Heart valve disease occurs if one or more of your heart valves doesn't work well.
There are several types of heart valve disease.
Valvular stenosis and Valvular insufficiency are a couple types of valve disease.
Dr. Daniel Sporn, the Chief of Cardiology at Guthrie is here to discuss heart valve disease and what help Guthrie can offer you.
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Heart Valve Disease and the Guthrie Heart Valve Clinic
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Learn more about Dr. Daniel Sporn
Daniel Sporn, MD
Dr. Daniel Sporn is the Chief of Cardiology at Guthrie.Learn more about Dr. Daniel Sporn
Transcription:
Heart Valve Disease and the Guthrie Heart Valve Clinic
Bill Klaproth (Host): You may live your whole life and not think about the importance of healthy heart valves but what happens when one of your heart valves isn’t working properly? Here to talk with us is Dr. Daniel Sporn, Chief of Cardiology at Guthrie. Just a quick side note, Guthrie Robert Packer Hospital was named a Truven Health Top 50 Hospital for cardiovascular care in 2014, the 9th time the heart care team received that award. Dr. Sporn, that’s quite an accomplishment. Congratulations and thank you so much for being on with us today. So, I just want to jump right in. Can you tell us what is heart valve disease?
Dr. Daniel Sporn (Guest): Yes. People have four different valves in their heart and the valves are very important in moving blood from one chamber to another. Heart valve disease can develop for a number of reasons. Sometimes someone may have a heart attack and develop an abnormal heart valve. They can get an infection of a valve called endocarditis that can lead to valve leakage or what we call medically “regurgitation”. Sometimes just wear and tear over the years causes a heart valve to become narrowed and treatment needs to be performed to correct that.
Bill: And it can be congenital right? You can be born with this, too?
Dr. Sporn: Yes. Yes. There are some cases of congenital valve disease. Much, much less common but also something that requires attention many times even as a small child.
Bill: Are there lifestyle things that contribute to heart valve disease?
Dr. Sporn: Many of the same things that cause coronary disease, which is very prevalent, can cause heart valve problems. Diseases such as high blood pressure, hypertension can lead to this sort of thing, even smoking and elevated cholesterol. So, the bottom line is prevention as far as those things are concerned. Walking and living a healthy lifestyle can help to prevent heart valve problems.
Bill: You’ve mentioned that there are two basic forms of heart valve disease. There’s the leaky valve and then the narrowed valve. Is there one that’s more common than the other?
Dr. Sporn: Both are fairly common. The two most common valve problems we see are a narrowed aortic valve called aortic stenosis and this is a problem that typically people have as they get into their later years, their 70s, their 80s, their 90s, which is mostly from wear and tear over the years. Then, there’s the leaky or regurgitant valve. This typically involves mostly the mitral valve. That, again, can be related to wear and tear. It can be related to a heart attack. The other common cause would be congestive heart failure which people can have from many different causes that leads to an enlarged heart and subsequently a leaky mitral valve.
Bill: Is there one that’s more problematic than the other? Is there one that’s worse?
Dr. Sporn: Neither one is a great thing to have. The aortic narrowing, I would say, is probably the worst of the 2. All the blood that leaves the heart goes through the aortic valve and if you get a narrowed valve, unfortunately without fixing it, it just continues to get tighter and the blood can’t get out to the head and the rest of the body and alternately one will succumb to this if every care is not done.
Bill: So, this happens slowly over time. Are there symptoms that start to pop up and if so what are those?
Dr. Sporn: Yes. The most common symptoms with both of these illnesses would be shortness of breath, in some cases chest pain, especially with the aortic stenosis, the aortic valve narrowing. Another common symptom would be fatigue that would be prevalent with both of these problems or any type of valve problem. Those would be the main things. Some of the signs sometimes people may develop swelling in their feet, sometimes that swelling could occur in another part of the body, the hands, the abdomen. They may just notice weight gain for an unexplained reason.
Bill: How do you diagnose this?
Dr. Sporn: Well, there are several ways. The history taking that physicians take is still the most important thing that we do. That gives us 90% of diagnosis. Or, I should say it gives you the diagnosis 90% of the time. The physical examination adds to that and then the common cardiac tests we do. The most common to help secure the diagnosis is called an echo cardiogram. That’s an ultrasound test of the heart. It does not involve needles. We put a probe over the chest and we can see the four chambers of the heart. We can see the four valves. We can even measure pressures inside the heart and see how things are functioning.
Bill: What are the treatment options then? Is it the same for the leaky valve or the narrowed valve or is it different for each?
