About Mitral Valve Replacement

8/10/2019 About Mitral Valve Replacement

1/34

Heart Information Center

Introduction

What are heart valves?

Heart valve disorders

Infection Heart disease Congenital

Rheumatic fever Papillary muscle dysfunction Bicuspid aortic valve

Endocarditis Calcific aortic stenosis Mitral valve prolapse

Mitral valve conditions

Aortic valve conditions

Tricuspid & Pulmonic valve conditions

Artificial (Prosthetic) valve conditions

Glossary

Other Sites

Click topics above to see more information.

To return to Table of Contents click browser Back arrow or "Return to Top"

Introduction

For the heart to function properly, the four heart chambers must beat in an organizedmanner. Under normal conditions, the heart valves let blood to flow in only onedirection. Problems with aheart valve(or valves) may occur because of disease,

injury orcongenitalfactors. Two kinds of problems usually occur. If a valve is

narrowed (stenotic) the heart may have to work much harder to pump blood acrossthe valve. A second type of problem occurs when a valve (or valves) does not close

completely, causing some blood to be pumped backwards (regurgitation/incompetence) instead of forwards in the heart. Both types of problems can cause theheart to work too hard and eventually weaken over time.

Go toAnimated Heart Tutorialto see how the heart and valves work.(Use the back arrow in your browser to return to this page)
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiovaschomepg.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiovaschomepg.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#introhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#introhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#whathttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#whathttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#inhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#inhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#rfthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#rfthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pmdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pmdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#bavhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#bavhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#enhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#enhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cashttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cashttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvphttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvphttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#avhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#avhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tpvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tpvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#apvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#glhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#glhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#otherhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#otherhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#conhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#conhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#conhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#conhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#otherhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#glhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#apvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tpvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#avhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#mvphttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cashttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#enhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#bavhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pmdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#rfthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#cohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hdhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#inhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hvhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#whathttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#introhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiovaschomepg.html


2/34

Top

What are heart valves?

Heart valves are thin flexible flaps of connective tissue. The four heart valves are:

1. the tricuspid valve, located between the right atrium and right ventricle;2. the pulmonary or pulmonic valve, between the right ventricle and the

pulmonary artery;3. the mitral valve, between the left atrium and left ventricle; and4. the aortic valve, between the left ventricle and the aorta.

Blood flow occurs only when there's a difference in pressure across the valves thatcauses them to open.

Each valve has a set of flaps (also called leaflets or cusps). The mitral valve has two

leaflets while the other valves have three. The mitral and tricuspid valves areconnected to small muscles (papillary) along the wall of the heart by small string liketendons (chordeae tendineae). Papillary muscle contraction opens these valves. The

aortic and pulmonic valves are differently shaped do not have cordae tendineae norpapillary muscles.

Top

Heart valve disorders

Valvular problems may be caused by infection, heart disease, trauma or congenital

valvular conditions and may be isolated to a single valve or effect multiple valves.Right sided (tricuspid, pulmonary) valvular disease is much less common than leftsided (aortic, mitral) valvular disease. Roughly 90% of valvular disease is chronic,

having developed gradually over many years. Complications of rheumatic fever,

congenital disorders and aging cause the vast majority of chronic valvular disease.The remaining 10% of valvular disease that develops acutely (over days to weeks) isoften due to complications of recent heart attack or infections.

Infection

Rheumatic fever- Most valvular heart disease is still caused by childhood rheumatic

fever (a complication of untreated streptococcal infection). During a streptococcal

infection (typically in the throat) the body makes its' own antibodies to fight thebacterial infection. Antibodies recognize the structure of certain parts of the bacterialsurface, attach to it and destroy it. Unfortunately, the surface structure of certain

body tissues (heart valves, skin, joints, kidneys, etc..) may resemble that on certain

types of streptococcal bacteria. With rheumatic fever antibodies that normally fightinfection may attack the body's own tissues. It is important to stress that it is notbacteria that directly cause injury.

Rheumatic fever usually occurs 2-6 weeks after untreated strep throat. Symptoms of
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#top


3/34

rheumatic fever are multiple and may include:

Fever Arthritis (pain, swelling and warmth) that shifts from joint to joint.

Larger joints such as hips and knees tend to be more frequently

effected. Heart failure,newheart murmurs,fast heart rate orpericardial friction

rubdue to inflammation of heart muscle, valves orpericardium.This iscalled carditis and occurs during rheumatic fever. Carditis is different

from delayed valvular disease that slowly develops over many years

after rheumatic fever has occurred. The latter is due to slow butprogressive thickening of effected heart valves initially injured during

rheumatic fever.. Nodules may form under the skin on the backs side of the wrist, elbow,

and knees a temporary skin rash lasting several days may occur. Injury to brain tissues may cause repetitive involuntary writhing

movement of the head and arms. This is calledchorea.

The incidence of rheumatic fever in the USA has decreased greatly in recent years dueto the use of antibiotics to treat strep throat. Delayed symptoms of heart valvedisease may take 10-20 years to appear and gradually worsen over time. Rheumatic

fever may effect a single or multiple valves. Symptoms that occur years later isusually from injury to the mitral and aortic valves.

Top

Infective Endocarditisis infection of heart valves directly with bacteria or fungi.

Infection may occur after certain dental /surgical procedures or with IV drug use.

Infective endocarditis can involve any heart valve but most commonly involves theaortic or mitral valve (left sided heart disease). Infection of only the tricuspid valve(right sided disease) is usually seen in IV drug users.

During dental or surgical procedures a small amount of bacteria may get into the

blood stream. This is almost never a problem for otherwise healthy persons withnormal heart valves- the body easily takes care of this on its own. Bacteria from these

procedures caninfect previously injured heart valves (usually from rheumatic fever).Therefore, a dose of an antibiotic (prophylactic=preventative) is always recommended

prior to dental work and certain types of surgery for people with heart valve disordersto prevent endocarditis.

