A leaking heart valve, or valve regurgitation, occurs when one of the heart’s four valves does not close completely. This malfunction allows blood to flow backward into the previous chamber. This backward flow forces the heart muscle to work harder to maintain sufficient blood circulation, which can lead to complications over time. Procedures and treatments are used to correct this condition and restore proper blood flow.
Determining the Severity of the Leak
The decision to intervene on a leaking heart valve depends heavily on how severe the leak is and its effect on heart function. Doctors use specific imaging tools to quantify the amount of blood flowing backward and to assess any resulting strain on the heart’s chambers. This initial assessment guides the timing and type of treatment selected for the patient.
The most common diagnostic tool is the echocardiogram, which uses sound waves to create a moving picture of the heart. This test allows physicians to visually track the backward blood flow and measure the size and pumping ability of the heart chambers. For more complex cases or to gain a different perspective, additional imaging such as a cardiac CT scan or MRI may be utilized to provide precise anatomical detail.
For patients with a mild leak that is not causing significant symptoms or affecting the heart’s function, a strategy known as watchful waiting is often employed. This approach involves regular monitoring with echocardiograms to track the leak’s progression over time. Intervention is generally reserved for patients whose leaks are categorized as severe or those who begin showing signs of heart dysfunction or failure.
Managing Valve Leaks Without Surgery
While medications and lifestyle changes do not physically fix the valve itself, they are utilized to manage symptoms and slow the progression of the underlying condition. These non-surgical methods reduce the workload on the heart, particularly in patients with mild to moderate regurgitation. They are also used to stabilize patients who are awaiting a surgical procedure.
Lifestyle modifications focus on reducing factors that strain the cardiovascular system. Adopting a diet low in sodium is recommended to prevent fluid retention, which lessens the volume the heart must pump. Regular, moderate exercise helps maintain overall heart health and improve circulation, while maintaining a healthy weight reduces cardiac strain.
Specific medication classes are routinely prescribed to ease the symptoms associated with valve leakage. Diuretics, sometimes called water pills, help the body excrete excess fluid and sodium, reducing swelling and improving shortness of breath caused by fluid buildup in the lungs. Vasodilators and beta-blockers may be used to lower blood pressure and slow the heart rate, which decreases the overall resistance the heart must pump against.
Open-Heart Surgical Repair and Replacement
Open-heart surgery is the definitive treatment for severe valve regurgitation and is considered the standard approach. This procedure involves a large incision down the center of the chest and temporarily stopping the heart, which is managed by a heart-lung bypass machine. Surgeons aim to repair the native valve whenever possible, as this outcome is typically preferred over replacement.
Valve repair, known as valvuloplasty, involves placing an annuloplasty ring around the base of the damaged valve to tighten and reshape its opening. Other repair techniques include stitching together tears in the valve leaflets or removing excess tissue to allow the valve to close completely. Repair preserves the patient’s own tissue and avoids the long-term issues associated with artificial valves.
When repair is not feasible due to extensive damage, the valve must be removed and replaced with a prosthetic valve. The two primary types are mechanical valves and biological tissue valves. Mechanical valves are highly durable, but require the patient to take lifelong anticoagulant medication to prevent blood clots from forming on the valve surface.
Biological valves are typically made from animal tissue, such as a cow or pig heart valve, and generally do not require lifelong anticoagulation therapy. However, these valves have a limited lifespan and may need to be replaced after 10 to 20 years, especially in younger patients. The choice between mechanical and biological replacement is a joint decision made with the surgical team, considering the patient’s age and lifestyle factors.
Modern Minimally Invasive Treatment Options
Less invasive procedures have emerged as alternatives to open-heart surgery, offering quicker recovery times and smaller incisions. These catheter-based and small-incision techniques are beneficial for individuals who may be at higher risk for complications from traditional surgery. These methods access the heart through major blood vessels in the groin or a small incision between the ribs.
For patients with a leaking aortic valve, Transcatheter Aortic Valve Replacement (TAVR) has become a standard option. This procedure involves threading a new, collapsible tissue valve through a catheter and positioning it within the diseased aortic valve. The new valve is then expanded, pushing the old valve leaflets aside and immediately restoring proper blood flow.
Leaking of the mitral valve can be addressed using a catheter-based repair technique, such as the MitraClip. This device is guided to the heart and clips the edges of the mitral valve leaflets together to reduce the backward flow of blood. This procedure is performed while the heart is still beating and avoids the need for a large chest incision.
Minimally invasive options are being developed for the tricuspid valve, located on the right side of the heart. Catheter-based tricuspid valve repair and replacement devices are becoming available. Doctors can address leaks in this valve through the venous system.