Structural cardiology is a distinct and rapidly evolving subspecialty focused on repairing defects in the physical architecture of the heart. These defects involve the heart’s walls, chambers, or, most frequently, its valves, which control the direction of blood flow. Structural cardiologists address these anatomical problems, many of which were previously correctable only through traditional open-chest surgery. This field offers patients less invasive alternatives for treating complex heart issues.
The Specialized Focus of Structural Cardiology
Structural cardiology concentrates on the physical framework of the heart, correcting mechanical issues like congenital defects or acquired conditions such as stiff or leaky heart valves. This differs from general cardiology, which manages chronic conditions using medication and lifestyle changes. The practice relies heavily on advanced imaging and catheter-based interventions to visualize and repair internal structures without major surgery.
This approach requires a high level of collaborative expertise, often involving a multidisciplinary “Heart Team” for complex decision-making. The team includes interventional cardiologists, cardiothoracic surgeons, and imaging specialists who collectively determine the most appropriate and safest treatment plan. This collaborative model ensures patients receive a comprehensive assessment, weighing the risks and benefits of both minimally invasive and surgical options.
Common Heart Conditions Addressed
Structural heart specialists primarily treat diseases that compromise the heart’s efficiency by affecting its valves or septal walls.
Aortic Stenosis is a progressive disease where the aortic valve leaflets stiffen and narrow, often due to calcium buildup. This narrowing reduces blood flow from the left ventricle to the rest of the body, forcing the heart muscle to work harder and potentially leading to heart failure.
Mitral Regurgitation is another common condition, occurring when the mitral valve fails to close completely. This causes blood to leak backward into the upper chamber, which increases pressure in the lungs and reduces the amount of oxygenated blood delivered to the body. Both conditions significantly impair the heart’s ability to function as an effective pump.
The field also manages congenital defects, such as septal defects. A Patent Foramen Ovale (PFO) is a small, flap-like opening between the two upper chambers that failed to seal after birth. The Atrial Septal Defect (ASD) is a larger hole in the wall separating the atria, which can lead to abnormal blood flow and strain on the right side of the heart.
Another important area is Left Atrial Appendage (LAA) management, which addresses a common cause of stroke in patients with non-valvular atrial fibrillation (A-Fib). The LAA is a small pouch attached to the left atrium where blood can pool and form clots. Because more than ninety percent of stroke-causing clots in A-Fib patients originate in this appendage, structural intervention can be used to seal it off and reduce stroke risk.
Minimally Invasive Treatment Options
The use of minimally invasive, catheter-based procedures is the defining feature of structural cardiology. Catheters are thin, flexible tubes inserted through a small puncture, often in the groin, and guided through blood vessels to the heart. This eliminates the need for large chest incisions and the use of a heart-lung machine, leading to quicker recovery times and reduced hospital stays.
Structural cardiologists perform several key procedures:
- Transcatheter Aortic Valve Replacement (TAVR): This less-invasive method replaces a diseased aortic valve. A compressed replacement valve is delivered via the catheter and expanded within the old valve, immediately restoring proper blood flow. TAVR is often the preferred treatment for patients with severe aortic stenosis, especially those high-risk for traditional open-heart surgery.
- Transcatheter Mitral Valve Repair (TMVR): For Mitral Regurgitation, devices like the MitraClip are used. The catheter delivers a small clip that grasps the edges of the valve leaflets and pulls them together. This reduces the backward flow of blood, minimizing the leak without replacing the entire valve structure.
- Septal Defect Closures: For PFO and ASD, a catheter delivers a small, self-expanding closure device. This device is positioned to straddle the hole, creating a patch that permanently seals the abnormal connection between the heart chambers.
- Left Atrial Appendage Occlusion: Procedures using devices like the WATCHMAN focus on stroke prevention. The device is deployed to seal off the LAA opening, acting as a permanent barrier against blood clots. This offers an alternative to long-term blood thinners for select patients with non-valvular A-Fib who face an elevated risk of bleeding.