Vegetations (a mixture of bacteria and blood clots) may form on valves of the left,

right or both sides of the heart. Vegetations can embolize (break loose) and travel toother parts of the body. Emboli from the left heart valves (mitral or aortic) will travelvia the aorta to the body; those from the right heart valves (tricuspid or pulmonic)

will travel to the lungs. Emboli lodging in the brain can cause a stroke. Emboli maycarry infection to other parts of the body. Emboli lodging in the lungs may causeshortness of breath and cough.
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#perhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#perhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#perhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#9http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#9http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#9http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#perhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pfrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chf


4/34

Endocarditis is divided into several categories

Acute endocarditisusually occurs on previously normal valves and is most often due

to IV drug use and is due to aggressive types of bacteria associated withcontaminated needles. Rapid destruction of the heart valve(s) can happen, causingsevereheart failure.

Symptoms of acute infective endocarditis may include:

fever and chills weakness fast heart rate shortness of breath and chest pain.

People are usually quite ill.Heart murmursmay be heard as well. Stroke symptoms

may occur if vegetations break loose and lodge in brain arteries. Severe heart failuremay occur if the aortic or mitral valves rupture.

Subacute endocarditisusually occurs on artificial or previously injured valves andprogresses more slowly. Bacteria associated with subacte endocarditis are not

asvirulentas bacteria associated with acute endocarditis. Symptoms of subacuteinfective endocarditis,often not as obvious, may include:

recurrent fever weight loss decreased appetite feeling very run down

People often think they have recurrent flu or may have been treated with antibioticsseveral times with antibiotics for presumed bacterial infections such as bronchitis.

As in the case of acute infective endocarditis bacterial vegetations can break loose andgo to other parts of the body. Physical signs are related to the part of the body theylodge in:

small hemorrhages may be seen in finger and toe nail beds; retinal hemorrhages may be seen in the eyes; tender nodules (Osler nodes) may be felt on finger and toe tips; nontender plaques (Janeway lesions) may occur on the palms of the

hands and soles of the feet.

Diagnosisof infective endocarditis is made if blood cultures are positive for bacteria

or fungi known to cause endocarditis and there is evidence of valvular injury orvegetations. The heart and valves are imaged usingechocardiography.

Treatmentgenerally requires hospitalization and intravenous antibiotic therapy for at

least 4 weeks. Infection is almost never adequately treated with oral antibiotics.Persons with severe valvular destruction may require valve replacement.

Preventionis extremely important because infective endocarditis is so difficult totreat and can cause severe disability or death.All persons with evidence of
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#virhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#virhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#virhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#virhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chf


5/34

valvular injury or deformity should take preventative antibiotics beforedental or surgical procedures are performed.If you have a known heart murmuror valvular problem consult your dentist and doctor prior to dental or surgical

procedures.

Top

Heart disease

Papillary muscle dysfunction ( papillary muscles do not work properly) may occur

from a heart attack, cardiomyopathy or congestive heart failure. This can causeregurgitation to occur across the tricuspid or mitral valves. Rupture of a papillary

muscle (usually after a heart attack) may cause sudden regurgitation of blood back

into the lungs. This may cause severe breathing problems due to excess fluid in thelungs- this is called congestive heart failure.

Top

Calcific aortic stenosisis a degenerative condition that is the most common causeof aorticstenosisin people over 70. Calcium deposits cause narrowing of the aorticopening. Blood flow to the aorta is partially blocked causing the left ventricle to work

harder. This may eventually cause the left ventricle to weaken and not pump blood

efficiently.

Top

Congenital valvular conditions (present at birth)

Bicuspid aortic valve( aortic valve has 2 cusps instead of 3 cusps) is the most

common cause of aorticstenosisin all people. Persons with a bicuspid valve oftendevelop symptoms in their 50's.

Top

Mitral valve prolapse(click murmur syndrome)is a condition that has caused muchdebate and controversy in the medical community. Mitral valve prolapse (MVP) occurs

when one or both of the mitral valve leaflets push back (bow) into the left atrium

during contraction of the left ventricle. MVP is probably only important if a person has

both excess bowing of the mitral leaflets into the atrium andactual regurgitation ofblood from the left ventricle to the left atrium when the heart contracts.

The use ofechocardiogram(ultrasound of the heart) over the past 20 years has

revolutionized examination of the heart. Using earlier ultrasound criteria it was

estimated 5-10% of the population has MVP. However, recent studies suggest thatslight bowing of the mitral valve (not accompanied by regurgitation) is normal for

many people and that MVP was likely over diagnosed because of the ability of
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#17http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#17http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#7http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#7http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#7http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#sthttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#17http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#8


6/34

ultrasound to see extremely small variations in the mitral valve shape. Using revisedcriteria it is believed that MVP is present in less than 1% of the general population.

People, particularly women, with heartpalpitationsdue to anxiety often see a doctorand have heart evaluation (including ultrasound) performed. Many persons with a

panic (anxiety) disorder were found to have mild mitral valve bowing on ultrasound- It

was believed that panic attacks were more common in people with mitral valveprolapse. Newer studies suggest there is no correlation between panic attacks andmitral valve prolapse. Most patients who had ultrasounds and were diagnosed with

MVP did not have true MVP but simply normal variation in the shape of their mitral

valve. For many patients and physicians it may have been easier to accept that aphysical condition was responsible for panic attacks. Most people have no symptomsof MVP.

Persons with MVP having demonstratedregurgitationare at slightly

increased risk of developing endocarditis during dental/surgical proceduresand should receive antibiotic prophylaxis.A very small number are at increasedrisk of sudden death.

Top

Mitral Valve Disorders

The mitral valve normally allows one way flow of blood from the left atrium to the leftventricle. Disorders of the mitral valve may cause mitral valve stenosis, mitral valveregurgitation or mitral valve prolapse (previously discussed).

