Today, approximately 2.5 percent of the population suffers from some type of valve disease — and it’s much more common among older adults. That’s because as we age, the heart valves can become lined with calcium deposits that make valves thicken and become stiffer — leading to malfunction. Because heart valve disease is far more common in the elderly, it frequently goes undetected as patients may mistake symptoms as normal signs of aging.

“While valve disease can cause a variety of symptoms, it often presents as decreased exertional capacity, or what patients report as just ‘slowing down or tiring out more quickly than they used to — which is also common with aging,” explains Dr. Bryon Boulton. “Unfortunately, too many patients dismiss these symptoms and just assume they’re tiring more easily because of their age — but it’s important to pay attention to changes in how you feel at every stage of life and to talk to your doctor about them.”

Valve disease can also occur due to congenital problems, high blood pressure, heart attack, heart failure, rheumatic fever (from untreated strep throat) or infection.

Other common symptoms include heart palpitations, dizziness, chest discomfort, rapid weight gain or swelling in the feet, ankles or abdomen.

Heart Valves — The Basics

Much like the plumbing in our homes, many of us don’t think about our heart valves until there is a problem. Yet, our heart valves play a critical role in the many functions of the circulatory system. They’re largely responsible for directing blood flow throughout the body to ensure our heart, lungs and cells get the blood they need to work properly.

Getting to know your heart valves begins with understanding how the heart and circulatory system function. First, when your heart pumps or beats, it pushes blood throughout the body in a consistent pattern — from the body, through the right side of the heart, over to the lungs to receive oxygen, back through the left side of the heart, and out to the rest of the body. This process is made possible by the heart’s four chambers and four valves.

In between each chamber (two atria and two ventricles), a valve is present to ensure blood empties from the previous chamber and flows forward in the correct direction. These valves are complex structures made up of small flaps of tissue called leaflets or cusps. The four valves include the aortic valve, the mitral valve, the pulmonary valve and the tricuspid valve.

The Heartbeat Explained

During the first half of each heartbeat, the valves open to allow blood to move forward through the heart. During the second half of the heartbeat, they close to prevent blood from flowing backward. If the valves have problems with opening or closing, or if there are congenital problems with the anatomy of the valve, that’s when valve disease occurs.

The Importance of Early Detection

Early heart valve disease doesn’t cause noticeable symptoms — which can make detection difficult. However, valve disease can be detected when a doctor listens to your heart using a stethoscope and hears a murmur. Dr. Boulton urges all of his patients to keep up with routine annual physical examinations — and to ask your doctor to listen to your heart regularly.

“In an age of virtual visits and digital health care, patients may not have a standard physical exam as often as they would have had ten years ago,” explains Dr. Boulton. “I encourage all patients to ask their doctors to listen to their heart using a stethoscope at least once a year. And, if you are told (or have been told at any age) that you have a potential heart murmur, it’s important to ask for an echocardiogram — even if you don’t have any symptoms.”

That’s because treating heart valve problems early can prevent disease progression and reduce the risks of advanced valve disease.

Types of Valve Disease

While any of the four valves can experience problems, the mitral valve and the aortic valve are most typical to become diseased. Here are the most common types of heart valve disease:

Stenosis

This occurs when the valve’s leaflet tissue becomes stiff and the opening is narrowed by calcification over time. When the opening becomes narrow, there’s less blood flow — causing the heart to pump harder.

Regurgitation

Also known as incompetence, insufficiency or a ‘leaky valve,’ regurgitation occurs when the leaflets don’t close properly. Blood leaks backward into the chamber from where it came. To counteract this backward flow, the heart has to work harder.

Atresia

This is a congenital problem where the leaflets are fused, which means the valve doesn’t form properly and can’t accommodate normal blood flow.

Mitral Valve Prolapse

This common problem occurs when the mitral valve flaps don’t close smoothly or evenly, but instead bulge upward (prolapse) into the left atrium when the heart beats, creating a backward flow of blood.

Minimally-Invasive Approach

WakeMed Heart & Vascular is one of the only programs in the Southeast to offer a minimally-invasive


approach for open heart valve surgery — a unique procedure that requires just a 4 cm incision rather than a full sternotomy (which requires breaking the breastbone open). This approach can be used for operations performed on the aortic valve, mitral valve and tricuspid valve – and while the operation itself is the same, patients recover in half the time.

