Heart Valve Disease (Structural Heart Disease)

Open surgery for valve repair and replacement involves cutting and spreading the breastbone, which extends healing time and increases the risk of infection and complications. Our Minimally Invasive Valve Program is unique in Houston in its primary focus on less-invasive approaches to valve surgery.

The program is staffed by specialists with expertise in noninvasive cardiology, interventional cardiology, cardiovascular surgery and cardiovascular imaging. Surgeons use mini-incisions to replace and repair heart valves, allowing many patients to avoid the traditional sternotomy, an incision in the center of the chest that separates the sternum (breastbone) to allow access to the heart.

Minimally invasive approaches to valve repair and replacement decrease the need for blood transfusions, lower the risk of infection, shorten hospital stays and allow for an earlier return to productivity.

Our affiliated physicians provide preoperative, operative and critical care for all valve diseases, including:

• Mitral valve regurgitation
• Aortic valve regurgitation
• Mitral valve stenosis
• Aortic valve stenosis

They care for patients with congenital, degenerative, rheumatic and ischemic heart valve disease, as well as patients whose disease is related to valve endocarditis. 

Many of our innovative approaches to valve repair are based on research done at Memorial Hermann-Texas Medical Center and The University of Texas Medical School at Houston. Clinical research team members serve as principal investigators in local, national and international research trials, and publish the results of their research in major subspecialty journals and general medical journals such as Annals of Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery.

For more information on our services for patients with valve disease, or for a referral to an affiliated physician, call 713.7CARDIO (713.722.7346).

Diagnosis

At the Memorial Hermann Heart & Vascular Institute-Texas Medical Center, multiple noninvasive imaging modalities are used to diagnose structural heart disease, including:

• Echocardiography
• Cardiac MRI
• Cardiac CT

Cardiologists start the heart disease diagnostic process by taking a history of your symptoms, followed by a detailed physical exam to detect signs of disease and by an electrocardiogram. Most often, the clinical diagnosis is confirmed by various echocardiography tests.

Transthoracic echocardiography (TTE) is a completely noninvasive test that uses reflected sound waves (echoes) to create images of the beating heart. During the test, a device called a transducer will be placed on the surface of your chest. The transducer sends sound waves through the chest wall to the heart, which reflects the sound waves back to the transducer, creating echoes that are converted into 2D or 3D images. You will be able to watch your heart beating on a computer screen as the test is being done.

TTE provides a wealth of information about the size and shape of the heart, the functioning of the heart muscle and valves, as well as information about the blood flow through the heart. This bedside test represents the easiest way to diagnose valve narrowing  (stenosis) or backflow (regurgitation). Occasionally, TTE is performed in conjunction with a stress test (typically treadmill exercise). This combination is known as a stress echocardiogram and helps your physician understand your symptoms better and choose between major treatment options.

Transesophageal echocardiography (TEE) may be recommended by your physician. During TEE, a very small transducer is attached to the end of a thin, flexible tube, which is gently and painlessly guided down the throat and into the esophagus and stomach. A mild sedative is given intravenously, which requires a short recovery time at the end of the 15-minute procedure.

TEE is complementary to TTE and produces high-resolution images of the smallest heart structures. This test can be performed at the bedside, or during cardiac catheterization or surgery, guiding the procedures of interventional cardiologists or surgeons aiming to repair structural heart disease.

Cardiac magnetic resonance imaging (cMRI) is a noninvasive test that provides a highly detailed assessment of the structure and function of the heart and its vessels. cMRI does not rely on X-rays, but on magnetic fields and radio waves. The patient is placed in a large “doughnut” which contains a powerful magnet; a radio wave is transmitted by a light antenna (coil) placed on the chest. The coil receives back the radio waves as modified by the magnet and a complex computer program transforms the radio wave signal into a 2D or 3D image.

