Heart Valve Problems
The valves of your heart perform a very important function: they keep your blood flowing in the right direction at the proper pressure and prevent it from flowing backward. Here is a crash course in healthy hemodynamics:
- The mitral valve and the tricuspid valve separate the upper chambers of the heart (called the atria) from the lower chambers (ventricles).
- Blood always flows downward – from the atria into the ventricles.
- On the left side of the heart, the mitral valve is the gatekeeper regulating this flow
- On the right side, the tricuspid valve performs this function.
- The ventricles pump blood out of the heart.
- On the left side of the heart, the left ventricle pumps oxygen-rich blood out into the aorta, the largest of all the arteries, and thus to the rest of your body. This is done through the aortic valve.
- On the right side of the heart, the right ventricle pushes oxygen-poor blood into pulmonary artery, which leads to the lungs, where the blood is oxygenated. This is controlled by the pulmonary valve.
Los Angeles cardiologist Dr. Arash Bereliani is an expert in diagnosing and treating all kinds of heart valve problems, and sees a great many patients with heart valve disease at the Beverly Hills Institute for Cardiology and Preventive Medicine, where he practices. According to Dr. Bereliani, many patients are surprised to learn that symptoms they have been experiencing are a result of heart valve disease.
What kinds of problems occur in your heart valves?
There are two main types of valve disorders:
Stenosis – the valve is narrowed, preventing a normal volume of blood from flowing through the valve
Regurgitation – the valve doesn’t close all the way, allowing some blood to leak back out of it
So this means each of the valves can have either stenosis or regurgitation.
Which valves are more commonly affected and why?
The mitral and aortic valves are the ones that most often develop problems. A major reason for this is that these valves are both on the left side of the heart. The left side of your heart works the hardest and has the most pressure. Pulmonary and tricuspid valve problems are much rarer, typically happening in early childhood, and will not be discussed here. If you have questions about these kinds of valve disorders, please call Dr. Bereliani’s office at 310-550-8000.
What are the different types of heart valve problems?
Aortic stenosis
Aortic stenosis may result from a congenital defect – especially if you are born with a valve that only has two leaflets instead of the usual three. However, this condition most commonly results from calcification of the aortic valve.
How is aortic stenosis diagnosed? Dr. Bereliani can look for stenosis using a color Doppler echocardiogram, but evaluating calcification is best done with a coronary calcium scan. This is also helpful because it reveals calcification in the coronary arteries – and atherosclerosis – which is often present if the valve is calcified. Calcified valves tend to happen as you get older, but that doesn’t mean it’s inevitable. Dr. Bereliani’s preventive cardiology program can help you reduce inflammation and lipid deposition, which are necessary for calcification to begin.
What are the symptoms of aortic stenosis?
Symptoms of aortic stenosis include:
- Angina (chest pain)
- Syncope (fainting)
If untreated, aortic stenosis causes severe strain on the left side of the heart, which may lead to congestive heart failure. Stenotic aortic valves that are calcified may result in your heart’s electrical system being disrupted; this can cause heart block.
How is aortic stenosis treated?
Dr. Bereliani can give you medical therapy, but this will only treat the symptoms. Nitroglycerin given sublingually (under the tongue) can help with angina attacks. ACE inhibitors are drugs that may help reduce the load on your heart. If you have signs of congestive heart failure, you may need diuretics such as furosemide (Lasix) to prevent pulmonary edema (fluid buildup in the lungs) and digitalis to increase the pumping strength of your heart.
Ultimately, in many cases, Dr. Bereliani will recommend surgery to replace the aortic valve. Aortic valve replacement surgery has come a long way since its introduction over 40 years ago, and outcomes are excellent. Dr. Bereliani maintains close relationships with the top cardiothoracic surgeons, who are literally on the “cutting edge” of their profession. He can direct you to the top Los Angeles doctors who perform percutaneous valve replacement procedures; these do not even require open-heart surgery!
Mitral stenosis
Mitral stenosis used to be very common when more people got rheumatic fever in childhood. It can also be a congenital defect, or can arise after a bacterial infection (endocarditis).
What are the symptoms of mitral stenosis?
