About heart valve repair

Heart valve repair is a procedure that corrects a defective heart valve. In 2003, an estimated 95,000 heart valve repair or replacement procedures were performed. The majority of these procedures are accomplished through open-heart surgery, although researchers are making steady advances with catheter-based heart valve procedures.

The conditions most often treated by heart valve repair include narrowing (stenosis) or leaking (regurgitation) of one of the heart’s four valves:

• Mitral valve. This valve is located between the left atrium and the left ventricle and is the most common valve to be repaired.
  
  
• Tricuspid valve. This valve is located between the upper–right chamber (right atrium) and the lower–right chamber (right ventricle) of the heart.
  
  
• Pulmonic valve. Also known as the pulmonary valve, this valve is located between the right ventricle and the pulmonary artery, which is the main artery carrying oxygen–poor blood from the heart to the lungs for more oxygen.
  
  
• Aortic valve. This valve is located between the left ventricle and the aorta, which is the main artery carrying oxygen–rich blood from the heart to the rest of the body.

A number of strategies may be used to repair a defective heart valve. They include:

• Percutaneous balloon valvuloplasty
• Valvotomy
• Decalcification
• Annuloplasty ring
• Complex mitral valve repair

The percutaneous balloon valvuloplasty is a nonsurgical procedure to treat stenosis. During the procedure, a cardiologist uses a local anesthetic to numb the area of the body (usually the groin) where an incision will be made for the insertion of a thin, flexible tube called a catheter. The catheter is then inserted into the blood vessel and fed all the way up to the heart. Upon reaching the damaged valve, a balloon at the tip of the catheter is inflated. The inflated balloon stretches, widens and separates the narrowed valve.

This procedure may be an alternative for patients who cannot undergo open–heart surgery because of failing health or other reasons. There is a risk that the valve will re–narrow (restenosis) or that it will no longer be able to close properly, allowing blood to leak back in the wrong direction (regurgitation).

A valvotomy (also known as a valvulotomy) is a type of open–heart surgery in which the surgeon cuts into a valve to repair valvular damage. One such type is a commissurotomy, a procedure in which narrowed valve leaflets are widened by carefully opening the fused leaflets or commissures with a scalpel.

For repairing either the mitral or the tricuspid valve, surgeons may also implant an annuloplasty ring at the point where the leaflets meet the fibrous ring (annulus). An annuloplasty ring is designed to help support the valve so the leaflets can come together properly.

During a decalcification procedure, the surgeon removes built-up calcium deposits from the surface of the valve leaflet. Calcium deposits can affect the function of the valve by making it stiffer and by preventing the valve from closing properly.

A complex mitral valve repair may involve a number of techniques including:

• Partial removal (resection) of a faulty valve flap (or leaflet)
  
• Shortening of a faulty valve chord and/or repositioning of the chord
  
• Insertion of artificial chords (chordae tendineae)
  
• Reducing the size of the valve ring through a special surgical process (annular plication)
  
• Annuloplasty ring implantation (to reinforce the above)

In some cases, these operations can be performed through smaller incisions, resulting in less surgical trauma to the patient. This type of surgery is known as minimally invasive heart valve surgery. First performed in 1996, these procedures can be used to perform surgery on either the aortic or mitral valves. During a minimally invasive procedure, a smaller incision is made in the sternum (partial sternotomy) or in the side, between the ribs (a thoracotomy incision). Although smaller, these incisions allow the surgeon to work with specialized equipment and successfully complete the surgery.

Although these minimally invasive strategies involve the patient spending more time in surgery as these delicate procedures are performed, they offer a lower risk of surgical trauma, a shorter recovery time and reduced pain. They are being performed with greater frequency on patients with selected valve diseases, particularly those involving the aortic and mitral valves.