A leaky heart valve, medically known as valvular regurgitation, occurs when one of the heart’s four valves does not close completely, allowing blood to flow backward into the heart chambers. This backward flow forces the heart to work harder to pump blood, straining the heart muscle over time and potentially leading to heart failure. The valves most frequently affected are the mitral valve, located between the left upper and lower chambers, and the aortic valve, which controls blood flow out of the heart. Treatment depends on the severity of the leak and the patient’s symptoms, ranging from observation to complex surgical or catheter-based interventions.
Non-Invasive Management and Monitoring
For individuals with mild or moderate valvular regurgitation who are not experiencing significant symptoms, the initial approach is typically non-invasive management. This strategy involves “watchful waiting,” where a cardiologist actively monitors the condition’s progression without immediate structural intervention. Regular check-ups, including echocardiograms, are performed to assess the valve’s function, measure the size of the heart chambers, and quantify the severity of the backflow.
Lifestyle modifications form an important part of this management plan to reduce strain on the heart. Recommendations include adopting a heart-healthy diet low in sodium and saturated fats, maintaining a moderate weight, and engaging in appropriate physical activity as advised by a doctor. Medications are often prescribed, not to physically fix the leak, but to manage symptoms and lower the heart’s workload. Diuretics reduce fluid buildup in the lungs and body, while blood pressure medications like vasodilators relax blood vessels, easing the effort required for the heart to pump blood forward.
Traditional Open-Heart Surgical Interventions
When valvular regurgitation becomes severe or begins to cause symptoms like shortness of breath, a physical fix is necessary. Traditional open-heart surgery remains the definitive option for many complex cases. This approach requires a full sternotomy, or cutting through the breastbone, and connecting the patient to a heart-lung bypass machine to temporarily stop the heart during the procedure. The surgeon then directly accesses the valve to perform either a repair or a replacement.
Valve repair is generally preferred over replacement, especially for the mitral valve, as it preserves the patient’s own valve structure and results in better long-term heart function. Repair techniques often involve annuloplasty, where a ring is surgically sewn around the valve’s opening to tighten and support the structure. Other methods include chordal repair, which fixes or replaces the small, cord-like tendons that support the valve leaflets.
If the valve is too damaged, a full replacement is performed using one of two primary types of prosthetic valves. Mechanical valves are made from durable, carbon-coated materials and are designed to last a lifetime, but they require the patient to take lifelong anticoagulant medication, such as Warfarin, to prevent dangerous blood clots from forming on the valve. Bioprosthetic, or tissue, valves are made from animal or human tissue and typically do not require lifelong anticoagulation. However, these valves are less durable, usually lasting between 15 and 20 years, and may necessitate a future replacement procedure.
Minimally Invasive and Transcatheter Repairs
Advances in cardiac care have introduced minimally invasive and transcatheter procedures, offering alternatives that avoid the need for a full sternotomy and heart-lung bypass. These techniques are typically performed through small incisions or by threading a catheter through a major blood vessel, often in the groin. This less-invasive approach is particularly beneficial for older patients or those with other health conditions that make them high-risk candidates for traditional open-heart surgery.
For a leaky aortic valve, the most common transcatheter procedure is Transcatheter Aortic Valve Replacement (TAVR). A new replacement valve, crimped onto a balloon or self-expanding frame, is delivered via the catheter and positioned directly inside the diseased native valve. The new valve then expands and takes over the function of the old, leaky valve. This method is primarily used for aortic stenosis, where the valve is narrowed, but can also be adapted to treat regurgitation.
For a leaky mitral valve, the most established transcatheter repair is the MitraClip procedure. This procedure uses a specialized clip delivered through a catheter, usually inserted through a vein in the leg, to grasp and clip together the edges of the mitral valve leaflets. This creates a double-orifice valve, which reduces the backward flow of blood while still allowing blood to move forward. The MitraClip is a well-established repair option for high-risk patients with both degenerative and functional mitral regurgitation.
Life After Valve Repair or Replacement
Recovery time varies significantly depending on the procedure performed. Patients who undergo transcatheter procedures like TAVR or MitraClip often experience a much faster recovery, sometimes returning home within two to three days. Recovery from traditional open-heart surgery, which involves the healing of the sternum, typically takes two to three months.
Long-term medical management and monitoring are necessary regardless of the method used. Individuals with a mechanical replacement valve must adhere to a strict, lifelong regimen of anticoagulant medication, such as Warfarin, which requires regular blood tests. All patients with a repaired or replaced valve must maintain follow-up visits with a cardiologist, typically including annual echocardiograms. Precautionary antibiotics are often required before certain medical and dental procedures to guard against infectious endocarditis.