Mitral Stenosisis narrowing of the mitral valve opening that usually gradually occurs

over time due chronic scarring. Rheumatic fever is still the most common cause ofmitral valve stenosis.

As the mitral opening narrows the left atrium enlarges (dilates) over time because itmust work harder to pump blood into the left ventricle. Many people (upto 50%)eventually developatrial fibrillationbecause of progressive dilatation of the left

atrium. In atrial fibrillation the left atrium quivers instead of effectively pumping bloodto the left ventricle causing a decreased amount of blood to the left ventricle.

Severe stenosis may also cause pressure to built up in the lung blood vessels(pulmonary veins) that supply blood to the left atrium. The lung blood vessels arenormally under much lower pressure (as is the right side of the heart that pumps

blood to the lungs) than the left ventricle, aorta and its' arterial branches. Increasedblood pressure in the lungs is called pulmonary hypertension.

Symptomsmay not appear for many years but are usually due tocongestive heartfailure.The first ( and most common) symptom to appear is usually shortness ofbreath (beyond normal) during physical activity. Any stimulus that rapidly increases

heart rate or blood flow can cause sudden increase in lung congestion and causeshortness of breath. Other factors responsible for shortness of breath in those withmitral stenosis (in additional to physical activity) include stress, fever, pregnancy, or
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#palhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#palhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#palhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#6http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#6http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#afhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#afhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#afhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#chfhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#afhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#6http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#pal


7/34

onset of atrial fibrillation. As the disease worsens shortness of breath at rest or whilelying down may occur. Severe disease is common withpulmonary hypertension.

The second most common symptom to initially appear is coughing up blood due torupture of a bronchial (lung) vein.

Blood clots are more likely to form in the left atrium during atrial fibrillation - theseblood clots (emboli) may dislodge and travel to other body organs including the brain,eyes, heart and kidneys. The risk of stroke or heart attack (due to emboli traveling tothe brain or coronary arteries) is higher in persons with atrial fibrillation.

Diagnosisof mitral stenosis is suspected in a person with a history of congestiveheart failure, findings of a specific type of mitralheart murmuron physical exam, and

suggestive chest x-ray and EKG findings. Definitive diagnosis is made usingultrasound- The entire valve can be visualized.

Cardiac catheterization ( dye is injected into a blood vessel near the heart and movie-

like pictures taken) is performed if surgical repair or replacement of the mitral valve is

considered. Catheterization will detect if there is narrowing of the coronary arteries.Coronary artery disease increases the risk of heart attack during surgery and mayneed to be corrected prior to surgical valve repair or replacement.

Treatmentdepends on the severity of symptoms, health and age of an individual,

amount of mitral valve narrowing, and whether coexisting aortic valvular disease ispresent. Persons requiring treatment for this disorder must be under the care of aphysician!

Persons without symptoms and mild to moderate stenosis do not needto restrict physical activity.

Persons with mild symptoms (shortness of breath) with physical activity

are usually started on a mild diuretic, a low salt diet, advised to avoidvigorous exercise and extreme stress. ACE inhibitors may be used inconjunction with diuretics.

Blood thinning agents (coumadin) are recommended with mitral

stenosis, particularly if atrial fibrillation is present, to decrease the riskof embolization to other areas of the body.

Persons with symptoms should be evaluated by a cardiologist. Valvularrepair or replacement should not be delayed until symptoms occur at

rest or with minimal exertion. This is particularly true for youngerpersons who are otherwise healthy.

Surgical treatment options include:

1. Percutaneous balloon mitral valvulotomy- a balloon tipped catheter isthreaded through an artery into the heart. The balloon is inflated to

expand the mitral valve. This technique has been very effective inyounger patients with valves that are not calcified (excessively stiff).

2. Surgical valvulotomy (commisurotomy)- the natural valve is widened bymaking a cut in the mitral valve.

3. Total valve replacement- the mitral valve is replaced by a prosthetic("artificial")valve. Valves may be either bioprosthetic (pig, cow, or
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#phhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#phhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#ph


8/34

human) or synthetic (usually metal alloys). Valvular replacement isusually required in older patients with heavily calcified (stiff) mitralvalves.

Prognosis

Most people have no symptoms the first 10 years, increasing shortness of breath onexertion the next 10 years followed by worsening symptoms that may begin to occurat rest during the next decade.

All people having mitral stenosis of any degree require antibiotic prophylaxisto prevent infective endocarditis prior to dental or surgical procedures.

Top

Mitral Regurgitationoccurs when blood flows back into the left atrium from the leftventricle during left ventricular contraction because of a "leaky" mitral valve. Mitral

regurgitation can occur acutely (suddenly) with infective endocarditis or with a heartattack that causes rupture of the papillary muscles or chordae tendineae. Symptomsof severe congestive heart failure ( severe shortness of breath, fast heart rate, andfluid in the lungs) requiring urgent surgical intervention usually occur with acute mitral

valve rupture.

Rheumatic fever is the most common cause of chronic (gradual over many years)

mitral regurgitation. Chronic regurgitation, even with large regurgitant blood flow, isoften tolerated for years due to compensatory changes in the heart. The left atriumdilates over time to handle the increased blood volume.

Symptomsare very similar to mitral stenosis. As with mitral stenosis the most

common first symptom is shortness of breath with exertion, atrial fibrillation iscommon in later stages and the risk of emboli is as high as 20%. Most emboli travelto tissues that do not cause symptoms. However, emboli traveling to the brain maycause stroke and emboli traveling to the coronary arteries may cause heart attack.

Diagnosismay be made by a person giving a history of shortness of breath with

exertion and the doctor hearing aheart murmursuggestive of mitral regurgitation. As

with all valvular disorders definitive diagnosis is made with ultrasonography. Personsconsidered for valvular repair or replacement will have cardiac catheterizationperformed.

