A leaky heart valve, or valvular regurgitation, occurs when one of the heart’s four valves does not close completely, allowing some blood to flow backward with each beat. The heart’s four valves—the mitral, aortic, tricuspid, and pulmonary—function like one-way doors to ensure blood moves in the correct direction. When a valve leaks, the heart must work harder to re-pump the backward-flowing blood, straining the heart muscle over time. This inefficiency can lead to symptoms like shortness of breath, fatigue, or swelling in the legs. Treatment depends on the specific valve affected and the severity of the leak, ranging from monitoring to complex surgical or catheter-based procedures.
Initial Management and Monitoring
For individuals with mild or moderate regurgitation causing no significant symptoms, the initial strategy involves careful observation rather than immediate intervention. This approach, often called “watchful waiting,” requires routine check-ups and diagnostic tests to track the condition’s progression. The most common monitoring tool is the echocardiogram, which uses sound waves to create moving pictures of the heart and measure the degree of leakage and its impact on heart function.
Managing underlying conditions and making lifestyle adjustments help reduce strain on the heart muscle. Doctors recommend a heart-healthy diet, including reduced sodium intake to minimize fluid retention, and regular physical activity. Medications are frequently prescribed to manage symptoms and prevent complications, even though they do not physically fix the valve. Diuretics (water pills) are used to reduce fluid buildup in the lungs and legs, easing a main symptom of heart strain. Other medicines, such as certain blood pressure medications, may be used to lower the overall workload on the heart, preserving its function until intervention is necessary.
Traditional Surgical Repair and Replacement
When the leak becomes severe or causes significant symptoms, physically addressing the damaged valve is required. The traditional method is open-heart surgery, which involves a sternotomy where the breastbone is opened for direct access to the heart. Surgeons prefer to repair the native valve rather than replace it, as repair results in a lower risk of infection and avoids complications associated with artificial valves. For a leaking mitral valve, repair often involves annuloplasty, where a ring or band is sewn around the base of the valve to tighten the opening and help the leaflets close properly.
If the valve is too damaged to be repaired, it must be removed and replaced with a prosthetic valve. There are two main types of replacement devices: mechanical and biological (tissue valves). Mechanical valves are highly durable, often lasting 20 to 30 years, making them a common choice for younger patients. However, their metal or carbon construction carries a risk of blood clot formation, necessitating lifelong use of blood-thinning medication like warfarin.
Biological valves are typically made from animal tissue, such as from pigs or cows, and are sewn onto a supportive frame. The primary advantage of a biological valve is that it usually does not require lifelong anticoagulation medication, reducing the risk of bleeding complications. This makes them a preferred option for older patients or those for whom blood thinners are too risky. The trade-off is that tissue valves are less durable, with an expected lifespan of about 10 to 20 years before they may degenerate and require re-replacement.
Minimally Invasive and Transcatheter Interventions
Advancements in medical technology have introduced less invasive options that can fix a leaky valve without a full sternotomy or stopping the heart. These transcatheter procedures use thin, flexible tubes to reach the heart through blood vessels, typically accessed via a small incision in the groin or chest. These methods are suitable for patients considered high-risk for traditional open-heart surgery due to age or other health concerns.
For aortic valve replacement, Transcatheter Aortic Valve Replacement (TAVR) has become a widely used procedure. During TAVR, the new valve is compressed onto a catheter and delivered to the site of the diseased valve, where it is expanded and deployed within the old valve. The procedure avoids opening the chest and is associated with a faster recovery time and a shorter hospital stay than traditional surgery.
For the mitral valve, a common transcatheter repair technique is the MitraClip procedure, which is a form of Transcatheter Edge-to-Edge Repair (TEER). A small clip is guided to the mitral valve and used to grasp the two leaking leaflets, bringing them closer together to reduce blood backflow. This intervention can significantly improve heart failure symptoms and is a viable alternative for patients who cannot undergo open-heart repair. While these minimally invasive techniques offer benefits in recovery speed and reduced trauma, their suitability depends on the specific anatomy and complexity of the patient’s valve disease.
Life After Valve Treatment
Recovery following a valve procedure varies significantly depending on the method used. Patients who undergo traditional open-heart surgery typically require a hospital stay of about a week and a rehabilitation period of two to three months before fully returning to normal activities. Conversely, those treated with transcatheter interventions may be discharged within one or two days and experience a quicker return to daily life.
Regardless of the procedure, supervised cardiac rehabilitation is often recommended to help the patient regain strength and fitness safely. Long-term follow-up is important, involving regular check-ups and imaging tests like echocardiograms to monitor the function of the new or repaired valve. Medication management is a significant consideration, especially the need for anticoagulants. Patients with a mechanical replacement valve must remain on blood thinners for life. Those with a tissue valve may only need a short course of medication or none at all. Patients are advised to watch for signs of potential issues, such as a return of shortness of breath, unexplained weight gain, or fainting, and to report these to their medical team immediately.