Structural Heart Disease
Aortic valve diseases
The aortic valve controls blood flow from the left ventricle of the heart to the aorta, a major blood vessel that delivers blood to the rest of the body. Aortic valve diseases prevent blood from flowing properly through the heart.
There are two main types of aortic valve disease: aortic stenosis and aortic regurgitation.
Aortic stenosis (AS)
In severe aortic stenosis (AS), the opening of the aortic valve becomes narrowed, which restricts the flow of blood though the valve and forces the heart to work harder. As aortic stenosis worsens, the heart becomes increasingly weaker. This increases the risk of heart failure, a very serious disease that occurs when your heart cannot pump enough blood to the body. If severe aortic stenosis is not diagnosed and treated, about half of the people who have it will die within an average of two years.
In aortic regurgitation, also known as aortic insufficiency, the aortic valve does not close as tightly as it should. This leads to the backward flow of blood from the aorta into the left ventricle, causing the heart to work harder than it should. If aortic regurgitation is severe, surgery may be required to replace the valve.
Aortic valve disease treatment (TAVR)
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to implant a prosthetic valve inside your diseased valve. The procedure allows the physician to insert a new valve into the heart while it is still beating, so the patient usually does not have to be on a heart-lung bypass machine. The new valve is inserted via a thin, flexible tube called a catheter, so it is less invasive than valve replacement surgery.
Scripps interventional cardiologists are San Diego’s leaders in TAVR surgery. Scripps heart doctors were among the first in the US to test the devices in clinical trials before the procedure received FDA approval in 2011. More than 1,000 Scripps patients have benefitted from TAVR as a treatment for heart valve disease.
Mitral valve diseases
The mitral valve allows blood to flow between the two chambers on the left side of your heart. When the heart relaxes, the valve is open, allowing blood to flow from the lungs to the main pumping chamber of the heart. When the heart squeezes, the valve closes, so that blood goes forward toward the brain and body and not to the lungs. Mitral valve diseases prevent the proper flow of blood through the heart.
There are two main types of mitral valve disease: mitral regurgitation and mitral stenosis.
The most common type of heart valve disorder, mitral regurgitation, is a condition in which the mitral valve does not close completely. As a result, the blood can flow backward into the upper heart chamber and toward the lungs, reducing the amount of blood that flows to the rest of the body and placing an abnormal amount of pressure on the lungs.
Your heart works harder to pump blood, and your lungs feel strained. This can lead to shortness of breath, irregular heartbeats, elevated blood pressure in the lungs, stroke or congestive heart failure. If the amount of mitral regurgitation is severe, surgery or catheter-based therapy may be required to repair or replace the valve.
In mitral stenosis, the mitral valve does not open enough to let blood flow freely through it. This means less blood flows to the body, and blood and fluid may collect in the lung tissues, which makes breathing difficult. Mitral stenosis usually comes from an infection called rheumatic fever that affects children and often goes unrecognized.
Often, medication is not sufficient to control severe mitral regurgitation, and surgery may be needed to repair or replace the mitral valve.
Mitral valve disease treatment
Scripps offers advanced treatments for mitral valve disease, including transcatheter mitral valve repair and transcatheter balloon mitral valvuloplasty.
Transcatheter mitral valve repair
Patients who are not able to have heart surgery, most commonly because of other medical conditions that make surgery problematic, may be able to have a minimally invasive procedure called transcatheter mitral valve repair. Scripps interventional cardiologist Matthew Price, MD, performed the first transcatheter mitral valve procedure in San Diego as part of a clinical trial; the procedure is now a solution for many patients.
The procedure uses a heart valve clip to treat mitral regurgitation by clipping together the leaflets of the valve at the spot where they are not coming together correctly, thereby fixing the leak. The physician inserts a thin tube called a catheter into the upper leg and up to the heart, and then guides the heart valve clip through the catheter and carefully positions it on the mitral valve. Once the device is in place and working properly, the catheter is removed.
Generally, patients spend one or two nights in the hospital after the procedure. Most patients experience an immediate reduction of mitral regurgitation and significant improvement in quality of life soon after the procedure.
Transcatheter mitral balloon valvuloplasty
Mitral stenosis, or narrowing of the valve due to rheumatic fever, is first treated with medication that slows down the heart. If shortness of breath still occurs despite medication, the valve narrowing can be treated with a catheter-based minimally invasive procedure in which a catheter with a balloon is threaded up into the heart and across the valve.
The balloon is then inflated and removed, which alleviates the narrowing and allows the blood to flow across the valve more normally. On occasion, the valve cannot be fixed with this balloon; in such cases, surgery to replace the valve is usually recommended.
Congenital and septal defects
Congenital heart defects are structural problems with the heart that are present at birth. Many congenital heart defects may be treated during childhood, but in some cases they are discovered later in life. Such adult congenital heart disease may require additional treatment, such as medication, surgery or less invasive procedures performed by an interventional cardiologist. There are several types of procedures; your physician will determine which is best for you.