Treatmentis similar to that for mitral stenosis except balloon valvuloplasty is not

performed unless the mitral valve is also stenotic. Most cases of mitral regurgitationdo not involve significant stenosis. Valve replacement or reconstruction is indicated formost persons with severe symptoms (shortness of breath at rest or with minimal

exertion.

Anticoagulation ( blood thinning agents) is recommended for those with mitral

regurgitation, especially persons with atrial fibrillation, due to increased risk of strokefrom emboli.
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#5http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#5http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#5


9/34

Prognosis- The time course from the presence of this disease to the first symptomsis similar to that for mitral stenosis.

All people having mitral regurgitation require antibiotic prophylaxis toprevent infective endocarditis prior to dental or surgical procedures.

Top

Aortic Valve Disorders

The aortic valve normally allows one way flow of blood from the left ventricle to the

aorta. Disorders of the aortic valve may cause aortic valve stenosis or aortic

valveregurgitation.

Aortic Stenosisis narrowing of the aortic valve.

Causesinclude:

1. congenital heart disease (bicuspid valve)- most common cause2. rheumatic heart disease- second most common3. degenerative heart disease (calcific aortic stenosis)- most common in

persons over 70 years of age.

What happens with aortic stenosis?

As the aortic valve narrows the left ventricle must work harder to pump the sameamount of blood through a narrower opening. The left ventricle is the largest and

strongest pumping chamber of the heart- it must pump blood to the entire body. The

left ventricular muscle increases in size (hypertrophies) over time to compensate forthe extra work it must perform. The strength and ability of the left ventricle tocompensate for increased work load may mask the symptoms of aortic stenosis for

many years until the valve becomes extremely narrow. When the aortic valve narrows

past a certain point the left ventricle can no longer fully compensate. Not as muchblood can be pumped across the aortic valve to the body, particularly during activities

requiring increased blood flow to the organs and muscles. At this point symptoms mayappear.

Symptomsinclude:

1. Shortness of breath with exertion. This symptom may occur earlier invery physically active people. This is usually the first symptom but is

not specific for aortic stenosis.2. Shortness of breath awakening a person from their sleep (second most

common symptom).3. Passing out (syncope) with exertion, angina, or heart attack are also

common and indicate severe disease.

Who gets aortic stenosis?
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#4http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#4http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#4


10/34

Most people do not develop symptoms until late in the course of aortic stenosis. Ageat onset of symptoms (clinically apparent aortic stenosis) usually indicates the causeof aortic stenosis. Symptoms in people younger than 30 years is almost always due to

congenital causes (usually bicuspid aortic valve). Symptoms in people 30-70 yearsmay be due to either bicuspid valve or rheumatic heart disease. Aortic stenosis causedby rheumatic fever occurs 10-15 years later than mitral stenosis caused by rheumatic

fever. Symptoms developing in the elderly are usually due to calcific degenerativechanges of a normal aortic valve (wear and tear of aging).

How is aortic stenosis detected?

People may see their doctor concerning symptoms of aortic stenosis. Chest pain or

passing out during exertion is very concerning and may prompt a doctor intoexamining the heart in detail. If aortic stenosis is present a certain type ofheartmurmur may be detected when a doctor listens with a stethoscope. The doctor may

order further tests. Aortic stenosis can be definitively diagnosedusingechocardiogram(heart ultrasound).

Atrial fibrillation and traveling emboli are less common in isolated aortic stenosis.

Is aortic stenosis serious?

Once symptoms develop aortic stenosis is very serious. The presence of symptoms

almost always means that the aortic valve is extremely narrow and will not toleratefurther narrowing. Once symptoms occur with aortic stenosis, particularly angina or

shortness of breath with minimal exertion or congestive heart failure, many people diewithin several years if not treated.

Sudden death, due tocardiac arrhythmias,may occur in upto 20% of people withaortic stenosis. The cause of sudden death is speculative (unknown).

How is aortic stenosis treated?

Asymptomatic persons with mild stenosis do not have to limit physical activity. Periodic monitoring should be done because rapid narrowing can occur over as

little as a few years. Persons with more severe stenosis should be evaluated by a cardiologist

whether or not they have symptoms. Persons with symptoms of passing out on exertion, angina or congestive heart

failure due to aortic stenosis require immediate evaluation by a cardiologistand may be considered for valve repair or replacement.

Your doctor may treat symptoms of either angina or congestive heart failure

with medications as they occur. If these symptoms are caused by aorticstenosis definitive treatment is valve repair or replacement. Very old age (80's)

is not a contraindication to valve replacement as long heart function andoverall health are reasonable.

Persons requiring treatment for this disorder must be under the care of aphysician!
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#echohttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hmhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#hm


11/34

Top

Pulmonary and Tricuspid Valve Disorders

Isolated valvular disorders of the right side of the heart (receiving and pumping

venous blood to the lungs for oxygenation) are much less common than left sided

valvular disease. Combined left (mitral and/or aortic) and right (tricuspid and/orpulmonic) heart valvular disease is more common.

Tricuspid Valve Disorders- Tricuspid valve normally allows one way blood flowfrom the right atrium to the right ventricle.

Isolated tricuspid disease is most commonly due to endocarditis from IVdrug use.

Right ventricular failure causing tricuspid regurgitation is usually due to

heart attack effecting the right ventricle Tricuspid disease and left sided valvular disease due to rheumatic fever

may occur.

Pulmonary Valve Disorders- Pulmonic valve normally allows one way blood flowfrom the right ventricle to the pulmonary (lung) arteries.

Pulmonary stenosis most frequently caused by a congenital defect

(Tetralogy of Fallot) that is detected and surgically corrected in infancy. Pulmonary regurgitation (incompetence) is most commonly due

topulmonary hypertension.

