Valve & Structural Heart Conditions We Treat
This is a congenital defect where a hole has formed in the wall of tissue that separates the right and left atria (upper chambers of the heart). ASDs cause oxygen-rich blood to mix with oxygen-poor blood, which can result in oxygen-poor blood being delivered to vital organs and to abnormal enlargement of the right atrium. Large ASDs can eventually lead to pulmonary hypertension or heart failure.
Types of ASDs:
- Ostium secundum is the most common type of ASD and occurs when a portion of the atrial septum fails to develop normally. This defect can most often be closed using a minimally invasive transcatheter procedure.
- Ostium primumis is a defect in part of the atrioventricular canal and is associated with a split (cleft) in the mitral valve.
- Sinus venosus is classified as a hole between the superior vena cava (main vein that is returning blood from the upper body) and the right atrium (right upper chamber of the heart).
- Coronary sinus is the rarest ASD. This is characterized by a hole the coronary sinus, a major vein in the heart.
When an abnormal connection between an artery and a vein occurs it forms a fistula. This connection reroutes blood from the artery to the vein, interrupting blood flow to the organ and instead bypasses it altogether. Fistulas vary in severity. Small fistulae can be treated with medical management or physical therapy. Larger fistulae can be closed with a specially designed vascular plug that is delivered to the fistula through catheterization, a process where a thin tube is guided to the heart through a blood vessel and is used to place the plug.
A healthy aortic valve will have three flaps to seal the valve and regulate blood flow. People are born with the congenital condition bicuspid valve disease only have two aortic valve leaflets. Without the third leaflet, the valve will not close properly and blood can leak backwards into the heart, which reduces blood flow to the rest of the body. Patients with bicuspid aortic valve disease usually have valve repair or replacement surgery to prevent further health problems.
Many structural heart defects are conditions that are present at birth. With the evolution of modern medicine, many children born with congenital heart defects live well into adulthood. Read more about our congenital heart disease at the Center for Adults with Congenital Heart Disease.
Prolapse develops when one of the leaflets that act as the seal for the mitral valve have extra tissue that protrudes into the upper left chamber as the heart contracts. When this happens, the seal is ineffective and blood is able to flow back into the left atrium. For many people, this is a mild condition without any symptoms or complications, but if the regurgitation is severe, the condition may require treatment.
Paravalvular leaks occur in patients who have undergone valve repairs or replacements. In some rare circumstances, the surgically implanted valve may become “loose” and allow blood to leak around the valve. Small leaks may be able to be treated with medication, but larger, symptomatic leaks may require a minimally invasive transcatheter approach.
Similar to ASDs, a patent foramen ovale also occurs when a hole forms in the septal tissue that separates the upper chambers of the heart. With a PFO, instead of an open hole, there is a flap-like structure that opens when there is pressure in the chest, such as during a cough of a sneeze. PFOs lead to abnormal blood flow and the mingling of oxygen-poor blood with oxygen-rich blood.
When the lining of the aorta (the largest artery in the heart) is damaged or begins to leak, blood pools outside the wall, creating a bulge in the artery, or a pseudoaneurysm (PSA). Treatment depends on the size and location of the defect. Smaller PSAs can be treated with medications. Larger PSAs often require additional intervention. Some can be treated using catheterization, which places a small vascular plug to manage the PSA, but others may require surgical treatment.
Tricuspid atresia a congenital condition (present at birth) where the tricuspid valve is not fully formed. Instead, the patient is born with tissue growth between the upper right chamber and the lower right chamber that obstructs blood flow between the atria and the ventricle. Since blood does not flow properly throughout the heart and into the lungs, patients with tricuspid atresia are often short of breath and tire quickly due to lack of oxygen. Typically, surgery is needed to correct this issue.
Regurgitation occurs when the flaps (or leaflets) do not seal properly around the opening of the valve, allowing blood to leak backwards through the valve. Treatment depends on whether the condition is impacting heart functionality. Cases where the heart has weakened due to compensating for regurgitation may need valve repair or replacement surgery or transcatheter mitral valve repair with MitraClip to fix the issue.
There are four types of valve regurgitation:
- Mitral valve regurgitation
- Aortic valve regurgitation
- Tricuspid valve regurgitation
- Pulmonary valve regurgitation
Stenosis is characterized by a narrowing of the valve due to plaque build-up (atherosclerosis). When the valve thickens or narrows, the opening becomes smaller and blood cannot pass through the valve as easily. With stenosis, the heart works hard to compensate for the constricted opening and blood flow is reduced to other chambers of the heart and/or to vital organs. In severe cases, heart valve surgery or interventional procedures may be necessary to prevent serious health complications. Patients can be diagnosed with:
- Mitral valve stenosis
- Aortic valve stenosis
- Tricuspid valve stenosis
- Pulmonary valve stenosis
A ventricular septal defect is an opening in the intraventricular septum, the wall between the left and right ventricles (lower chambers of the heart). VSDs can be congenital or develop later in life after experiencing a heart attack. The hole allows blood from the left ventricle to flow back into the right ventricle and can lead to low blood pressure, low oxygen content and even heart failure.
Types of VSD
- Perimembranous is an opening in the upper section of the septum and is most commonly repaired through open-heart surgery.
- Muscular is the most common type of VSD. Muscular VSD can close spontaneously without intervention or and can be treated using an interventional transcatheter procedure.
- Conal Septal is the rarest VSD and can be found below the pulmonic valve.
- Infarct-Related VSD occurs when a portion of the heart is being deprived of blood, such as during a heart attack. When the heart experiencing prolonged deprivation, heart tissue may begin to die and develop a hole in what previously normally functioning heart tissue.