Heart valve disorders can arise from two main types of malfunctions: regurgitation (or leakage of the valve) and stenosis (or narrowing of the valve). Heart valves can develop both malfunctions at the same time (regurgitation and stenosis). Also, more than one heart valve can be affected at the same time.
Treatment varies, depending on the type of heart valve disease, and may include one, or a combination of, the following:
Transcatheter Aortic Valve Implantation (TAVI): CoreValve/Sapien
Transcatheter aortic valve implantation, or TAVI, is a new alternative for some cases of aortic valve stenosis. This hybrid procedure typically is done by a cardiac surgeon and an interventional cardiologist.
The diseased valve may be repaired using a ring to support a person's own valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be mechanical (made of metal or plastic) or tissue (made from animal valves or human valves taken from cadavers).
Valvuloplasty is performed, in certain circumstances, to open a stenotic (stiff) heart valve. In valvuloplasty, a very small, narrow, hollow tube (known as a catheter) is advanced from a blood vessel in the groin through the aorta into the heart. Once the catheter is placed in the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets (flaps) of the valve are opened. Once the valve has been opened, the balloon is deflated and the catheter is removed.
Aortic Valve Repair
In some cases, surgery on the malfunctioning valve can help alleviate symptoms. Examples of heart valve repair surgery include cutting scarred flaps so they open more easily; remodeling valve tissue that has enlarged; or inserting prosthetic rings to help narrow a dilated valve. In many cases, heart valve repair is preferable, because a person's own tissues are used.
Aortic Valve Replacement
When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves, which can be metal, plastic, or another artificial material.
Valve-sparing Aortic Root Replacement
The aortic root is where the aorta attaches to the heart.
The David's valve-sparing aortic root replacement method (named after Dr. Tirone David) is a surgical treatment for aneurysms of the aortic root. This method allows the aneurysm to be repaired while the existing aortic valve is preserved, helping to avoid the need for long-term anticoagulant (blood thinner) medication and helping to reduce the risk of stroke or endocarditis.
If the patient's aortic valve is diseased or cannot be used during surgery, a bioprosthetic valve can be used, also helping to prevent the need for long-term anticoagulation medication.