Symptoms

Shortness of breath, particularly while laying flat are the most commoninitial symptoms of tricuspid and pulmonary valve disorders. Symptoms

of worsening disease, in addition to shortness of breath, includeswelling of the feet, liver, abdomen or neck veins due to fluid retention.

Top

Artificial (Prosthetic) Valves

Artificial valves are placed in over 40,000 persons a year in the United States. There

are more than six dozen types of valves. Prosthetic valves can be grouped into two

main categories:

1. Mechanical (nontissue models) usually made of metal or composite alloys.2. Tissue valves(bioprostheses) made from pig, cow or human valves.

Discussion of individual valve types is beyond the scope of this article. Readers havingquestions about specific valve types or technical details must consult with their doctor,

cardiologist or cardiothoracic surgeon. Patients with prosthetic valves should always
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#phhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#phhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#phhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#top


12/34

carry a card that describes their valve.

What type of problems occur with prosthetic valves?

Are more common in patients having more advanced heart disease (cardiomyopathy,congestive heart failure, and/orarrhythmias)at time of valve replacement.

Prosthetic valves may be slightly narrow (stenotic). A small amount

ofregurgitation,due to incomplete closing, is common. Thrombi (blood clots) can form on prosthetic valves. If thrombi become large

enough they can interfere with blood flow or prevent the valve from closing

properly. Thrombi can embolize. This is the most important complication of

mechanical (nontissue) valves. This occurs in about 1% of people per year with

mechanical valves. This is not as common in tissue valves. Those withmechanical valves almost always need to take blood thinning medications(anticoagulation). Not all tissue valves require anticoagulation.

Bioprostheses may gradually deteriorate.

Mechanical valves often cause anemia due to increased red blood celldestruction.

Rarely, mechanical valves can suddenly fail (break). This is often fatal. Endocarditis is more likely to occur on artificial valves.

What symptoms occur with prosthetic valve problems?

Many patients have ongoing shortness of breath and decreased exercisetolerance after successful valve replacement. This is more likely in persons withpoorer heart function or atrial fibrillation.

Persons with a sudden decrease in normal exercise tolerance or new chest pain

should see their doctor. In addition to these symptoms people with prosthetic valve problems may

experience symptoms of emboli. Minor episodes (temporary) are common and

can include stroke like symptoms, abdominal pain (emboli blocking intestinal

blood vessels), and arm or leg pain (emboli blocking muscle blood vessels).Major blockages can cause stroke, heart attack, and permanent intestinal

injury. Severe hemorrhage can occur during anticoagulation therapy. People on

anticoagulants noticing blood in the urine, feces, saliva or new skin bruisingmust see their doctor.

Those with fever should see their doctor urgently. Fever could indicate infectiveendocarditis.

Patients with prosthetic valves should receive antibiotic prophylaxis beforedental and surgical procedures.

Top

Glossary
http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arrhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#tophttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#reghttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.html#arr


13/34

Atrial fibrillation left atrium of heart ineffectively quivers instead of normallycontracting.

Arrhythmia irregular beating of the heart that may cause the heart to beattoo fast or slow. Certain arrhythmias may cause the heart to

stop beating.Chorea repetitive involuntary writhing movement of the head and

arms.

Congenital a condition present at birth

Congestive heart

failurethe heart can't pump enough blood to meet the needs of the

body's other organs.

Echocardiography a technique that views the heart valves using sound wavesand a computer generated image. Also called a heartultrasound.

Heart murmur sound caused by turbulent blood flow across a heart valve(s)heard by a doctor using a stethoscope.

Heart valves are thin flexible flaps of connective tissue normally permittingone-way blood flow through the heart.

Palpitations An uncomfortable awareness of the heart beating. May beslow, normal or fast.

Pericardium a tough fibrous layer of tissue normally covering the heart.

Pericardial

friction ruba sound heard with a stethoscope due to rubbing of the heart

against the pericardium that may occur with inflammation ofthe pericardium.

Pulmonary

hypertensionincreased pressure in the lung veins and arteries. These

vessels are normally under lower blood pressure than arteriesarising from the aorta and its' branches. May contribute to orbe caused by chronic congestive heart failure. Often

secondary to increased left atrial pressure, due to mitralstenosis, causing blood to back up in the lungs.

Regurgitation backward flow of blood through a heart valve. Also calledvalvular incompetence.

Stenosis narrowing of the valve opening

Virulence the ability of an infection to cause illness / injury to the body.

Other Sites/References


14/34

Cline, D. M., "Valvular Emergencies and Endocarditis" in Emergency Medicine4th edition. 1996.

Liberthson, R. R.,"Management of Aquired Valvular Heart Disease" in Primary

Care Medicine- Office evaluation and Management of the Adult Patient 3rd

edition. 1995.

The American Heart Association

Dental Care and Heart Disease

Doctors Corner INternet Group, Inc. 1997-2004

Statement

Artificial heart valveFrom Wikipedia, the free encyclopedia

[hide]This article has multiple issues. Please helpimprove itor discuss these issues on the

This article needs additional citations forverification.(November 2008)

This article includes alist of references,but its sources remain unclear because it has insu

This article possibly containsoriginal research.(November 2013)

An artificial heart valveis a deviceimplantedin theheartof apatientwithvalvular heartdisease.[1][2]When one of the fourheart valvesmalfunctions, the medical choice may be to replacethe natural valve with an artificial valve. This requiresopen-heart surgery.