Dr. Sporn: Well, it is different with that narrowed valve there isn’t a whole lot one can do in terms of medication. Initially, the problems someone will have is they’ll accumulate fluid and one can give a diuretic, so-called water pill, that takes some of the fluid out of the body but, ultimately, that valve gets so tight that that will not continue to take care of the problem. So, that valve has to be replaced and there are a couple of ways of doing that these days. With the leaky valve, one has some increased medical, or medication options. Ultimately, if that leak is severe, one needs to consider surgery for that and, again, there are different types of surgeries that are performed for the mitral valve regurgitation.
Bill: So, tell me about heart valve replacement then. What does that consist of?
Dr. Sporn: With the aortic stenosis, the traditional operation has been an open aortic valve replacement by a cardiothoracic surgeon, a procedure where someone comes in and is in the hospital for about a week and then goes home, recoups from that and basically lives a normal life. The latest and greatest procedure, which is appropriate for some patients that need aortic valve replacement, is called TAVR, which is a transcatheter aortic valve replacement, where we can actually replace that valve without opening the chest, typically doing it in a similar way to how we do a heart catheterization, going up from the femoral artery and putting a new valve inside of the old valve and it works very, very nicely.
Bill: What’s the percentage of TAVR vs. traditional, now?
Dr. Sporn: It continues to increase. It’s a newer procedure and so, right now it’s indicated for the highest risk patents. The ones that typically are just so high risk that they cannot undergo an open procedure or those that are so high risk that we deem them a better candidate for the TAVR rather than the surgical aortic valve replacement which we call SAVR. I would say it’s very much continuing to increase the number of TAVR’s we’re doing. It’s probably right now in the range of 5-10% of the total that are done in this newer TAVR way.
Bill: Now, what’s the recovery time of traditional vs. TAVR?
Dr. Sporn: The traditional surgery, generally you’re in the hospital about 5-7 days after the operation and you go home and over the next few weeks, you continue to recuperate. So, most people by a month out from the surgical operation, and certainly two months out, you’re back to driving, you’re back to work. You’re doing everything that you want to do, really without restriction. With the less invasive approach, most of the time, the goal is to get people out within several days of the procedure. Places are now even starting sometimes to get a patient out the very next day. Those patients, typically, are back to full activity a week later.
Bill: When someone thinks heart surgery, you think, “Oh, my god. Scary.” Is this becoming more of a routine thing? Do people not have to worry as much about this type of heart surgery?
Dr. Sporn: Yes. I mean, it really is the people involved in doing that at Guthrie, you know, are very experienced at this. We’ve developed processes and teams that allow for efficient and effective care and the outcomes are excellent. So, I think as much as it sounds daunting to people, if you need this done, you know, the success rates are very, very good and, again, you should be able to go on and live a normal life once you’ve recuperated.
Bill: Great information, Dr. Sporn. Thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth and this is Guthrie Radio. Thanks for listening.
Heart Valve Disease and the Guthrie Heart Valve Clinic
Bill Klaproth (Host): You may live your whole life and not think about the importance of healthy heart valves but what happens when one of your heart valves isn’t working properly? Here to talk with us is Dr. Daniel Sporn, Chief of Cardiology at Guthrie. Just a quick side note, Guthrie Robert Packer Hospital was named a Truven Health Top 50 Hospital for cardiovascular care in 2014, the 9th time the heart care team received that award. Dr. Sporn, that’s quite an accomplishment. Congratulations and thank you so much for being on with us today. So, I just want to jump right in. Can you tell us what is heart valve disease?
Dr. Daniel Sporn (Guest): Yes. People have four different valves in their heart and the valves are very important in moving blood from one chamber to another. Heart valve disease can develop for a number of reasons. Sometimes someone may have a heart attack and develop an abnormal heart valve. They can get an infection of a valve called endocarditis that can lead to valve leakage or what we call medically “regurgitation”. Sometimes just wear and tear over the years causes a heart valve to become narrowed and treatment needs to be performed to correct that.
Bill: And it can be congenital right? You can be born with this, too?
Dr. Sporn: Yes. Yes. There are some cases of congenital valve disease. Much, much less common but also something that requires attention many times even as a small child.
Bill: Are there lifestyle things that contribute to heart valve disease?
Dr. Sporn: Many of the same things that cause coronary disease, which is very prevalent, can cause heart valve problems. Diseases such as high blood pressure, hypertension can lead to this sort of thing, even smoking and elevated cholesterol. So, the bottom line is prevention as far as those things are concerned. Walking and living a healthy lifestyle can help to prevent heart valve problems.
Bill: You’ve mentioned that there are two basic forms of heart valve disease. There’s the leaky valve and then the narrowed valve. Is there one that’s more common than the other?
