In the last two weeks, I have discussed the two most common valvular problems that we cardiologists see\u2014AS and MR.\u00a0This week I\u2019ll give a quick overview of the other valvular problems that we can encounter.<\/p>\n\n\n\n

First of all, the aortic valve can also develop regurgitation.\u00a0Called \u201cAR,\u201d aortic regurgitation<\/em>, when severe, can lead to heart enlargement, shortness of breath, chest pain, and eventually congestive heart failure.\u00a0It can develop due to the abnormal thickening that causes AS, but other causes include infection, congenital (bicuspid aortic valve), and structural abnormalities of the aortic root (the part of the aorta that is immediately adjacent to the aortic valve).\u00a0Ultimately, symptomatic severe AR requires surgery, though researchers continue to work on utilizing TAVR (see blog from October 30) for this condition.\u00a0Because AR doesn\u2019t necessarily lead to calcification of the aortic apparatus, the standard TAVR valve that is used for AS can\u2019t \u201canchor\u201d into the aorta\u2014hence the need for something a little different.<\/p>\n\n\n\n

The mitral valve can also become stenotic.\u00a0In decades past, the primary cause of this was the late effects of rheumatic fever.\u00a0However, as this infection has become much less common, mitral stenosis<\/em> (MS) is more often due to progressive calcification of the mitral valve apparatus (meaning the valve and all its supporting structures, including the annulus, chordae and papillary muscles).\u00a0Rheumatic MS can respond well to a catheter procedure called balloon valvuloplasty, <\/em>where a balloon is inflated across the valve, separating the leaflets and enlarging the opening.\u00a0However, this is not effective in highly calcified valves, so in that situation severe MS usually requires surgical replacement of the valve.<\/p>\n\n\n\n

On the right side of the heart are the tricuspid and pulmonic valves.\u00a0I\u2019ll set aside the pulmonic valve quickly by saying that serious disorders of this valve\u2014either stenosis or regurgitation\u2014are extremely rare in adults.\u00a0 Generally, they are seen in infants and children with congenital heart disease or in adults who have had repaired congenital heart defects.\u00a0In my 25+ years as a cardiologist, I\u2019ve seen only 2 people who have had severe pulmonic regurgitation<\/em> (PR) and 2 with severe pulmonic stenosis<\/em> (PS).\u00a0Even with that, they have not needed surgery.<\/p>\n\n\n\n

The tricuspid valve is another story, though.\u00a0It is sometimes referred to as the \u201cforgotten\u201d valve, in that it is often not recognized as causing a problem.\u00a0While tricuspid stenosis<\/em> (TS) is rare in adults, tricuspid regurgitation<\/em> (TR) is common and can lead to what we call right-sided heart failure<\/em>, manifested as generalized fatigue, edema of the legs, and abdominal bloating, due to fluid accumulating in the body.\u00a0It can be due to a primary problem with the valve or can be secondary to pulmonary hypertension<\/em> (high blood pressure in the lung circulation). The increased pressures that the right ventricle pumps against produce backward pressure against the tricuspid valve and enlargement of the tricuspid annulus, pulling the valve leaflets apart so that they don\u2019t come together all the way.\u00a0Pulmonary hypertension itself can be a primary problem, can be secondary to disorders within the lungs, or can develop due to left-sided heart failure (often due to severe MR), as the increased pressures in the left heart are transmitted passively backward into the lungs.<\/p>\n\n\n\n

Again, surgery is often necessary to correct TR, though the \u201cfix\u201d is usually a repair with a ring placed in the tricuspid annulus, rather than complete replacement of the valve.\u00a0This type of surgery is probably underutilized, partly because patients with severe TR are often very sick and at higher risk for surgery, but also because it is often assumed that when severe TR is caused by left-sided heart failure from severe MR, fixing the MR will fix the TR.\u00a0Increasingly we are realizing that this is not necessarily the case.<\/p>\n\n\n\n

Trials are currently underway investigating less invasive, catheter-based methods to correct severe TR.\u00a0Pima Heart & Vascular is participating in one of these studies.\u00a0 So, stay tuned\u2014and let me know if you or a friend or loved one has severe TR!<\/p>\n\n\n\n

Greg Koshkarian, MD, FACC<\/p>\n","protected":false},"excerpt":{"rendered":"

In the last two weeks, I have discussed the two most common valvular problems that we cardiologists see\u2014AS and MR.\u00a0This week I\u2019ll give a quick overview of the other valvular problems that we can encounter. First of all, the aortic valve can also develop regurgitation.\u00a0Called \u201cAR,\u201d aortic regurgitation, when severe, can lead to heart enlargement, shortness of breath, chest pain,…<\/p>\n","protected":false},"author":1,"featured_media":1370,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24],"tags":[80,76,97,107,210],"yoast_head":"\n