Valvesare integral to the normalphysiologicalfunctioning of thehumanheart.Naturalheartvalvesareevolvedto forms that perform the functional requirement of inducing unidirectionalbloodflowthrough the valve structure from one chamber of the heart to another. Natural heartvalves becomedysfunctionalfor a variety ofpathologicalcauses. Some pathologies may require

completesurgicalreplacement of the natural heart valve with a heart valveprosthesis.[3]

Contents

[hide]

1 Types of heart valve prostheses

2 Mechanical valves

o 2.1 Types of mechanical heart valves
http://www.americanheart.org/http://www.americanheart.org/http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/dental.htmlhttp://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/dental.htmlhttp://your-doctor.com/healthinfocenter/disclaimer.htmlhttp://your-doctor.com/healthinfocenter/disclaimer.htmlhttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edithttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edithttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edithttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:No_original_researchhttp://en.wikipedia.org/wiki/Wikipedia:No_original_researchhttp://en.wikipedia.org/wiki/Wikipedia:No_original_researchhttp://en.wikipedia.org/wiki/Implant_(medicine)http://en.wikipedia.org/wiki/Implant_(medicine)http://en.wikipedia.org/wiki/Implant_(medicine)http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-1http://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-1http://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-1http://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Human_physiologyhttp://en.wikipedia.org/wiki/Human_physiologyhttp://en.wikipedia.org/wiki/Human_physiologyhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Evolvedhttp://en.wikipedia.org/wiki/Evolvedhttp://en.wikipedia.org/wiki/Evolvedhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Dysfunctionalhttp://en.wikipedia.org/wiki/Dysfunctionalhttp://en.wikipedia.org/wiki/Dysfunctionalhttp://en.wikipedia.org/wiki/Pathologicalhttp://en.wikipedia.org/wiki/Pathologicalhttp://en.wikipedia.org/wiki/Pathologicalhttp://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Prosthesishttp://en.wikipedia.org/wiki/Prosthesishttp://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-3http://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-3http://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-3http://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Mechanical_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Mechanical_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_mechanical_heart_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_mechanical_heart_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_mechanical_heart_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Mechanical_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Types_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-3http://en.wikipedia.org/wiki/Prosthesishttp://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Pathologicalhttp://en.wikipedia.org/wiki/Dysfunctionalhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Evolvedhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Human_physiologyhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Cardiac_surgeryhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-1http://en.wikipedia.org/wiki/Artificial_heart_valve#cite_note-1http://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Implant_(medicine)http://en.wikipedia.org/wiki/Wikipedia:No_original_researchhttp://en.wikipedia.org/wiki/Wikipedia:Citing_sourceshttp://en.wikipedia.org/wiki/Wikipedia:Verifiabilityhttp://en.wikipedia.org/wiki/Talk:Artificial_heart_valvehttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edithttp://en.wikipedia.org/wiki/Artificial_heart_valvehttp://your-doctor.com/healthinfocenter/disclaimer.htmlhttp://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/dental.htmlhttp://www.americanheart.org/


15/34

o 2.2 Durability

o 2.3 Cavitation

o 2.4 Fluid mechanics

o 2.5 Blood damage

3 Tissue (biological) valves

4 Functional requirements of heart valve prostheses

5 Design challenges of heart valve prostheses

6 Replaceable models of heart valve prostheses

7 Typical configuration of a heart valve prosthesis

8 Additional images

9 See also

10 References

11 Sources

12 External links

Types of heart valve prostheses[edit]

There are three main types of artificial heart valves: the mechanical,the biological,and the tissueengineeredvalves.

Mechanical heart valve

Percutaneousimplantation

Stentframed

Not framed

Sternotomy/Thoracotomyimplantation

Ball and cage

Tilting disk

Bi-leaflet

Tri-leaflet

Tissue (biological) heart valves Allograft/isograft

Xenograft

Tissue Engineered heart valves

Mechanical valves[edit]

A mechanical artificial heart valve with a pivoting disc.

Mechanical heart valves(MHV) are prosthetics designed to replicate the function of the naturalvalves of the human heart. The human heart contains four valves:tricuspid valve,pulmonicvalve,mitral valveandaortic valve.Their main purpose is to maintain unimpeded forward flowthrough the heart and from the heart into the major blood vessels connected to the heart,thepulmonary arteryand theaorta.As a result of a number of disease processes, both acquired and
http://en.wikipedia.org/wiki/Artificial_heart_valve#Durabilityhttp://en.wikipedia.org/wiki/Artificial_heart_valve#Durabilityhttp://en.wikipedia.org/wiki/Artificial_heart_valve#Cavitationhttp://en.wikipedia.org/wiki/Artificial_heart_valve#Cavitationhttp://en.wikipedia.org/wiki/Artificial_heart_valve#Fluid_mechanicshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Fluid_mechanicshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Blood_damagehttp://en.wikipedia.org/wiki/Artificial_heart_valve#Blood_damagehttp://en.wikipedia.org/wiki/Artificial_heart_valve#Tissue_.28biological.29_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Tissue_.28biological.29_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Functional_requirements_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Functional_requirements_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Design_challenges_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Design_challenges_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Replaceable_models_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Replaceable_models_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Typical_configuration_of_a_heart_valve_prosthesishttp://en.wikipedia.org/wiki/Artificial_heart_valve#Typical_configuration_of_a_heart_valve_prosthesishttp://en.wikipedia.org/wiki/Artificial_heart_valve#Additional_imageshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Additional_imageshttp://en.wikipedia.org/wiki/Artificial_heart_valve#See_alsohttp://en.wikipedia.org/wiki/Artificial_heart_valve#See_alsohttp://en.wikipedia.org/wiki/Artificial_heart_valve#Referenceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Referenceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Sourceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Sourceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#External_linkshttp://en.wikipedia.org/wiki/Artificial_heart_valve#External_linkshttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=1http://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Stenthttp://en.wikipedia.org/wiki/Stenthttp://en.wikipedia.org/wiki/Sternotomyhttp://en.wikipedia.org/wiki/Thoracotomyhttp://en.wikipedia.org/wiki/Thoracotomyhttp://en.wikipedia.org/wiki/Thoracotomyhttp://en.wikipedia.org/wiki/Allografthttp://en.wikipedia.org/wiki/Isografthttp://en.wikipedia.org/wiki/Isografthttp://en.wikipedia.org/wiki/Isografthttp://en.wikipedia.org/wiki/Xenografthttp://en.wikipedia.org/wiki/Xenografthttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=2http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=2http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=2http://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/File:Heartvalve.jpghttp://en.wikipedia.org/wiki/File:Heartvalve.jpghttp://en.wikipedia.org/wiki/File:Heartvalve.jpghttp://en.wikipedia.org/wiki/File:Heartvalve.jpghttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Pulmonic_valvehttp://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=2http://en.wikipedia.org/wiki/Xenografthttp://en.wikipedia.org/wiki/Isografthttp://en.wikipedia.org/wiki/Allografthttp://en.wikipedia.org/wiki/Thoracotomyhttp://en.wikipedia.org/wiki/Sternotomyhttp://en.wikipedia.org/wiki/Stenthttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=1http://en.wikipedia.org/wiki/Artificial_heart_valve#External_linkshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Sourceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Referenceshttp://en.wikipedia.org/wiki/Artificial_heart_valve#See_alsohttp://en.wikipedia.org/wiki/Artificial_heart_valve#Additional_imageshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Typical_configuration_of_a_heart_valve_prosthesishttp://en.wikipedia.org/wiki/Artificial_heart_valve#Replaceable_models_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Design_challenges_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Functional_requirements_of_heart_valve_prostheseshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Tissue_.28biological.29_valveshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Blood_damagehttp://en.wikipedia.org/wiki/Artificial_heart_valve#Fluid_mechanicshttp://en.wikipedia.org/wiki/Artificial_heart_valve#Cavitationhttp://en.wikipedia.org/wiki/Artificial_heart_valve#Durability


