Valve Clinic

Transcatheter aortic valve replacement has revolutionized the treatment of aortic stenosis and has now replaced traditional open-heart surgery as the primary treatment modality for most patients. Aortic stenosis is progressive condition in which the aortic valve is blocked not allowing the heart to pump blood into the rest of the body. Patients with aortic stenosis experience slow and gradual decline in their stamina and develop symptoms of shortness of breath, chest pain, dizzy spells or loss of consciousness. The blockage also increases the work of the heart muscle and eventually causes the heart to get weak if not repaired on time. 

The only treatment option for aortic stenosis is valve replacement. This can be achieved by open heart surgery or transcatheter aortic valve replacement (TAVR). Being a minimally invasive procedure with similar outcomes and much improved comfort, procedure recovery and quicker resumption of normal activity, TAVR has become the preferred option. TAVR can also be performed in individuals who had previous aortic valve replacement and the valve has failed over time (known as valve-in-valve procedure). 

Patient evaluation typically includes an echocardiogram (ultrasound of the heart) to assess the degree of aortic stenosis and evaluate the rest of the heart structures, heart catheterization procedure to assess the coronary arteries for concomitant coronary blockages, and TAVR dedicated CT scan to precisely measure the aortic valve size, assess surrounding structures and assess the arteries from the groin to the heart to confirm technical feasibility of delivering the valve to position. Most patients can have the procedure performed through the artery in the groin. In patients in which this approach is not feasible other alternative options include using the artery in the upper chest, neck and the leg vein. Our interventional cardiologist will review your medical history and imaging studies before recommending the appropriate approach. 

Mitral regurgitation is a condition in which the mitral valve does not close properly allowing blood to flow backwards. When mitral regurgitation becomes severe, it can cause symptoms of fatigue, shortness of breath and can lead to heart failure (congestion of the lungs and leg swelling) and heart arrhythmia such as atrial fibrillation. Mitral regurgitation can occur due to abnormal mitral valve structure such as mitral valve prolapse (primary mitral regurgitation) or secondary to disease of the left ventricle (secondary mitral regurgitation). Repair or replacement of the mitral valve is considered to relieve symptoms and prevent long term complications due to this condition.

Mitral valve repair is traditionally performed by open heart surgery. Mitraclip is an alternative technique to repair the mitral valve using a catheter that is inserted via a small incision in the groin. The individual is typically evaluated by the heart valve team that includes a heart surgeon and interventional cardiologist. Our interventional cardiologist has extensive experience in the Mitraclip procedure and will guide you through the evaluation process to assess your suitability for the procedure and perform the procedure if determined to be the appropriate option.

Mitral stenosis is a condition in which the mitral valve is blocked and does not allow the blood to move freely between the left heart chambers. This increases the pressure in the lungs leading to shortness of breath and development of arrhythmias such as atrial fibrillation. It also interferes with the heart’s ability to provide adequate circulation leading to fatigue. The most common cause of mitral stenosis is rheumatic heart disease which is a condition that starts in childhood after suffering from a throat infection and leads to damage to the heart valves. The damage progresses slowly leading to mitral stenosis as adults. 

Mitral balloon valvuloplasty is a procedure in which a special balloon (Inoue balloon) is used to open the mitral valve blockage. It is performed through a small incision in the groin and is considered the first line therapy for this disease. The alternative option is surgical mitral valve replacement which is typically considered in patients that are not suitable for the valvuloplasty procedure. Our interventional cardiologist will guide you through the evaluation process and perform the valvuloplasty procedure if mitral valve anatomy is suitable for this technique. 

Patent foramen ovale (PFO) is a small hole between the two upper chambers of the heart. It is present in a quarter of the population and does not cause harm in most individuals. For some patients it has been implicated to causing stroke by allowing blood clots to travel between the heart chambers and reach the brain. PFO is diagnosed by echocardiography (ultrasound of the heart) where small bubbles are injected visualize the shunting of blood between the heart chambers and transesophageal echocardiogram (ultrasound of the heart done through endoscopy) where the hole can be directly seen. 

After a stroke or transient ischemic attack (commonly termed mini-stroke), a battery of tests are typically performed to identify the cause. The results are then used to treat the underlying cause the reduce the risk of subsequent stroke. Studies have shown that If a patent foramen ovale is present and no other cause if stroke is identified, closing the hole reduces the risk of subsequent stroke compared to medical therapy alone. Our interventional cardiologist will evaluate your suitability for the patent foramen ovale closure procedure and perform the procedure introducing a small catheter through a vein in the groin to plug the hole.

Patients who have atrial fibrillation are at increased risk of stroke due to blood clot formation. The left atrial appendage (LAA) is small sac in the muscle wall of the left upper chamber of the heart and is the e most common site for clot formation in patients with atrial fibrillation. Patients with atrial fibrillation are typically prescribed medications called “blood thinners” to prevent clot formation and strokes. Patients with atrial fibrillation are commonly older and occasionally experience complications from blood thinners. Left atrial appendage occlusion, for example using Watchman device, is a novel, catheter-based procedure that reduces the risk of stroke while allowing the patient to stop the blood thinners and avoid bleeding complications. 

Our interventional cardiologist and electrophysiologist will evaluate your suitability for the procedure using a shared decision-making tool. If you or your loved one has atrial fibrillation and had problems tolerating blood thinners, do not hesitate to contact our clinic to arrange for consultation with our providers to discuss alternative treatment options.