Symptoms of mitral stenosis include:
- Shortness of breath, especially during exercise
- Chest pain
- Palpitations
If untreated, mitral stenosis – after sufficient narrowing of the valve – can cause the left atrium to enlarge, which may result in severe atrial fibrillation. Left heart enlargement, as in aortic stenosis, may lead to congestive heart failure.
Mitral regurgitation
Mitral regurgitation is one of the most common types of heart valve problems. It is most often a consequence of mitral valve prolapse (MVP), a condition in which the leaflets of the mitral valve are too big. This causes the valve to prolapse; it sags back into the left atrium and cannot close properly. The incomplete closure may allow blood to flow backward; this is called mitral regurgitation.
Not everyone who has MVP has mitral regurgitation that is clinically significant. In fact, most people with MVP have no symptoms and require no treatment. It is when mitral regurgitation becomes moderate to severe that many people start experiencing symptoms. Mitral regurgitation more rarely may develop secondary to dilated cardiomyopathy.
How is mitral regurgitation diagnosed?
Dr. Bereliani will perform a color Doppler echocardiogram. This is essential because it will show not only the defect in the mitral valve, but also will measure how severe the displacement is and allow Dr. Bereliani to hear how much regurgitation is going on. If the left side of the heart is enlarged, this is further evidence of the severity of the problem.
What are the symptoms of severe mitral regurgitation?
- Shortness of breath, especially on exercising or lying down flat on your back
- Lowered exercise tolerance
- Severe fatigue
- Atrial fibrillation
If untreated, severe mitral regurgitation can cause left-sided enlargement of the heart (left ventricular hypertrophy, or LVH); this may lead to congestive heart failure.
How is mitral regurgitation treated?
If you are experiencing symptoms, but the mitral regurgitation is not severe, Dr. Bereliani may give you an ACE inhibitor, a drug that is also used to treat high blood pressure. ACE inhibitors reduce the load on your heart. If you have signs of fluid buildup, a diuretic may be in order.
In severe cases of mitral regurgitation, surgery is required. Dr. Bereliani will carefully evaluate all aspects of your condition before recommending surgery. A few years ago, the only option was replacement of the mitral valve with a prosthetic valve – either porcine or artificial – using standard open-heart surgery. Today, things have changed! Now, it is possible for a cardiologist to recommend repair, rather than replacement, of the valve. The surgeon can actually fix the defect in your mitral valve, often with excellent results. Instead of open-heart surgery, now minimally invasive robotic surgery is available. There is also a new device called the MitraClip, which is inserted through your femoral artery – the same artery that is used during an angiogram – and threaded up through to your mitral valve, where it is attached. Dr. Bereliani can arrange for you to receive these procedures should you need them.
Aortic regurgitation
Aortic regurgitation, also called aortic insufficiency, occurs when blood flows through the aortic valve in the opposite direction, from the aorta back into the left ventricle. It may be caused by chronic hypertension (high blood pressure) as well as by congenital defects, infection, or autoimmune disorders like rheumatoid arthritis and lupus.
How is aortic regurgitation diagnosed?
Dr. Bereliani uses color Doppler echocardiography in order to diagnose this condition. He can clearly identify the defect in the valve, as well as hear the abnormal flow (the “regurgitant jet”). He will also look for LVH (left ventricular hypertrophy), the enlargement of the left ventricle.
What are the symptoms of aortic regurgitation?
Many people with aortic regurgitation do not have apparent symptoms. When they do, the symptoms may include:
- Shortness of breath, especially during exercise or lying down flat on your back
- Chest pain
- Palpitations
How is aortic regurgitation treated?
If your aortic regurgitation is fairly stable, Dr. Bereliani may give you an ACE inhibitor, a drug that is also used to treat high blood pressure. ACE inhibitors decrease the stress on the left ventricular wall and reduce the load on your heart.
If your aortic regurgitation is severe – you have bothersome symptoms and/or you have a low ejection fraction (a measure of how well your heart is pumping) – Dr. Bereliani will recommend you have an aortic valve replacement.
How can I find out more about heart valve problems?
Call the Beverly Hills Institute for Preventive Medicine and Cardiology at 310-550-8000 or click here to make an appointment. Our friendly, helpful staff will be glad to schedule a consultation for you with Dr. Bereliani, and to answer any questions you might have. We are conveniently located in the heart of Beverly Hills, within easy driving distance for most residents of greater Los Angeles.