Christopher  L. La Mendola, MD FACS FACC

Although your heart has four different valves, disease is most often associated with the Aortic or Mitral valves and occasionally with the Tricuspid valve.  It is extremely rare for the Pulmonic valve to cause problems in adults.

The Aortic or Mitral valves may become "stenotic", that is thickened, calcified and obstructive to blood flow, or they may become "insufficient", that is thin, floppy and leaky.  The Tricuspid valve does not become stenotic, but may become insufficient.  Sometimes valves become infected from bacteria in the blood, and this condition, "endocarditis", can be life threatening and must be treated immediately.

Valvular problems of the heart may be associated with symptoms such as palpitations, chest pain, shortness of breath or fluid build-up in the body, but occaionally  valvular disease is "asymptomatic", or free of symptoms. 

A diagnosis of valvular heart disease is most often made when a physician hears a "heart murmur" with a stethoscope and it is usually confirmed with an Echocardiogram or Cardiac Catheterization.   Not all heart murmurs require treatment, but all should be evaluated by a cardiologist.

If your cardiologist determines that your valvular heart disease requires surgical treatment, your valve may either be repaired or replaced.  Often this type of surgery can be performed through a minimally invasive technique, something Dr. La Mendola has done since 1996.  Despite many advantages, minimally invasive surgery may not always be the best choice for a patient, and so, you should discuss your options carefully with your surgeon.

In the vast majority of cases both Aortic Stenosis and Aortic Insufficiency should  be treated with valve replacement.  Often, cases of Mitral Stenosis will require valve replacement as well. Most cases of Mitral Insufficency, however, can, and should be repaired.  There are many, well documented studies to support the advantages of Mitral valve repair over replacement, and so you should choose a surgeon who is philosophically dedicated to performing Mitral valve repair as the primary procedure, and one who has the training and experience necessary to do it sucessfully.  Dr. La Mendola trained under one of the world experts in Mitral valve repair, and so has been performing the procedure with excellent results since he entered private practice, and is  dedicated to Mitral valve repair whenever possible.

If a heart valve must be replaced, there is generally one important decision that you, as the patient, will play a key role in making: Should your valve replacement be a mechanical valve, or should it be a biologic valve?  Mechanical valves are man-made from space age materials such as titanium and carbon composites, while biologic valves come from animals or humans.

There is no "perfect" heart valve, but each has advantages and disadvantages that must be weighed by both you and your surgeon prior to your operation.  Biologic valves (pig, cow, human) are very similiar to normal human valves, and so, require little in the way of maintenance.  Often, for the long term they can be managed with an aspirin each day as the only form of blood thinning; you can go on with the routines of life without having to focus on the care of your heart valve.  The disadvantage of a biologic valve is that it will degrade or "wear out" with time, and will need to be replaced when it does.  For most people these types of valves will last between 10 and 20 years.  Usually, the valve "wears out" slowly, over the course of months, during which time you may begin to develop symptoms, but when it does, you will need to undergo another open-heart operation.  Since valve degradation may not come into play in the older patient, these valves are often preferred by the elderly. As biologic valves have improved over the past decade, there has been a general trend among heart surgeons to use these valves in younger and younger patients.

Mechanical valves will not normally wear out during your lifetime, and so, offer to the younger patient the prospect of going through life without a need for a re-operation.  They do, however, have a significant disadvantage; since they are made of man-made materials, the valves have a tendency to form small clots on them, which can break off and travel through the bloodstream (embolize) to other parts of the body and cause complications such as strokes or kidney failure.  To help lessen the risk of these very serious complications, any patient who has a mechanical heart valve will be placed on a very strong blood thinner called warfarin (Coumadin).  Although Coumadin involves taking only one pill each day,  patients must have their blood thinning levels (INR) checked frequently, and so they must have blood drawn at least monthly, and sometimes more often.  Further, the ability of Coumadin to thin the blood can be adversely affected by the intake of Vitamin K.  Since Vitamin K is a strong antagonist to Coumadin, Vitamin K intake must be severely restricted.  Vitamin K is generally found in dark green vegetables, but can be found in other foods, and is often a component in multi-vitamins.  If you choose a mechanical valve, you will have to closely monitor your intake of certain foods. 

Although the choices and decisions in valve surgery can be a bit overwhelming, Dr. La Mendola is more than willing to take the time to answer your questions, and help you with your decisions.