Dr. Sporn: Both are fairly common. The two most common valve problems we see are a narrowed aortic valve called aortic stenosis and this is a problem that typically people have as they get into their later years, their 70s, their 80s, their 90s, which is mostly from wear and tear over the years. Then, there’s the leaky or regurgitant valve. This typically involves mostly the mitral valve. That, again, can be related to wear and tear. It can be related to a heart attack. The other common cause would be congestive heart failure which people can have from many different causes that leads to an enlarged heart and subsequently a leaky mitral valve.
Bill: Is there one that’s more problematic than the other? Is there one that’s worse?
Dr. Sporn: Neither one is a great thing to have. The aortic narrowing, I would say, is probably the worst of the 2. All the blood that leaves the heart goes through the aortic valve and if you get a narrowed valve, unfortunately without fixing it, it just continues to get tighter and the blood can’t get out to the head and the rest of the body and alternately one will succumb to this if every care is not done.
Bill: So, this happens slowly over time. Are there symptoms that start to pop up and if so what are those?
Dr. Sporn: Yes. The most common symptoms with both of these illnesses would be shortness of breath, in some cases chest pain, especially with the aortic stenosis, the aortic valve narrowing. Another common symptom would be fatigue that would be prevalent with both of these problems or any type of valve problem. Those would be the main things. Some of the signs sometimes people may develop swelling in their feet, sometimes that swelling could occur in another part of the body, the hands, the abdomen. They may just notice weight gain for an unexplained reason.
Bill: How do you diagnose this?
Dr. Sporn: Well, there are several ways. The history taking that physicians take is still the most important thing that we do. That gives us 90% of diagnosis. Or, I should say it gives you the diagnosis 90% of the time. The physical examination adds to that and then the common cardiac tests we do. The most common to help secure the diagnosis is called an echo cardiogram. That’s an ultrasound test of the heart. It does not involve needles. We put a probe over the chest and we can see the four chambers of the heart. We can see the four valves. We can even measure pressures inside the heart and see how things are functioning.
Bill: What are the treatment options then? Is it the same for the leaky valve or the narrowed valve or is it different for each?
Dr. Sporn: Well, it is different with that narrowed valve there isn’t a whole lot one can do in terms of medication. Initially, the problems someone will have is they’ll accumulate fluid and one can give a diuretic, so-called water pill, that takes some of the fluid out of the body but, ultimately, that valve gets so tight that that will not continue to take care of the problem. So, that valve has to be replaced and there are a couple of ways of doing that these days. With the leaky valve, one has some increased medical, or medication options. Ultimately, if that leak is severe, one needs to consider surgery for that and, again, there are different types of surgeries that are performed for the mitral valve regurgitation.
Bill: So, tell me about heart valve replacement then. What does that consist of?
Dr. Sporn: With the aortic stenosis, the traditional operation has been an open aortic valve replacement by a cardiothoracic surgeon, a procedure where someone comes in and is in the hospital for about a week and then goes home, recoups from that and basically lives a normal life. The latest and greatest procedure, which is appropriate for some patients that need aortic valve replacement, is called TAVR, which is a transcatheter aortic valve replacement, where we can actually replace that valve without opening the chest, typically doing it in a similar way to how we do a heart catheterization, going up from the femoral artery and putting a new valve inside of the old valve and it works very, very nicely.
Bill: What’s the percentage of TAVR vs. traditional, now?
Dr. Sporn: It continues to increase. It’s a newer procedure and so, right now it’s indicated for the highest risk patents. The ones that typically are just so high risk that they cannot undergo an open procedure or those that are so high risk that we deem them a better candidate for the TAVR rather than the surgical aortic valve replacement which we call SAVR. I would say it’s very much continuing to increase the number of TAVR’s we’re doing. It’s probably right now in the range of 5-10% of the total that are done in this newer TAVR way.
Bill: Now, what’s the recovery time of traditional vs. TAVR?
Dr. Sporn: The traditional surgery, generally you’re in the hospital about 5-7 days after the operation and you go home and over the next few weeks, you continue to recuperate. So, most people by a month out from the surgical operation, and certainly two months out, you’re back to driving, you’re back to work. You’re doing everything that you want to do, really without restriction. With the less invasive approach, most of the time, the goal is to get people out within several days of the procedure. Places are now even starting sometimes to get a patient out the very next day. Those patients, typically, are back to full activity a week later.
Bill: When someone thinks heart surgery, you think, “Oh, my god. Scary.” Is this becoming more of a routine thing? Do people not have to worry as much about this type of heart surgery?
Dr. Sporn: Yes. I mean, it really is the people involved in doing that at Guthrie, you know, are very experienced at this. We’ve developed processes and teams that allow for efficient and effective care and the outcomes are excellent. So, I think as much as it sounds daunting to people, if you need this done, you know, the success rates are very, very good and, again, you should be able to go on and live a normal life once you’ve recuperated.
Bill: Great information, Dr. Sporn. Thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth and this is Guthrie Radio. Thanks for listening.