Heart Valve Disease

More than five million Americans are diagnosed with heart valve disease (also known as valvular heart disease) each year. Heart valve disease takes many forms that all have one thing in common: They occur when one or more valves of the heart are not working properly.

Penn Medicine is one of the largest heart valve disease programs in the Mid-Atlantic and is recognized nationally for our innovative procedures and successful patient outcomes. Our skilled team of surgeons and cardiologists routinely treat both common and complex cases of heart valve disease in order to give our patients a chance for an improved quality of life.

The Function of the Heart Valves

Your heart has four valves: the aortic, mitral, tricuspid and pulmonary valves. They work to pump blood in the correct direction through and out of the heart, acting as one-way channels for blood flow between ventricles. Each valve has flaps (also called cusps or leaflets) that open and close to control blood flow. These flaps also help to prevent backward flow of blood.

What Is Heart Valve Disease?

Heart valve disease refers to a group of disorders that affect any of the four valves of the heart. With heart valve disease, flaps on one or more of these valves do not function as they are supposed to. Causes of heart valve disease include congenital heart conditions (present at birth), rheumatic fever, infection and age.

There are two common ways that a heart valve can fail:

• Stenosis: Valve stenosis means the flaps are stiff or thickened. In some cases, they may be fused together. Stenosis causes your valve to narrow, limiting the flow of blood.
• Regurgitation: Also known as leaky valve or valve insufficiency, regurgitation happens when your valve flaps do not close securely. Blood may leak backward through the valve. Your heart must pump harder to push blood in the right direction.

Types of Heart Valve Disease

At Penn Medicine our cardiac surgeons manage and treat all types of heart valve disease with both minimally invasive and open-heart surgical approaches. The conditions we most commonly treat include:

• Aortic Valve Conditions: If you have been diagnosed with aortic valve regurgitation, aortic stenosis or bicuspid aortic valve (BAV) disease, our specialty-trained aortic valve team provides disease management and advanced treatment options. Penn also has a designated Center for Bicuspid Aortic Valve Diseases.
• Mitral Valve Conditions: Our cardiac team treats mitral valve prolapse, mitral valve regurgitation and mitral valve stenosis. We are experts in complex mitral valve repair and offer both minimally invasive surgery and catheter-based treatment options for mitral valve disease.
• Pulmonary Valve Conditions: Pulmonary valve stenosis is a congenital condition usually first treated in childhood but may require additional treatment as an adult. At Penn's Adult Congenital Heart Center, we monitor your condition, and our cardiac team repairs or replaces your pulmonary valve when necessary.
• Tricuspid Valve Conditions: While tricuspid stenosis is a congenital condition diagnosed and treated in childhood, tricuspid valve regurgitation can occur in adults. Penn experts surgically repair or replace tricuspid valves and are involved in innovative catheter-based trials to replace the valve.

Heart Valve Disease Symptoms and Warning Signs

Some people may not experience symptoms for many years before their heart valve disease is diagnosed. Others may experience a sudden onset of symptoms that are hard to ignore. When symptoms present, they may include:

• Chest pain
• Heart murmur
• Fatigue
• Shortness of breath
• Swelling of ankles or feet
• Dizziness
• Fainting
• Irregular heartbeat
• Abdominal pain

Even if symptoms of heart valve disease progress slowly, damage to your heart may still be significant. That’s why it’s important to see your primary care provider for your annual physical and follow-up with them if any new symptoms develop.

How Is Heart Valve Disease Diagnosed?

During a physical examination, your doctor will listen for a heart murmur as a possible sign of heart valve disease. Based on your symptoms and general health, your provider may then recommend additional testing that may include:

• Echocardiography
• Echocardiogram (ECG)
• Transesophageal echocardiogram (TEE)
• Chest x-ray
• Cardiac MRI
• Cardiac catheterization
• Stress test

Heart Valve Disease Treatment at Penn Medicine

At Penn, we offer both surgical and nonsurgical (catheter-based) options for heart valve replacement and repair. Whenever possible, our surgeons and cardiologists will repair your heart valve instead of replacing it. Heart valve repair retains your valve's strength and function. It also comes with a lower risk of infection and reduces your need to take lifelong blood-thinning medications.

Heart Valve Surgery

Penn performs the most heart valve surgeries in Pennsylvania, New Jersey and Delaware. We deliver high success and low complication rates, even when treating high-risk and elderly patients. Our skilled surgeons use both open-heart surgery and minimally invasive heart surgery, including robotic techniques, whenever possible to reduce pain and recovery time. We surgically repair and replace:

• Aortic valves: Our cardiovascular surgeons use aortic valve repair and replacement surgery to replace valves with aortic stenosis and repair aortic regurgitation.
• Mitral valves: If you have mitral stenosis or mitral regurgitation, you may require mitral valve repair or replacement surgery to correct the valve. Our surgeons also perform complex mitral valve repairs for regurgitation.
• Pulmonary valves: While pulmonary stenosis is a congenital disease treated surgically in childhood, Penn surgeons correct this valve with pulmonary valve repair and replacement surgery when necessary in adults.
• Tricuspid valves: Our surgeons treat tricuspid regurgitation with tricuspid valve repair and replacement surgery, often while operating on other heart conditions. We are involved in investigational approaches to treat tricuspid valve disease without surgery.

