur, and the recommended treatment options. Services to treat heart valve issues are coordinated through The Valve Center, a multidisciplinary program that brings together all the resources needed to care for patients with heart valve problems.

Click here to learn about The Valve Center.

Get to know physicians on staff at Baptist. Watch their video profiles:

William Harris, MD (surgical procedure)

Chris Waterer, MD (cath lab procedures)

Tests You May Need

To fine tune your diagnosis, your physician may perform any number of tests, including:

Echocardiogram:

An echocardiogram may be performed in the physician's office or at the hospital as an outpatient test. An echocardiogram shows your physician how the blood is flowing through the heart and the actual functional capacity of the muscle and all the valves. To perform the test, a sonagrapher specializing in cardiac testing moves a wand covered in gel across the outside of your chest, similar to an ultrasound test used in pregnancy. This wand picks up sound waves that create a moving picture of the inner workings of your heart.

Cardiac Catheterization

A cardiac catheterization is an invasive imaging procedure that allows your doctor to "see" in greater detail how well your heart is functioning. A cardiac catheterization is performed in the hospital and may require an overnight stay. However, when this procedure is done only as a diagnostic test, it typically is performed on an outpatient basis. During the catheterization, a long, narrow tube, called a catheter, is inserted into a blood vessel in your arm or leg and guided, using a special X-ray machine, to your heart. Contrast dye is then injected so that X-ray videos of your valves, coronary arteries, and the four chambers of your heart can be recorded.

Recommended Treatment

Depending on what your physician discovers during any diagnostic tests you may receive, your treatment will range from medications, to a procedure in our Cath Lab, to surgery.

Physicians who repair and replace heart valves at Baptist's Cardiovascular Center may use our brand new Hybrid OR Suite for these procedures. This surgical suite has the most advanced technology of its kind in the state of Mississippi. The suite allows physicians to perform both catheter-based and surgical techniques during the same procedure. This is designed to provide better outcomes for patients and reduce the number of hospital admissions necessary to achieve treatment goals.

Baptist offers all the following treatment options:

Medical Management

Medicines are used to slow down or stop the progression of valve disease. Some medicines are used to control symptoms caused by valve disease. It is not uncommon to try medications first before proceeding to surgical repair or replacement if necessary. Some medications may be stopped while others are continued after the valve has been repaired or replaced.

Valvuloplasty

In some cases of valve stenosis, physicians may be able to repair the valve by widening it in a procedure called valvuloplasty. The procedure is done in Baptist's Cath Lab. During the procedure, the physician inserts a catheter through an incision in the groin, and threads it through the veins into the heart. There, a tiny deflated balloon is placed into the valve and then inflated to widen the opening. The balloon is then deflated and removed. During the procedure, the cardiologist may also perform an echocardiogram to get a better picture of the valve.

Valvuloplasties are used for certain patients with symptomatic mitral valve stenosis, certain older people with aortic stenosis who are not able to undergo surgery, and some patients with pulmonic stenosis.

Chris Waterer, MD performs valvuloplasties

Surgical Repair and Replacement of Heart Valves

In surgery, valves can be repaired or replaced. During traditional open heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.

In some cases, patients may be treated by minimally invasive heart valve surgery. This is a type of surgery performed through smaller incisions, eliminating the need to cut the breastbone. This type of surgery reduces blood loss, trauma, and your length of stay in the hospital. At Baptist is Dr. William Harris, the only surgeon in Mississippi who can perform this type of procedure. Prior to surgery, Dr. Harris will review your diagnostic tests to determine if you are a candidate for minimally invasive valve surgery.

Watch a video of Dr. Harris discussing minimally invasive heart surgery to treat atrial fibrillation in the video player on this page.

TAVR - Transcatheter Aortic Valve Replacement

Additionally, Baptist physicians from The Valve Center performed the Jackson area's first transcatheter aortic valve replacement (TAVR) procedure. TAVR technology is available for the treatment of aortic stenosis in selected patients. The Edwards SAPIEN Valve, approved by the FDA in November 2011, is designed to replace a patient's diseased aortic valve without the need for open-heart surgery or the use of a heart-lung machine. The Edwards SAPIEN valve is approved for the treatment of patients with severe symptomatic native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement and in whom existing co-morbidities would not preclude the expected benefit from correction of the aortic stenosis.

Click here to read more about TAVR and to watch videos from Baptist

Click here to watch a short YouTube video about TAVR

See patient testimonies at newheartvalve.com

Heart Valve Repair Surgery

The mitral valve is the most commonly repaired heart valve, but the aortic, pulmonic, and tricuspid valves may also be repaired surgically.

If your valve can be repaired, your surgeon will perform surgery, depending on your diagnosis, to:

• Separate leaflets to widen the valve opening
• Remove calcium deposits that have formed on the leaflets causing them to become stiff
• Reduce the size of a leaflet that is too big and floppy to seal properly
• Tighten the ring of tissue ("annulus") that supports the valve
• Patch leaflets with tears or holes

Heart Valve Replacement Surgery

If your heart valve cannot be repaired, your doctor will replace the valve with one of three types:

Mechanical valve

These valves are made of mechanical parts well-tolerated by the body. Mechanical valves are very sturdy and made to last many years. People who receive them will need to take blood-thinners for the rest of their lives to prevent clots from forming in the valve.

Biological valve

These valves are made of animal tissue (usually pig or cow tissue). Tissue valves may also have some artificial parts. Most people who receive these valves don't have to take blood thinners, unless they are taking them to treat another condition.

Homograft valve

These are either aortic or pulmonic valves from donated human hearts. Frequently, there is limited availability.

The location of the valve being replaced will determine which type of replacement valve is recommended. Your physician will discuss with you what options are available.

Cardiac Rehab

After you have begun treatment, your physician may recommend that you participate in Baptist's Cardiac Rehab program. This is an outpatient program that combines supervised exercise with heart-specific education. Cardiac rehab can help patients feel better and reduce their risk for future heart problems

About Baptist Heart

Baptist has earned several prestigious certifications, accreditations and awards for our care of patients with cardiovascular conditions. Additionally, Baptist was the Jackson area's first hospital to be enrolled in the Helium research study sponsored by Edwards LifeSciences. This study evaluated outcomes and identified contributing factors of adult patients diagnosed with severe aortic stenosis who did not have their aortic valve repaired. Information obtained from this study has led to better patient identification and appropriate selection for valve intervention.

Preventing Heart Disease and Stroke

If you have a family history of heart disease and/or stroke, you may be interested in our low cost screening programs. These screenings are available year round and provide results you can have sent to your personal physician.

Learn more about our heart and stroke screening programs.