NORMAL HEART VALVE STRUCTURE AND FUNCTION
Your heart has four chambers and needs valves between the chambers and the chambers and main circulation, to allow blood to be pumped forwards without overflowing backwards. The upper chambers of the heart are called atria (left and right), the lower main pumping chambers are called ventricles (left and right). The valves between the atria and ventricles are called atrioventricular valves, mitral on the left and tricuspid on the right. The valve between the ventricles and main blood vessels leaving the heart are called semilunar valves, aortic on the left and pulmonary on the right. The diagram below shows the heart valves and how blood flows through the heart
The flow of blood during a cardiac cycle is as follows: Blood low in oxygen from the veins (called venous blood shown in blue) returns from the body via the vena cava into the upper receiving chamber (right atrium). This venous blood passes from the right atrium through the tricuspid valve and is pumped into the right pumping chamber (right ventricle). The right ventricle when full then pumps this venous blood out of the heart into the lungs. As this happens the tricuspid valve (between the right ventricle and atrium) closes to stop blood going backwards. As pressure builds up the valve between the right ventricle and lungs (pulmonary valve) opens allowing venous blood into the lungs, where it passes into small blood vessels called capillaries where carbon dioxide is released and the blood replenished with fresh oxygen. After contraction (pumping) of the right ventricle is complete the pulmonary valve closes to stop the venous blood going back into the heart, as the right ventricle relaxes to refill from the right atrium. The venous blood pumped into the lungs passes through capillaries and becomes arterial (red) blood. Arterial blood returns from the lungs to the left upper receiving chamber (left atrium). This arterial blood passes from the left atrium through the mitral valve and is pumped into the left pumping chamber (left ventricle). The left ventricle then pumps this arterial blood out of the heart into the body, via the aorta. As this happens the mitral valve (between the left ventricle and atrium) closes to stop blood going backwards. As pressure builds up between the left ventricle and aorta the aortic valve opens allowing arterial blood to be pumped around and supply the body. After contraction (pumping) of the left ventricle is complete the aortic valve closes to stop the arterial blood going back into the heart, as the left ventricle relaxes to refill from the left atrium. The cardiac cycle then starts again.
PROBLEMS THAT CAN DEVELOP WITH VALVES
As the body ages it is common for the valves to degenerate causing either leakage(regurgitation) or narrowing (stenosis). In many cases these problems just need regular surveillance with an echo scan. Certain conditions including valve abnormalities people are born with, diseases associated with tissue problems and endocarditis (infection of the heart) can accelerate either regurgitation or stenosis. As these problems become severe symptoms, such as being short of breath doing things and the valves may need to be fixed. Where possible the gold standard is usually heart valve surgery. However, sometimes minimally invasive techniques can be used to either fix or replace valves. Problems with the aortic, mitral and tricuspid valve are commonly seen and treated by adult cardiologists. Problems with the pulmonary valve are far more rare and mainly seen in congenital heart disease, for which patients would normally see a specialist in congenital heart disease.
AORTIC VALVE DISEASE AND TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI PROCEDURE)
Both leakage (regurgitation) and narrowing (stenosis)of the aortic valve, are common and causes similar symptoms as shown below. Our cardiologists and can see you and assess this with an echocardiogram scan. In younger patients needing valve replacement then open-heart surgery (surgical aortic valve replacement) is often the gold standard treatment. However, in more elderly or complex patients with aortic valve disease then Transcatheter Aortic Valve Implantation (TAVI) otherwise called Transcatheter Aortic Valve Replacement (TAVR) may be more appropriate.
TREATMENTS FOR THE MITRAL VALVE, INCLUDING PERCUTANEOUS MITRAL VALVE EDGE-TO-EDGE REPAIR (mTEER)
The mitral valve mainly becomes leaky (regurgitation) but more rarely can become narrowed (stenosis) Our cardiologists and can see you and assess this with an echocardiogram scan. In younger patients then open-heart surgery, often with a repair of the valve but rarely with replacement of the valve (surgical mitral valve repair or replacement), is often the gold standard treatment. However, in more elderly or complex patients with mitral valve disease then percutaneous methods to treat the valve, including mitral valve edge-to-edge repair (mTEER) and trans catheter mitral valve replacement (TMVR) can be done.
TREATMENTS FOR THE TRICUSPID VALVE, INCLUDING PERCUTANEOUS TRICUSPID VALVE EDGE-TO-EDGE REPAIR (tTEER)
Percutaneous Tricuspid Valve Edge-to-Edge Repair is an innovative minimally invasive treatment for patients with significant tricuspid regurgitation, a condition where the tricuspid valve leaks and allows blood to flow backwards within the right side of the heart.
Transcatheter mitral valve replacement (TMVR)
Transcatheter Mitral Valve Replacement (TMVR) is an advanced structural heart procedure designed to treat severe mitral valve disease using a minimally invasive catheter-based approach, whereby a TAVI valve is placed inside the mitral valve to create a new working mitral valve.
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