Early Treatment Is Best

Valve disease creates a situation where the heart can’t pump efficiently – forcing the heart to work harder. This can lead to a variety of health problems and serious potential complications as the disease progresses, such as heart failure, stroke, cardiac arrhythmias, blood clots, and/or sudden death. Dr. Boulton encourages early surgical intervention to help patients not only preserve their long-term quality of life and increase life expectancy, but also to preserve ventricular function and structure. He cautions that once structural damage is done, it can’t be reversed. Here are some of the common ways valve disease is treated at WakeMed Heart & Vascular.

Early Valve Disease — Your cardiologist may recommend a combination of medication and lifestyle changes, such as incorporating moderate exercise, limiting or eliminating alcohol and tobacco use, and eating a healthy diet that’s high in fiber and low in sodium and saturated fat. Medication therapies could


include ones to treat high blood pressure like diuretics and ace inhibitors, or even a beta blocker to reduce the heart rate.

“I tell patients their heart is a muscle just like the bicep, but with valve disease, you want to decrease the amount of work the heart has to do,” explains Dr. Boulton. “If you have high blood pressure, it’s like adding more weight to the barbell — which is like putting extra pressure on the valve. Particularly if you have a leaky valve (mitral valve regurgitation), you want to reduce that pressure, which is why medication is a good start for early stages of disease.”

Advanced Valve Disease — For those patients who are experiencing intense physical symptoms, a number of surgical and non-surgical options are available, depending on the valve and underlying cause of the disease.

• A valve repair procedure can be used to treat valve disease in most cases. A cardiothoracic surgeon
  
  
  can use open surgical or minimally-invasive techniques to fix problems with valve leaflets (valvuloplasty) or to tighten or strengthen the valve base (annuloplasty). Other common repair procedures include placing stents to allow blood flow or plug a leaking valve, or implanting a device (MitraClip™) to treat mitral valve regurgitation for patients who aren’t candidates for surgery.
• Valve replacement in general is only performed when a repair isn’t a good option due to complications or other factors such as when the valve is too damaged or calcified to be fixed. Valve replacement can be performed with an open procedure or using a minimally-invasive technique known as TAVR (transcatheter aortic valve replacement).

Support for Patients with Valve Disease

WakeMed is pleased to partner with heartvalvesurgery.com to support patients with valve disease. This comprehensive online resource offers patients a highly credible source of education and information about valve disease, treatment options and what to expect. Patients can read personal stories, find encouragement and make connections with others who have valve disease.

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About Bryon Boulton, MD, FACS

As a board certified cardiothoracic surgeon and the surgical director of the WakeMed Structural Heart Program, Dr. Bryon Boulton brings to WakeMed Heart & Vascular Physicians unique surgical expertise with transcatheter aortic valve replacement (TAVR) and off-pump coronary artery bypass surgery. He specializes in minimally invasive cardiac surgery, robotic cardiac surgery and hybrid revascularization, mitral valve repair, thoracic endovascular aortic repair (TEVAR), and aortic aneurysm repair; as well as the full complement of general thoracic services.

Dr. Boulton also performs minimally invasive atrial fibrillation surgery, adult congenital heart surgery including anomalous coronary artery repair, and pulmonary valve replacements, and he co-leads the structural heart team that uses the MitraClip percutaneous mitral valve repair device.

An award-winning researcher, Dr. Boulton is the co-author of several articles and book chapters that have been published in prestigious medical publications. He was honored by the Triangle Business Journal as a 2015 40 Under 40 award recipient for his expertise in TAVR and various other accomplishments. Dr. Boulton was also a 2015 Vitals Patients’ Choice Award winner.

Dr. Boulton feels fortunate to be part of the team at WakeMed because of the way in which our doctors and specialists collaborate to provide the highest quality of patient care as well as this organization’s commitment to innovation, technology, and serving people from all walks of life.

“At WakeMed, the needs of our patients always come first,” said Dr. Boulton. “And as surgeons, our goal is to provide world-class surgical services available right here in Wake County.”

Patients can always expect that Dr. Boulton will take the time to educate them on their disease process, ease their anxieties and fears, and thoroughly discuss their surgery as well as expectations for recovery. He is also very supportive of family involvement and makes it a priority to engage family members while providing patient care.

Dr. Boulton and his wife Stacy, who is also a physician at WakeMed, have four sons that keep them both very active. In addition to coaching his boys’ soccer teams, Dr. Boulton is an avid cyclist. The Boulton family is very active with their church and enjoys traveling overseas to participate in medical mission trips including recent surgical mission work with Tenwek Hospital in Kenya.

This article is a reprint from Heart to Heart Magazine. Subscribe today for your free copy.