People with mild heart valve problems often live long, full lives and never
require treatment. But once a diseased valve begins to affect your heart’s
ability to pump blood, you may need a valve repair or replacement to prevent
serious complications such as:
heart failure, the heart’s inability to pump enough blood.
Atrial fibrillation, an irregular heartbeat.
Pulmonary hypertension, a type of high blood pressure in your lungs that forces the heart to
work harder, increasing the risk for heart-related complications.
- Death can also be an outcome.
“Fortunately, in the last decade there’s been a revolution
— not just an evolution — in repairing and replacing heart
valves,” said BCH Structural Heart Program Director
Dr. Srini Iyengar during a free online health lecture.
“We now have the capability to address serious internal cardiac
issues with minimally invasive techniques. The results with certain procedures
are now equivalent to, if not better than, traditional surgical treatment,” he said.
Watch Dr. Iyengar's online lecture on "Latest Treatments for Heart Valve Problems"
Please click on the links below to see more info:
Heart Valve Disease: A Problem of Faulty Heart Valves
There are four heart valves that keep blood flowing through the heart and
in the proper direction. They are the aortic, mitral, pulmonic and tricuspid valves.
“Heart valve disease occurs when a valve becomes damaged. Although
the damage is often linked to age-related factors, sometimes it can develop
from illnesses such as rheumatic fever, infective endocarditis or a prior
heart attack,” Dr. Iyengar said.
There are two main issues that can occur with the heart’s four valves:
regurgitation and stenosis.
Regurgitation occurs when a valve does not fully close and allows blood to leak backwards.
This is commonly referred to as a leaky valve.
Stenosis is the narrowing of a valve that prevents blood flow. It is often described
as a tightening valve.
Any of the four valves can have regurgitation or stenosis—sometimes
both—but the mitral and aortic valves are most likely to be damaged.
Mitral Regurgitation affects thousands of Americans each year, and is the most common type
of heart valve insufficiency in the U.S. It occurs when the mitral valve
does not fully close, allowing blood to leak backwards. Dr. Iyengar warned,
“If you have a mitral regurgitation that starts to progress, it
will eventually lead to heart failure. For this reason, it's important
to keep a close eye on a diagnosed leaky valve.”
Aortic stenosis is the narrowing of the aortic valve that prevents blood flow. It is one
of the most serious valve disease problems. Many people who have aortic
stenosis live without symptoms for many years. Yet once they start to
experience even minor symptoms— angina, shortness of breath, lightheadedness
and even fainting—urgent treatment is critical because the disease
“For those with severe aortic stenosis, the survival rate is low
when left untreated. Survival is only 50 percent at two years after the
onset of symptoms and 20 percent at five years without treatment,”
Dr. Iyengar emphasized.
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Minimally Invasive Endovascular Valve Repair or Replacement
Treatment for mitral or aortic valve disease depends on the severity of
the damage and may include prescribed medication. While medications can
help manage the symptoms, they cannot reverse the underlying disease.
If your condition becomes severe, you may need a valve repair or replacement.
“Traditionally this required open-heart surgery, formerly the gold
standard treatment,” according to Dr. Iyengar. During an open-heart
procedure, patients are connected to a heart-lung bypass machine, which
does the work of the heart while their heart is stopped.
However, open-heart surgery becomes riskier with those too frail to endure
such an invasive procedure.
“For high-risk patients, a minimally invasive
endovascular heart valve repair or replacement can be a safer alternative. These newer procedures don’t require
opening up your chest or being placed on a heart-lung machine,”
said Dr. Iyengar. “They can also result in reduced scarring, less
postoperative pain and a shorter recovery time, when compared to open
He added, "Current data now points to patients who are at intermediate
or even low risk can get certain procedures to address their underlying
valve disease — i.e., aortic stenosis.”
Minimally invasive endovascular valve procedures involve inserting a catheter
through a small incision in the upper leg and guiding it through your
artery or vein (depending on the type of procedure) — via fluoroscopy
(special x-ray) and echocardiography (type of ultrasound)—to reach
Your doctor will determine whether:
• Mitral valve repair or replacement is the most appropriate for
• You're a candidate for either open-heart surgery or a minimally
invasive endovascular procedure such as
MitraClip® Therapy or
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MitraClip for Mitral Valve Repair
Dr. Iyengar explained that Boulder Community Health’s full-service
cardiology program—the only one in Boulder County—recently added
MitraClip® Therapy to its range of minimally invasive endovascular treatments.
The procedure repairs a leaky mitral valve (regurgitation) by using a small, dime-sized clip to close the center of the valve. The
physician guides the clip through a large vein in your leg to your heart
via a steerable catheter, which delivers and attaches the device to the
mitral valve. Once the clip is attached, your mitral valve closes more
completely, helping to restore normal blood flow through your heart.
“Clinical data from patients who underwent the MitraClip procedure
demonstrate an immediate reduction in mitral regurgitation. The hospital
stay is usually just 24 hours,” Dr. Iyengar said.
He added, “Patients who were studied one year after the procedure
continued to experience improvement in their quality of life. And there
was a 73 percent reduction in hospitalizations for heart failure in the
year following the procedure compared to the year prior.”
MitraClip Therapy is Food and Drug Administration (FDA) approved only for
people with mitral regurgitation for whom surgery is too risky.
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TAVR: Newer, Less Invasive Treatment for Aortic Stenosis
An alternative to traditional open-heart valve replacement surgery for
severe aortic stenosis is a new, less invasive endovascular option called
Transcatheter Aortic Valve Replacement (TAVR). The procedure involves replacing the faulty valve by threading a synthetic
one through a blood vessel.
Dr. Iyengar noted on the day of his presentation, “There’s
data being released today that indicates, for the first time in U.S. medical
history, there are more TAVR procedures being performed for aortic stenosis
than open surgical procedures.” He was excited to add, “This
technology has surpassed open surgery and is considered the new gold standard
for replacing aortic valves with stenosis.”
The FDA recently expanded the number of patients diagnosed with severe
aortic stenosis who will be able to receive TAVR. It opened use of TAVR
to not only high-risk but also to low- and intermediate-risk patients.
View/download a PDF of slides shown during Dr. Iyengar's lecture on “Latest Heart Valve Treatments.”
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Make an Appointment
To make an appointment with
Dr. Srini Iyengar, or if you have questions about heart valve disease, contact Boulder Heart’s
Structural Heart Team at 303-442-2395.
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