16/34

congenital, any one of the four heart valves may malfunction and result in either stenosis (impededforward flow) and/or backward flow (regurgitation). Either process burdens the heart and may lead toserious problems includingheart failure.A mechanical heart valve is intended to replace a diseasedheart valve with its prosthetic equivalent.

There are two basic types of valves that can be used for valve replacement,mechanicaland tissuevalves. Modern mechanical valves can last indefinitely (the equivalent of over 50,000 years in an

accelerated valve wear tester).[citation needed]However, current mechanical heart valves all requirelifelong treatment with anticoagulants (blood thinners), e.g.warfarin,which requires monthly bloodtests to monitor.[citation needed]This process of thinning the blood is calledanticoagulation.Tissue heartvalves, in contrast, do not require the use of anticoagulant drugs due to the improved blood flowdynamics resulting in less red cell damage and hence less clot formation.

[citation needed]Their main

weakness however, is their limited lifespan. Traditional tissue valves, made ofpigheart valves, willlast on average 15 years

[citation needed]before they require replacement (but typically less in younger

patients).

Types of mechanical heart valves[edit]

Starr-Edwards-Mitral-Valve (Caged ball valve).
http://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wiktionary.org/wiki/mechanicalhttp://en.wiktionary.org/wiki/mechanicalhttp://en.wiktionary.org/wiki/mechanicalhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Anticoagulationhttp://en.wikipedia.org/wiki/Anticoagulationhttp://en.wikipedia.org/wiki/Anticoagulationhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Pighttp://en.wikipedia.org/wiki/Pighttp://en.wikipedia.org/wiki/Pighttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=3http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=3http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=3http://en.wikipedia.org/wiki/File:Starr-Edwards-Mitral-Valve.jpghttp://en.wikipedia.org/wiki/File:Starr-Edwards-Mitral-Valve.jpghttp://en.wikipedia.org/wiki/File:Starr-Edwards-Mitral-Valve.jpghttp://en.wikipedia.org/wiki/File:Starr-Edwards-Mitral-Valve.jpghttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=3http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Pighttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Anticoagulationhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wiktionary.org/wiki/mechanicalhttp://en.wikipedia.org/wiki/Heart_failure


17/34

1. Starr-Edwards Valve

2. Starr-Edwards Valve

3. Smeloff-Cutter Valve

There are three major types of mechanical valvescaged-ball, tilting-diskand bileafletwith many

modifications on these designs.

The first artificial heart valve was the caged-ball, which utilizes a metal cage to house a siliconeelastomer ball. When blood pressure in the chamber of the heart exceeds that of the pressure on theoutside of the chamber the ball is pushed against the cage and allows blood to flow. At thecompletion of the heart's contraction, the pressure inside the chamber drops and is lower thanbeyond the valve, so the ball moves back against the base of the valve forming a seal. In1952,Charles A. Hufnagelimplanted caged-ball heart valves in ten patients (six survived theoperation), marking the first long-term success in prosthetic heart valves.

[citation needed]A similar valve

was invented by Miles "Lowell" Edwards andAlbert Starrin 1960 (commonly referred to as the Starr-Edwards Silastic Ball Valve).

[citation needed]The first human implant was on Sept 21, 1960.

[citation needed]It

consisted of a silicone ball enclosed in a cage formed by wires originating from the valve housing.Caged ball valves have a high tendency to forming blood clots, so the patient must have a high

degree of anti-coagulation, usually with a targetINRof 2.5-3.5.[citation needed]EdwardsLifesciencesdiscontinued production of the Starr-Edwards valve in 2007.

