Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm your host, Maggie McKay. Today, I'm sitting down with Dr. John Perry, and we're going to be talking about heart valves. Before we get started, I would love to know how heart care became a passion of yours. What made you become a cardiothoracic surgeon?

Dr. John Perry: It actually occurred after medical school. I initially wanted to be an orthopedic surgeon, but the preliminary years prior to entering orthopedic surgery brought us across a wide spectrum of specialties. And, lot of my rotations were in cardiac surgery. I said, you know what, orthopedics, probably not me, I think cardiac surgery is the way to go. So then I applied to training in cardiac surgery.

Host: Nice. So the heart has four valves. What's their function?

Dr. John Perry: The valves function to keep blood flowing in a forward direction, meaning the deoxygenated that comes back to the heart from the body, gets to the heart. It makes its way to the right heart. The right heart pushes it out to the lungs to re oxygenate it. It then comes back to the left heart and the left heart pushes it out to supply the body.

So the valves function to prevent blood going backwards, one, and it also should function not to obstruct the outflow of blood from the heart.

Host: So heart valve problems can affect newborns all the way up to the elderly. Do we know why they occur?

Dr. John Perry: In the newborn, they're usually congenital, meaning from birth, and there's a broad spectrum of congenital heart valve disease. The valve doesn't form properly. They're, we call them atresia of the valve. In adults, the majority are degenerative problems, meaning as the patient gets older, the valve leaflets degenerate, get stiffer, calcified and they can leak backwards or obstruct flow forwards. There are some other things that can affect the valve during a person's lifetime.

For instance, if you have a strep throat that's not treated properly, you could end up with what we call rheumatic fever, and that damages the entire heart, especially the valves, and so those valves can degenerate much earlier than than in the older population, that is what we call degenerative heart disease.

 Then there's another element of valvular heart disease that's infectious, not from strep throat and rheumatic fever. But if for instance, you have a valve that's not quite normal and you develop an infection, treatment of that infection is critical because if you get bacteria from the infection in your blood and your valve is somewhat diseased before, you can develop what we call endocarditis, which is an infection in the valve.

So, you're right. The spectrum is you're born with it, congenital, or you develop rheumatic fever that hurts the valves. It can be degenerative which means that as you age, the leaflets deteriorate, or you can develop an infection at any point in your life that can infect the valve and cause a problem.

Host: Wow, we better take those strep throats more seriously. I had no idea. That's fascinating. What symptoms are a sign of heart valve problems?

Dr. John Perry: The symptoms of heart valve problems is very similar to the blockages that cause you to need bypass surgery, but shortness of breath, dizziness, fatigue, swelling in your legs, for instance, congested lungs, and another element is arrhythmias, irregular heartbeat. As the chambers dilate with a valve problem, you can develop things like atrial fibrillation or other arrhythmias of the heart.

But those are some of the main symptoms. Shortness of breath is also a classic symptom.

Host: Dr. Perry, why is it important to treat a valve issue?

Dr. John Perry: Earlier on in valve problems, you may not be symptomatic at all. You may have no symptoms. Most patients are asymptomatic. Once you develop symptoms, the medications that we use to treat the symptoms, it's important to realize they don't reverse the process. There's really no medication to fix the diseased valve.

Nothing on the market can fix these valves. Now, earlier on, and if you're developing symptoms, your cardiologist, the heart doctors, may put you on medications to help alleviate some of your symptoms. However, it doesn't fix the valve. As you go on, and those valves get worse, in terms of either leaking, or obstruction, they are life threatening, and they cause more and more symptoms. So the reason for addressing it early is the fact that we have no medications that can fix them, and they only get worse over time.

Host: Dr. Perry, when it comes to heart valve treatment options, what do you offer?

John Perry, MD: If the valve is mildly diseased, usually nothing needs to be done. If the patient's develop symptoms, then sometimes medications can alleviate those symptoms. But as I said before, because this is not a reversible problem and probably will progress, eventually the cardiologist will refer the patient for surgery.

And the surgical options are either replacement of the valve or repair. There are a vast number of surgical tools that are being used today. Some of them don't require opening the chest. Some of them are considered minimally invasive, meaning smaller incisions, and some of them are catheter based. For instance, Mitral valves with a leak are now being fixed through the groin with a clip.

Aortic valves are now being replaced through the groin catheter based replacement and there are some patients who don't fall in those categories in terms of indication and so they need surgery to fix the valve. And replacement or repair; it depends on the severity of the problem and the valve that's involved that determines whether repair is in order or whether replacement is necessary.

Host: And what is recovery like following a treatment?

Dr. John Perry: Recovery, typically in the hospital, five to seven days in the hospital, and then the patient goes home, and usually recovery at home is maybe six to eight weeks. After that, cardiac rehabilitation may be recommended. Those are patients who go through whatever procedure is performed smoothly without any complications.

Now, there are patients that need to be in the hospital much longer because of complications. But typically, I would say, on average, five to seven days in the hospital and then home, and then slow recovery at home for the next six to eight weeks.

Host: So you have to really plan ahead. That's a time commitment. Just the recovery alone.

Dr. John Perry: Absolutely. And family support is absolutely essential.

Host: I'm sure. Is there anything else you'd like to add that we didn't discuss?

Dr. John Perry: Only that the symptoms of heart valve disease can mimic a lot of other illnesses. So it's important to check up with your physician. A heart murmur can prompt them to do more diagnostic testing to make sure your valves are fine and definitely follow up, but it should not be

 ignored. And follow up is definitely essential. Valvular heart disease is one of the structural problems of the heart that are not amenable to just ignoring it or medical treatment. The medications when I was in training, a lot of times until the patient was severely ill with severe symptoms, the valves were not touched.

Now we know there are distinct damages that can occur to the heart that can be permanent if you don't treat a valvular problem early enough. So now most cardiologists and most surgeons don't wait until the patient is an extremist. They'll treat the valve problem earlier rather than later if a severe problem exists.

But, coordination with the cardiologists who are the cardiac doctors, not, non-surgical, is very important. Follow up, every six months to a year with an echocardiogram to assess the valve, to assess the heart muscle function, make sure the heart's not getting overly dilated, or the heart muscle is not weakening, is critical. Some of those changes are irreversible.

Host: Well, that's reassuring to know that now they take it more seriously sooner than later. So good to know. Thank you so much for sharing your expertise with us. We appreciate you.

Dr. John Perry: Yes, absolutely. You're absolutely welcome.

Host: Again, that's Dr. John Perry. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Meaningful Medicine from Novant Health.