A Structural Heart Program is a specialized discipline within cardiology focused on treating structural defects of the heart that do not involve the coronary arteries. These programs address congenital or acquired abnormalities affecting the heart’s anatomy, including its valves, walls, and chambers. The goal is to provide comprehensive care for patients with complex cardiac conditions, often utilizing advanced, non-surgical techniques to restore normal heart function.
What Defines Structural Heart Disease Treatment
Structural heart disease treatment concentrates on anatomical problems rather than issues of heart rhythm or blockages in the coronary arteries. General cardiologists manage conditions like hypertension, while electrophysiologists specialize in the heart’s electrical system. Structural heart programs focus on defects in the physical structure of the heart, such as damaged valves or holes between chambers.
The defining characteristic of modern structural heart programs is the shift toward catheter-based, or percutaneous, intervention as an alternative to open-heart surgery. This approach allows physicians to repair or replace damaged structures by guiding thin, flexible tubes, called catheters, through blood vessels, typically accessed via a small incision in the groin. This method provides a less invasive option for patients, particularly those deemed high-risk for traditional surgical procedures.
Treating these anatomical defects involves sophisticated planning that relies on advanced cardiac imaging technologies. Specialists use tools like computed tomography (CT) scans and echocardiography (ultrasound) to precisely map the heart structure before a procedure. This detailed visualization is necessary to determine the exact nature of the defect and to guide the placement of therapeutic devices.
Common Conditions Addressed
Structural heart programs manage a broad spectrum of defects, which can be present from birth or develop over time. A primary focus is valvular disease, where the heart’s four valves fail to open or close properly. Aortic stenosis, for example, is a condition where the aortic valve thickens and narrows, restricting blood flow.
Another common valvular issue is mitral regurgitation, which occurs when the mitral valve does not seal completely, causing blood to leak backward into the upper chamber. These programs also regularly treat congenital defects, which are abnormalities present at birth. Examples include a Patent Foramen Ovale (PFO) or an Atrial Septal Defect (ASD), both holes in the wall separating the heart’s upper chambers.
A third category involves stroke prevention in patients with atrial fibrillation. These patients often undergo Left Atrial Appendage Closure (LAAC) procedures. The left atrial appendage is a small pouch attached to the heart’s upper left chamber where blood clots frequently form, posing a risk of stroke.
Minimally Invasive Treatment Options
The core function of a structural heart program is the performance of advanced, minimally invasive procedures that offer patients faster recovery and reduced trauma compared to traditional surgery. For patients with severe aortic stenosis, the Transcatheter Aortic Valve Replacement (TAVR) procedure is a common option. TAVR involves delivering a new, collapsible valve via a catheter, which is then expanded within the diseased native valve to restore proper blood flow.
Another frequently performed intervention is the Transcatheter Mitral Valve Repair, often using a device like the MitraClip. This procedure addresses mitral regurgitation by clipping the leaflets of the mitral valve together to reduce the backward flow of blood. The device is threaded through a catheter and guided into the heart using advanced imaging.
For patients with congenital defects, specialized closure devices are used to repair the anatomical abnormality. Devices are deployed to patch holes such as a PFO or an ASD, preventing the abnormal mixing of blood between the heart chambers.
For stroke risk reduction in atrial fibrillation patients, the Left Atrial Appendage Closure procedure is performed using devices like the Watchman implant. The device permanently seals off the left atrial appendage, preventing blood clots from entering the bloodstream. This catheter-based approach often results in a hospital stay of only one to three days.
The Specialized Team Approach
The modern treatment of structural heart disease is fundamentally built around a multidisciplinary model known as the “Heart Team” approach. This collaborative structure ensures that every patient’s case is evaluated by a diverse group of specialists before a treatment plan is finalized. The team jointly determines whether the best course of action is traditional open surgery, a minimally invasive catheter procedure, or medical management.
The team typically includes:
- Interventional Cardiologists, who specialize in catheter-based procedures.
- Cardiac Surgeons, who provide expertise in open-heart surgery.
- Advanced Cardiac Imaging Specialists, who interpret complex scans like transesophageal echocardiograms and CTs to guide treatment planning and device sizing.
- Specialized Cardiac Anesthesiologists, who provide tailored anesthesia and monitoring during the often intricate procedures.
This comprehensive group of experts meets regularly to discuss individual patient data, complex anatomy, and procedural risks and benefits. This collective assessment optimizes the decision-making process, ensuring the patient receives a highly personalized and safest possible intervention.