[citation needed]

Soon after came tilting-discvalves. The first clinically available tilting disk valve was the Bjork-Shiley valve and has undergone several significant design changes since its introduction in1969.[citation needed]Tilting disk valves have a single circular occluder controlled by a metal strut. Theyare made of a metal ring covered by anePTFEfabric, into which thesuturethreads are stitched inorder to hold the valve in place. The metal ring holds, by means of two metal supports, a disc whichopens and closes as the heart pumps blood through the valve. The disc is usually made of an
http://en.wikipedia.org/wiki/Charles_A._Hufnagelhttp://en.wikipedia.org/wiki/Charles_A._Hufnagelhttp://en.wikipedia.org/wiki/Charles_A._Hufnagelhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Albert_Starrhttp://en.wikipedia.org/wiki/Albert_Starrhttp://en.wikipedia.org/wiki/Albert_Starrhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratiohttp://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratiohttp://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratiohttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/EPTFEhttp://en.wikipedia.org/wiki/EPTFEhttp://en.wikipedia.org/wiki/EPTFEhttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/File:Prosthetic_Cardiac_Ball_Valves.jpghttp://en.wikipedia.org/wiki/File:Prosthetic_Cardiac_Ball_Valves.jpghttp://en.wikipedia.org/wiki/File:Prosthetic_Cardiac_Ball_Valves.jpghttp://en.wikipedia.org/wiki/File:Prosthetic_Cardiac_Ball_Valves.jpghttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/EPTFEhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Edwards_Lifescienceshttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Prothrombin_time#International_normalized_ratiohttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Albert_Starrhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Charles_A._Hufnagel


18/34

extremely hard carbon material (pyrolytic carbon), in order to allow the valve to function for yearswithout wearing out. TheMedtronic-Hall model is the most common tilting-disc design in the US. Insome models of mechanical valves, the disc is divided into two parts, which open and close as adoor.

Bileafletheart valvesconsist of two semicircular leaflets that rotate about struts attached to thevalve housing. This design was introduced in 1979

[citation needed]and while they take care of some of

the issues that were seen in the other models, bileaflets are vulnerable to backflow and so theycannot be considered as ideal. Bileaflet valves do, however, provide much more natural blood flowthan caged-ball or tilting-disc implants. One of the main advantages of these valves is that they arewell tolerated by the body. Only a small amount of blood thinner is needed to be taken by the patienteach day in order to prevent clotting of the blood when flowing through the valve.

These bileafletvalves have the advantage that they have a greater effective opening area (2.43.2square cm c.f. 1.52.1 for the single-leaflet valves).

[citation needed]Also, they are the least thrombogenic

of the artificial valves.

Mechanical heart valves are today very reliable and allow the patient to live a normal life. Mostmechanical valves last for at least 20 to 30 years.

[citation needed]

Durability[edit]

Mechanical heart valves have been traditionally considered to be more durable in comparison totheirbioprostheticcounterparts. The struts and occluders are made out of eitherpyrolytic carbonortitanium coated with pyrolytic carbon,

[citation needed]and the sewing ring cuff isTeflon(PTFE), polyester

or dacron.[citation needed]

The major load arises from transvalvular pressure generated at and after valveclosure, and in cases where structural failure does happen, it is usually as a result of occluderimpact on the components.

Impactwear andfrictionwear dictate the loss of material in MHV. Impact wear usually occurs in thehinge regions of bileaflets, between the occluder and ring in tilting-discs, and between the ball andcage in caged-ball valves. Friction wear occurs between the occluder and strut in tilting-discs, andbetween the leaflet pivots and hinge cavities in bileaflets.

[citation needed]

MHV, made out of metal are also susceptible to fatigue failure owing to

thepolycrystallinecharacteristic of metals, but this is not an issue with pyrolytic carbon MHVbecause this material is not crystalline in nature.[citation needed]

Cavitation[edit]

Cavitationis an event that can lead to MHV failure. While this has been a relatively rare occurrence,in 1988 the Edwards-Duramedics bileaflet had 46 reported failures in 20,000 implants related tocavitation damage.

[citation needed]Since then, manufacturers have made cavitation testing an essential

part of the design verification process. Cavitation is the rapid formation of vaporous microbubbles inthe fluid due to a local drop of pressure below the vaporization pressure at a given temperature.When conditions for cavitation are present bubbles will form and at the time of pressure recoverythey will collapse or implode. This event will cause pressure or thermal shockwaves and fluidmicrojets which can damage a surface. These thermodynamic conditions are known to be the cause

of MHV related erosion.

[citation needed]

The valvular event that causes such cavitating conditions to exist is the closing mechanics of theMHV. Several causes of cavitation relating to valve closure have been identified. Squeeze flow iscavitation that is said to occur as the occluder approaches the housing during closure and fluid issqueezed between the occluder and the valve housing causing a low pressure formation. Waterhammer is cavitation caused by the sudden stop of the valve occluder as it contacts the valvehousing. This sudden retardation of the fluid retrograde inertia is said to put the fluid under tensioncausing cavitation. Squeeze flow is said to form a cloud of bubbles at the circumferential lip of the
http://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Medtronichttp://en.wikipedia.org/wiki/Medtronichttp://en.wikipedia.org/wiki/Medtronichttp://en.wikipedia.org/w/index.php?title=Bileaflet_valve&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Bileaflet_valve&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Bileaflet_valve&action=edit&redlink=1http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=4http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=4http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=4http://en.wikipedia.org/w/index.php?title=Bioprosthetic&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Bioprosthetic&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Bioprosthetic&action=edit&redlink=1http://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Pyrolytic_carbonhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Teflonhttp://en.wikipedia.org/wiki/Teflonhttp://en.wikipedia.org/wiki/Teflonhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Impact_(mechanics)http://en.wikipedia.org/wiki/Impact_(mechanics)http://en.wikipedia.org/wiki/Frictionhttp://en.wikipedia.org/wiki/Frictionhttp://en.wikipedia.org/wiki/Frictionhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Polycrystallinehttp://en.wikipedia.org/wiki/Polycrystallinehttp://en.wikipedia.org/wiki/Polycrystallinehttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=5http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=5http://en.wikipedia.org/w/index.php?title=Artificial_heart_valve&action=edit&section=5http://en.wikipedia.org/wiki/Cavitationhttp://en.wikipedia.org/wiki/Cavitationhttp://

About Mitral Valve Replacement

Documents

Transcript of About Mitral Valve Replacement