Most patients can have a cMRI study, unless their body contains certain metallic implants that could be displaced by the magnet. The test can take up to 1 hour and you will be asked to hold your breath for relatively short periods of time during the scan.

cMRI provides vivid, highly detailed images and movies of your heart that can diagnose very complex congenital or acquired structural disease defects. In addition, cMRI represents the gold standard for evaluation of the heart pumping function and of heart muscle scars developed after a heart attack, helping the cardiologist to decide on future treatment strategies.

A rapidly advancing technology in the noninvasive evaluation of heart disease, cardiac CT provides X-ray-based information on the structure and function of the heart and its vessels. Similar to cMRI, the patient is placed into a large “doughnut” that contains multiple X-ray transmitters. These transmitters rotate extremely fast around the body inside the doughnut, and can acquire all required images within seconds.

The amount of X-ray delivered to the body is carefully limited to a minimum necessary. A contrast substance may be given intravenously to enhance image quality. Currently, cardiac CT is widely used to detect calcifications and blockages of the larger heart vessels, in addition to general information pertaining to the heart structures.

About the Women’s Heart Healthy Program

Our Women’s Heart Healthy Program offers exams that can detect heart valve disorders. Designed specifically for women who want to make healthy living – and a healthy heart – a personal priority, the program offers leading-edge technology in a private setting, with personalized hands-on care provided by board-certified cardiologists and cardiovascular surgeons affiliated with the Memorial Hermann Heart & Vascular Institute-TMC. Call 713.704.1000 to schedule an appointment for the Heart & Vascular Package.

Treatment

Conditions treated include:

• Mitral valve regurgitation
• Aortic valve regurgitation
• Mitral valve stenosis
• Aortic valve stenosis
• Pulmonic Valve Stenosis
  

No medications are available to cure heart valve disease. However, lifestyle changes and medications may relieve many of the symptoms and problems linked to valvular disease. These treatments also can lower the risk of developing a life-threatening condition, such as stroke or sudden cardiac death.

Eventually, a faulty mitral or aortic heart valve may need to be dilated, repaired or replaced. Cardiologists and surgeons affiliated with the Memorial Hermann Heart & Vascular Institute-Texas Medical Center use the least aggressive approach, preserving heart valves whenever possible. If a valve replacement is necessary, they are skilled at performing the most advanced techniques.

Mitral Valve Repair with Evalve®

Mitral valve repair with Evalve^® is available at the Memorial Hermann Heart & Vascular Institute-TMC, the only hospital in Houston and one of three in Texas chosen to participate in the nationwide Endovascular Edge-to-Edge Repair Study, or EVEREST II, investigating the minimally invasive Evalve Cardiovascular Valve Repair System for the treatment of mitral valve regurgitation.

Using this system, cardiologists deploy a tiny clip delivered by a catheter into the heart to repair the malfunctioning mitral valve. The heart beats normally during the procedure; heart-lung bypass is not required, and patients return to normal activity within several days. In addition to improving blood flow through the heart, the procedure may also relieve symptoms such as fatigue and shortness of breath, common conditions in patients with significant mitral valve regurgitation.

The Evalve MitraClip® may improve quality of life and help patients avoid surgery or delay it, preserving surgical options – valve repair or replacement – until a time when surgery becomes necessary. 

Valvuloplasty  

An innovative use of valvuloplasty – inserting a special balloon into a narrowed mitral valve – may also delay surgery in mitral valve stenosis patients for 8 to 10 years. During the procedure, a balloon-tipped tube is threaded through a blood vessel and into the faulty valve in the heart. The balloon is inflated to widen the opening of the valve, then deflated and removed along with the tube.

Balloon valvuloplasty has a shorter recovery time than surgery, and for some patients it may produce outcomes comparable to surgical repair or replacement of the valve.  It is now the treatment of choice for patients with mitral stenosis and valve structures suitable for the valvuloplasty procedure.

Minimally Invasive Valve Repair/Least Invasive Valve Surgery (LIV)

In minimally invasive mitral valve repair/least invasive valve surgery, the surgeon makes a small incision on the right side of the chest, below the breast fold, and repairs the valve under direct vision. Valve replacement can also be performed through the same type of incision.

