What Is Structural Heart Disease?
Structural Heart Disease is a term used to describe disorders of the structures within the heart such as the heart valves and other internal cardiac structures. These disorders can be congenital (present since birth) or acquired through one’s lifetime. In the past decade, treatment options for Structural Heart Disease have been catapulted by the commercialization of innovative technologies that have delivered revolutionary therapies through minimally invasive transcatheter procedures.
What Are the Symptoms of Structural Heart Disease?
Symptoms can vary broadly depending on the type of structural heart or valve disease one has, and the level of severity. Mild disease can often produce no symptoms at all. Symptoms typically start when the particular structural heart problem progresses in its severity. Common symptoms may include:
- Shortness of breath with activity/exertion or sometimes at rest or while laying flat
- Chest pain (angina pectoris) with exertion or at rest
- Passing out spells (medically known as “syncope”)
- Leg swelling
- Signs of the syndrome of Congestive Heart Failure (CHF)
Types of Structural Heart Therapies We Offer
Transcatheter Aortic Valve Replacement (TAVR)
Aortic valve stenosis is one of the most common heart valve conditions in the United States. It is a disease caused most often by calcification and hardening of the aortic valve, but can also be present in cases of congenital aortic valve disease where people are born with an aortic valve that has two leaflets instead of the normal three leaflet conformation. Severe aortic valve stenosis refers to the presence of severe narrowing of the valve creating an obstruction to flow across the valve. When patients with severe aortic stenosis develop symptoms such as shortness of breath, chest pain, lightheadedness or passing out, these symptoms are linked to decreased survival. Therefore, it is recommended that patients severe aortic stenosis pursue valve replacement. For decades the only treatment option for severe aortic stenosis was open heart surgery. However, due to the development of transcatheter valve replacement technology over the last decade, several pivotal research trials led to the U.S. FDA approval of TAVR for patients with severe aortic stenosis with low, moderate, or high surgical operative risk. There are currently two commercially approved transcatheter heart valves in the United States (depicted below). The TAVR procedure is performed through a transcatheter approach from the femoral (groin) artery under anesthesia in a hybrid operating room or cardiac catheterization lab.
Percutaneous Mitral Valve Transcatheter Edge-to-Edge Repair with the Abbott MitraClip® Device
Mitral valve regurgitation is the most common worldwide form of valvular heart disease in which there is abnormal function of the mitral valve leading to backwards flow (regurgitation) of blood from the left ventricle back into the left atrium. Additionally, mitral valve regurgitation leads to a form of congestive heart failure (CHF) and therefore is an enormous contributor to the global health and economic impact of heart failure hospitalizations and mortality. Open heart surgery with mitral valve repair or replacement has been a cornerstone therapy for the treatment of severe symptomatic mitral valve regurgitation. However, for patients who are felt to be high or prohibitive risk for mitral valve surgery, there is a transcatheter device called the MitraClip® that can deliver excellent outcomes in the appropriate anatomical and clinical situations to help treat the symptoms of mitral regurgitation, improve quality of life, and potentially reduce the likelihood of hospitalizations and death for certain subsets of patients. The MitraClip® device is implanted through a transcatheter approach from the femoral (groin) vein and is performed in a cardiac catheterization lab under general anesthesia with extensive x-ray and ultrasound imaging guidance.
Left Atrial Appendage Closure with the WATCHMAN® FLX Device
Atrial fibrillation is a common arrhythmia that is associated with the risk of stroke. Certain patients with atrial fibrillation are recommended to be on blood thinners (oral anticoagulation) to help reduce the risk of stroke. However, for many patients with atrial fibrillation the idea of taking a daily blood thinner can carry significant risk due to a history of prior major bleeding, frequent falls, side effects/intolerances to blood thinning medicines, cost, and other unique circumstances. The WATCHMAN® device is an alternative option for stroke risk reduction for patients with atrial fibrillation who cannot take long term blood thinners. The WATCHMAN device is implanted through a transcatheter approach from the femoral (groin) vein under general anesthesia and with x-ray and ultrasound imaging guidance. The procedure is performed in a cardiac catheterization lab.
Atrial Septal Defect (ASD) and Patent Foramen Ovale (PFO) Closure
ASD and PFO closure are forms of structural heart disease related to congenital abnormalities of the heart (present at birth). Atrial septal defects and patent foramen ovale’s are commonly referred to as “holes in the heart.” Patients with an atrial septal defect (ASD) can develop forms of congestive heart failure through abnormal mixing of oxygenated and deoxygenated blood within the heart, leading to significant symptoms and potential for mortality. Closure of ASD’s can be performed with transcatheter devices which can help to seal these abnormal openings in the heart. Patients with patent foramen ovales (PFO’s) can rarely be at risk for strokes, and research trials have shown that closure of PFO’s reduces the risk of recurrent stroke in those patients. There are multiple types of commercially available ASD and PFO closure devices that can be delivered through a catheter from the femoral (groin) vein under anesthesia support in a cardiac catheterization lab.
Other Types of Structural Heart Disease Therapies We Offer
- Transcatheter Mitral Valve-in-Valve Replacement (TMVR)
- Severe Tricuspid Valve Regurgitation Repair Options
- Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy
- Paravalvular Leak Closure