Diagnosis & Treatment of Structural Heart Problems

Virginia Mason Franciscan Health’s cardiologists and cardiac surgeons have decades of experience diagnosing and treating structural heart disease. If you suspect you have a heart problem, the specialists at the Center for Cardiovascular Health can determine if your symptoms are caused by structural heart disease. 

The risk of structural heart disease, also known as heart valve disease, increases with age. With older age, the valve leaflets thicken and become stiffer. Other risk factors include:

• High cholesterol
• High blood pressure
• Smoking
• Diabetes
• Obesity
• Lack of physical activity
• Intravenous drug use
• Birth defects
• A family history
• Use of diet medications, such as “fen-phen”

Other causes of heart valve disease include:

• Infections
• Rheumatic fever
• Heart failure
• Coronary artery disease
• Damage from a heart attack
• Autoimmune disorders
• Tumors in the digestive tract
• Marfan syndrome
• Metabolic disorders
• Radiation therapy to the chest

A heart murmur, a whooshing sound your doctor can hear when listening to your heart, may indicate a heart valve condition. The most common way to diagnose a heart valve disorder is an echocardiogram, which is an ultrasound of your heart.

Additional tests can include:

• Chest X-ray
• EKG
• Cardiac catheterization (a way to measure pressures in the heart)

While no medicines can cure structural heart disease, there are medications that can treat many of its symptoms and reduce the risk of complications. Medication may be the best choice if your condition is mild or you’re not a candidate for surgery.

Your cardiologist may recommend surgery to either repair the existing valves or replace them entirely. Repairing heart valves can involve patching holes with added tissue; reshaping the valves; fusing separated flaps; or widening the valves using a balloon on the end of a thin tube, called a catheter (balloon valvuloplasty).

In cases when your valve can’t be repaired, your surgeon will replace it with a new biological or mechanical heart valve. Your doctor will discuss these options with you so together, you make the best decision for you. A biological valve may need to be replaced in 10 to 15 years. A mechanical valve may never need to be replaced but can also require you to take blood thinning medication for the rest of your life, and it may be more prone to infection.

Heart valve repair or replacement surgery can sometimes be done through minimally invasive methods, called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). Minimally invasive surgery requires a much smaller incision than traditional surgery and can result in a faster recovery, lower risk of infection and less pain. 

TAVR is performed on a beating heart and does not require cardiopulmonary bypass as open-heart surgery does. With TAVR, a catheter is inserted into one of the leg arteries, and a new valve is advanced through the catheter to the heart. When the valve is in position, a balloon expands the valve, and the new valve starts working immediately. Patients having this procedure usually go home after one or two days.

Your cardiologist may recommend this procedure if you have symptomatic aortic stenosis. TAVR can be a life-changing procedure that gets people back to enjoying a more active life again. The TAVR/TAVI team at Virginia Mason Franciscan Health includes specially trained cardiac surgeons, interventional cardiologists and nurse coordinators.