Cardiac Catheterization

Catheter-based heart valve repair and replacement provides a nonsurgical option for patients, especially when surgery is not ideal. During these procedures, our interventional cardiologist inserts a thin flexible tube (catheter) into a blood vessel in your groin or arm. The catheter is advanced to your heart and used to replace or repair the valve.

Penn offers innovative catheter-based procedures to treat heart valve disease, including:

• Balloon valvuloplasty, for treatment of stenosis in mitral, aortic and pulmonary valves. Penn performs more balloon valvuloplasty procedures for mitral valve stenosis than any hospital in the region.
• Paravalvular leak closure, which is used to correct leaks that may occur in the space between natural heart tissue and a prosthetic valve in people who've already had a valve replaced.
• MitraClip™, which is a device that repairs mitral regurgitation. In 2003, we performed the second MitraClip procedure in the country. We are currently investigating how this procedure can be used to repair other heart valve disease, such as tricuspid valve disease.
• Transcatheter aortic valve replacement (TAVR), which is a technique used by our interventional cardiologists and cardiac surgeons since 2007. We are one of the top five TAVR programs in the country, performing nearly 600 procedures a year for aortic stenosis.
• Transcatheter mitral valve replacement (TMVR), where a new valve is placed in a previously replaced mitral valve that is failing.
• Transcatheter pulmonary valve replacement (TPVR), which is used to replace a failing pulmonary valve after prior congenital surgery.

Recovering from Heart Valve Disease Treatment

Your recovery will vary depending on the type of heart valve disease treatment you receive. At Penn, we try to perform minimally invasive procedures whenever possible. If both surgery and cardiac catheterization are needed, our multidisciplinary teams will work together to perform both procedures at the same time so that you only need to be under general anesthesia once and can begin your recovery right away.

Heart Valve Surgery Recovery

Heart valve surgery can be performed as an open-heart procedure or by using minimally invasive techniques. Because minimally invasive heart surgery only requires the use small incisions to access the heart, they are typically less painful and have a quicker recovery period compared to open-heart surgery. Most patients can expect a two to five-day hospital stay following minimally invasive heart valve surgery.

For heart valve surgery that requires an open-heart procedure, most patients stay in the hospital four to five days following their procedure and can expect to start feeling better about four to six weeks following surgery. Your doctor may also recommend that you participate in cardiac rehab to help regain your strength and stamina.

Learn more about cardiac rehabilitation at Penn Medicine

Cardiac Catheterization Recovery

Many catheter-based heart valve repair and replacement procedures only involve a one or two-day hospital stay, however, if your procedure is taking place at the same time as an open-heart surgical procedure, you will need to stay in the hospital for a longer period of time.

Most patients can return to their normal activities within two or three days following the procedure but will be recommended to avoid strenuous exercise and lifting heavy objects for up to two weeks. Your doctor will advise you of your limitations based on your personal health and specific procedure.

Treating Heart Valve Disease: The Penn Medicine Advantage

As one of the largest heart valve programs in the mid-Atlantic, Penn Medicine treats every heart valve condition, from routine to highly complex. When our experts treat your valve disease, you can count on:

• Experienced leaders in catheter-based intervention: Penn was the first in the region to offer advanced nonsurgical treatment options, including MitraClip™ therapy and transcatheter aortic valve replacement (TAVR). Today, we are one of top five TAVR programs in the country.
• Renowned surgical skills: Our cardiac surgeons perform complex valve repair and replacement when other regional hospitals cannot. For complex mitral valve conditions, our repair rate is near 100 percent, far exceeding the national average.
• Accessible innovation: Penn is an international leader in developing new therapies for heart valve repair and replacement. Participation in our clinical trials gives patients access to new treatments not available elsewhere in the region.
• Aortic disease expertise: Experts at the Penn Aortic Center treat both common and complex aortic disease. Our team of aortic specialists includes surgeons, cardiologists, imaging experts and geneticists.
• Complete care for bicuspid aortic valve disease (BAVD): Penn's Center for Bicuspid Aortic Valve Diseases is the only program in the region providing comprehensive care for patients with BAV and associated aortic aneurysm disease.
• Superior safety standards: To lower the risk of stroke associated with TAVR, Penn was the first in the region to evaluate and adopt a specialized stroke prevention system.

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