Scripps interventional cardiologists treat many congenital heart defects using minimally invasive catheter-based techniques. These defects include:
Atrial septal defect
In the womb, babies have an opening between the left and right upper chambers of the heart. Normally, tissue grows to close the opening before the baby is born. If this doesn’t happen, the hole in the heart is known as an atrial septal defect.
If the opening is small, the atrial septal defect may not cause symptoms or require treatment, but large openings can cause the heart to swell, put pressure on the lungs and reduce the amount of oxygen in the blood. This can cause shortness of breath and decrease the amount of exercise the person can do as they get older. Most atrial septic defects can be treated with minimally invasive techniques performed with only local anesthesia.
Ventricular septal defect
People who have a ventricular septal defect have a hole in the wall between the heart’s lower chambers (ventricles). In some cases, this can lead to pulmonary hypertension (high blood pressure) and weakening of the heart and may require treatment.
Whether the treatment must be done with surgery or with a minimally invasive catheter-based procedure depends on the location and size of the hole, and whether any other medical problems are present.
Patent ductus arteriosus
Patent ductus arteriosus is an open hole in a tube in the aorta, the main artery through which blood flows from the heart to the body. The ductus should close at birth, but in some cases, remains open (patent). In adults, it can lead to shortness of breath and swelling of the heart.
The defect can be treated through a minimally invasive catheter-based procedure, performed under local anesthesia and usually requiring only one day in the hospital.
Patent foramen ovale
The foramen ovale is an opening between the left and right chambers of the heart that is present in the womb. This hole normally begins to close as soon as a baby takes its first breath of air and closes completely within several months. But in approximately one out of four adults, it does not close entirely, and this is called a patent foramen ovale.
In people who have strokes without a known cause, particularly when they are younger, or in people who have problems getting enough oxygen in the blood, but have normal lungs and otherwise normal hearts, closing the patent foramen ovale with a minimally invasive, catheter-based technique can be considered.
Paravalvular leak and other heart conditions
In a small number of patients who have had a heart valve replaced, a space may open between the valve replacement and the patient’s natural heart tissue. This is called a paravalvular leak (PVL) and forces the heart to work harder than it should to pump blood through the body. Symptoms of PVL may include shortness of breath, unexplained weight gain, and swelling in the legs and feet. Without treatment, severe paravalvular leaking may lead to heart failure.
Scripps interventional cardiologists use minimally invasive surgery to place a device around a paravalvular leak that blocks or plugs the leak. The device is placed using a long, thin tube called a catheter. Once the device has closed the leak, the catheter is removed.
Several rare or unusual structural heart conditions are difficult or impossible to treat with surgery and can only be addressed with catheter-based techniques. These conditions include:
A pseudoaneurysm or “false aneurysm” happens when the wall of a blood vessel is injured and the blood becomes trapped in the tissues. A pseudoaneurysm may be a complication of a heart attack or a cardiac catheterization procedure.
Pseudoaneurysms often heal on their own. But some may require treatment to prevent hemorrhage or other complications. If your physician suspects you have a pseudoaneurysm, you may need an ultrasound exam to evaluate it and determine the best course of treatment. Most pseudoaneurysms can be treated with a minimally invasive catheter-based procedure.
Pulmonary and coronary arteriovenous fistulas
An arteriovenous fistula is a rare condition in which the connection between one of the coronary arteries and a chamber of the heart or a blood vessel is abnormal. Babies may be born with it; in adults, it can be caused by an infection, an injury to the heart or a complication of heart surgery.
Fistulas may be evaluated with an X-ray, ultrasound, MRI or cardiac catheterization, and many do not require treatment. Those that do can be treated with a minimally invasive catheter-based procedure that blocks the abnormal opening.
Hypertrophic cardiomyopathy occurs when the cells of the heart muscle enlarge and cause the walls of the ventricles to become thicker. If this blocks the flow of blood through the ventricle, the condition becomes obstructive hypertrophic cardiomyopathy. This condition can lead to elevated blood pressure levels, arrhythmia (irregular heartbeat) and, in rare cases, sudden cardiac arrest during vigorous physical activity.
If treatment is needed and medication does not control the condition, Scripps interventional cardiologists can perform minimally invasive catheter-based procedures including transcatheter alcohol septal ablation, where the physician injects a type of alcohol called ethanol through a tube into the artery that supplies blood to the thickened cells. The alcohol kills the cells, and the thickened tissue shrinks, allowing blood to flow more freely.
Atrial fibrillation (AFib), a type of irregular heartbeat, can increase the risk of stroke. Scripps heart specialists offer the following to help those affected by AFib reduce their risk.
- Transcatheter left atrial appendage closure
- Transcatheter left atrial appendage ligation