Advantages of LIV include reduced trauma from surgery, less blood loss, less chance of infection and faster recovery. The approach has been used in thousands of patients nationwide and can be used to treat both aortic and mitral valve disorders.

Advanced Aortic Valve Replacement  

Renowned for pioneering aortic surgery techniques, our affiliated surgeons are aggressive in their approach to aortic valve treatment, a condition in which valve replacement is often required. Surgeons at the Heart & Vascular Institute use bioprosthetic heart valves in some patients, an advancement that allows appropriately selected patients to avoid anticoagulant therapy.

Percutaneous Aortic Valve Replacement

For patients who are not candidates for open aortic valve replacement, new less-invasive or endovascular approaches to aortic valve replacement are currently in development. When clinical trials of the new percutaneous aortic valve replacement procedure begin in the United States, cardiac interventionalists at the Heart & Vascular Institute will offer them to appropriate patients. In the interim, alternative therapies are available, including balloon aortic valvuloplasty. 

Percutaneous Aortic Valvuloplasty  

Aortic valvuloplasty can be perfomed in patients with severe aortic stenosis that has resulted in severe heart failure or, in some cases, shock. Valvuloplasty is perfomed by carefully advancing a balloon retrograde across the narrowed valve and inflating it to stretch and enlarge the narrowed and hardened aortic valve structure. Typically, a 30 percent reduction in the severity of the stenosis can be achieved, which is enough to allow the heart recover from severe heart failure. This can also allow major non-cardiac surgeries to be performed in patients who are not candidates for valve replacement surgery, and subsequent valve replacement surgery to be performed more safely after the heart has recovered from severe failure. Unfortunately, in many patients the valve tends to narrow again over the course of approximately 6 months, which means that aortic valvuloplasty cannot be considered a permanent solution for patients with severe aortic stenosis.

Percutaneous Pulmonic Valvuloplasty  

Patients born with narrowed pulmonic valves who develop symptoms later in life – typically, shortness of breath on exertion – may be candidates for a similar balloon valvuloplasty procedure. In this case, a balloon-tipped catheter is threaded through the right atrium, tricuspid valve and right ventricle into the pulmonic valve, and then is carefully inflated, opening the valve area. Care must be taken to ensure that the area in the right ventricle beneath the tricuspid valve is not narrowed as well, as this can be hazardous for the valvuloplasty procedure.

Participation in Clinical Trials

Because our affiliated physicians are principal investigators in local, national and international clinical research trials, our patients have access to new medical therapies, innovative devices and technology very quickly after their introduction. Patients who qualify have the opportunity to participate in clinical trials of treatments not otherwise available.

Memorial Hermann Heart & Vascular Institute-Texas Medical Center

= Open to Enrollment

If you would like to learn more about participating in a research study or clinical trial, you may find our list of frequently asked questions (FAQ) helpful. If you have a question not addressed on our FAQ list, you may email us at research@memorialhermann.org.

Valvular Heart Disease

EVEREST I: A Study of the Evalve Cardiovascular Valve Repair System Endovascular Valve Edge-to-Edge Repair Study
Principal Investigator: Richard W. Smalling, M.D., Ph.D.

EVEREST I is evaluating the safety and effectiveness of the Evalve Cardiovascular Valve Repair System in the repair of mitral valve regurgitation during the 30-day period following repair. 

EVEREST II: A Study of the Evalve Cardiovascular Valve Repair System Endovascular Valve Edge-to-Edge Repair Study (Protocol #0401)
Principal Investigator: Richard W. Smalling, M.D., Ph.D.

Everest II is a prospective, multicenter, randomized study of the Evalve Cardiovascular Valve Repair System in the treatment of mitral valve regurgitation. Study participants undergo follow-ups at 30 days after treatment (or at hospital discharge if longer than 30 days), at six months and at 12 months.

Patient Stories

We believe our patients are the best advocates for what we do. We are sharing the stories of a few of our patients to provide a learning opportunity for others.