How is heart valve disease (valvular heart disease) treated?

Not all valvular heart disease needs treatment, although treatment may become more necessary over time. Changing lifestyle factors is often the first step, including quitting smoking, exercising and eating a healthy diet. Medications are used to prevent blood clots and thin blood, especially when valves have been artificially replaced, prevent irregular heartbeats, get rid of excess fluid that often accompanies heart failure, and lower cholesterol and blood pressure. When valvular heart disease becomes severe, heart valve repair and replacement may be necessary. There are different ways to repair and replace valves as well as different models of replacement valves.

There are four valves in the heart and all can have this disease. By far, the valves on the left side of the heart are the most likely to produce a problem. These valves are the aortic valve (between the pumping chamber in the heart and the large artery blood is pumped into) and the mitral valve (between the collecting chamber and pumping chamber on the left). Valve problems may be due to stenosis, or abnormal narrowing, which causes the valve opening to be constricted and limits blood flow across it. Another possibility is that the valve may leak, increasing the heart’s workload. Treatment depends on which valve is affected and the severity of the problem.

For leaking valves, patients can sometimes be treated with medication that will cause a dilation or enlargement of the arteries promoting more blood flow forward, and restrictions on salt and fluid intake. While this treatment usually does not fix the leakage, it can reduce the symptoms.

If valve disease is severe enough, then surgery is the ultimate treatment. Valve replacement may be required; or the valve (especially the mitral) may be able to be repaired. Valve repair is preferred, if possible, because it seems to result in better long-term outcomes. If a replacement is required, then the surgeon can choose between a mechanical valve that will last forever but likely will require the patient to take blood thinner, or a bioprosthetic valve (made out of real tissue) that does not require a blood thinner but will eventually wear out.

There are some ways to stretch open stenotic valves; however the long-term results have not be great and this is usually only done in patients considered too high risk for surgery. There are also some studies that are looking at ways to address leaking valves, and even to replace valves with catheters through the groin or smaller incisions just below the rib cage. These treatments are still experimental and not generally available.

The goals of heart valve disease treatment are to:

• Prevent, treat or relieve the symptoms of other related heart conditions.
• Protect your valve from further damage.
• Repair or replace faulty valves when they cause severe symptoms or become life threatening. Man-made or biological valves are used as replacements.

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay complications for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve. To relieve the symptoms of heart conditions related to heart valve disease, your doctor may ask you to quit smoking and follow a healthy eating plan low in salt, cholesterol and fat.

People who have heart valve disease are commonly prescribed medicines to:

• Treat heart failure. Heart failure medicines widen blood vessels and rid the body of too much fluid.
• Lower blood pressure or blood cholesterol levels.
• Prevent irregular heartbeats.
• Thin the blood and prevent clots (for people who have man-made valves). These medicines also are prescribed for mitral stenosis or other valve defects that make you prone to developing blood clots.

Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) eating plans. TLC is for people who have high blood cholesterol. DASH is for people who have high blood pressure (or for anyone who wants to follow a healthy eating plan).

This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

There are two main avenues for treatment of heart valve disease (valvular heart disease): management with medication and surgical intervention. If surgery is indicated, you will work with your surgeon to determine if your valve needs to be repaired or replaced, with normally only one valve being replaced at a time. New heart valves can be either synthetic or tissue-based from a pig, cow or a human donor.

• Balloon valvuloplasty is a surgical repair option, and is a procedure done during a cardiac catheterization whereby an expandable “balloon” is threaded into the heart, placed inside the tightened valve and then inflated in order to stretch open the valve and restore proper blood flow.
• Transcatheter aortic valve replacement (TAVR) is a minimally-invasive procedure that inserts a new, temporarily-collapsed valve into the damaged valve, effectively replacing it. The surgeon then “inflates” the new valve, and as it expands, it assumes blood flow management going forward. TAVR is a procedure ideally suited for those who are unable to undergo a traditional open-chest procedure, as it can be completed through small incisions that do not disturb the chest wall.