Heart Valve Surgery

In this procedure, the surgeon separates valve leaflets (cusps) that have thickened or are fused together, widening the valve opening and allowing more blood to flow through.

Sometimes the mineral calcium accumulates as hard deposits that line blood vessels and heart valves (often the aortic valve); eventually, the build-up may restrict blood flow and valve operation. Surgeons can remove the limited amounts of calcium deposits to reopen the valve or allow it to function more effectively.

If the base of the heart’s mitral or tricuspid valve (the annulus) becomes enlarged, dilated or damaged, a surgeon can sew a synthetic ring into the base of the valve to provide additional support. This also allows the valve to seal more tightly, preventing backflow of blood. Annuloplasty can now be done using minimally invasive techniques.

Weak or thickened mitral valve leaflets may bulge backward with every heartbeat, letting blood flow backward into the left atrium. To reshape the valve opening so it seals correctly, a surgeon can remove a section of one or more leaflets. An annuloplasty ring may also help strengthen the base of the valve.

In some cases of milder mitral stenosis (a narrowed mitral valve), a balloon-tipped catheter can be guided into the heart and the balloon gently inflated to push open the valve and improve blood flow. This minimally invasive procedure is also known as balloon valvotomy.

About 1% to 2% of people are born with two of their three aortic valve leaflets fused together—“bicuspid” means “with two valve tips”. A bicuspid valve often leaks (regurgitation) or doesn’t open all the way (stenosis). This may not cause significant problems, but if it does, a surgeon may be able to separate the leaflets. Otherwise, a valve replacement may be necessary (see below).

Severely diseased, narrowed or damaged valves can sometimes be replaced with a new valve—either mechanical or tissue (from pig, cow, or human donor). Different types of valves have different benefits and tradeoffs, which the surgeon will discuss with the patient. Sometimes heart valves can be replaced via minimally invasive procedures.

One option for younger patients with severe aortic valve problems may be a Ross procedure: the patient’s aortic valve is removed and replaced with the patient’s own pulmonary valve, which in turn is replaced by a donor pulmonary valve. This procedure may reduce the need for medications and future valve replacements, and may allow the patient to be more active.