This document provides an overview of valvular heart disease, focusing on aortic stenosis and mitral regurgitation. It defines valvular heart disease as any condition affecting the heart valves. Aortic stenosis and its causes, symptoms, diagnosis, and treatment options like surgical replacement and transcatheter aortic valve replacement are described in detail. Mitral regurgitation, its causes, symptoms, diagnosis, and potential treatments including surgery, mitral valve repair/replacement, and the new MitraClip procedure are also summarized. The document concludes by describing the multidisciplinary Heart Valve Clinic at Via Christi Hospitals for evaluating and treating patients.

1. Valvular Heart Disease
Richard Allenbach, PA-C
Director, Heart Valve Clinic
Via Christi Hospitals, Wichita

2. Definition of Valvular Heart Disease
Any condition that affects the proper function
of the heart valves.
 Congenital causes
 Infectious causes
Rheumatic fever
 Endocarditis

 Degenerative (age-related) causes
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3. Anatomy of the Heart
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4. Aortic Stenosis
 Gross specimen of minimally diseased aortic valve
(left) and severely stenotic aortic valve (right)
Images courtesy of Renu Virmani, MD at the CVPath Institute
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5. Aortic Stenosis Definition
A narrowing of the aortic valve leaflets that
restricts the normal flow of blood through
this valve.
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6. Prevalence of Aortic Stenosis
 Aortic stenosis is estimated
to be prevalent in up to 7%
of the population over the
age of 651
 It is more likely to affect
men than women; 80% of
adults with symptomatic
aortic stenosis are male3.
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7. What Causes Aortic Stenosis in Adults?
Aortic stenosis in patients over the age of 65 is
usually caused by calcific (calcium) deposits
associated with aging
Aortic stenosis can be caused by various
infections
Adults who have had rheumatic fever may also
be at risk for aortic stenosis
In some cases adults may develop aortic
stenosis resulting from a congenital
abnormality
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8. Aortic Stenosis Symptoms
 The SAD Triad
Syncope (passing out)
 Angina (chest pain, pressure, squeezing,
tightness, heaviness)
 Dyspnea (shortness of air)

 Fatigue
 Decrease in activity tolerance – “I just can’t do
what I used to be able to.”
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9. Diagnosis of Aortic Stenosis
Detailed Clinical History
Echocardiography
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Physical Exam
Heart Catheterization

10. Treatment of Aortic Stenosis
 Surgery
 Medical Management
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11. Natural History of Aortic Stenosis
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12. Dismal Prognosis for Aortic Stenosis
 50% one year survival
 15% two year survival
 5% 5 year survival
 Uniformly lethal disease
 Notable not only for
shortened life span, but
poor quality of life
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13. Sobering Perspective
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14. Addressing a Serious Unmet Need
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15. Cardiology Views on Severe
Symptomatic Aortic Stenosis
 Common, undertreated disease state
 Increasingly common in elderly
 There is no medical management
 Dismal short and long term prognosis
 There is no such thing as truly asymptomatic
severe aortic stenosis
 Fortunately, there are options
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16. Treatment: Surgical
Mortality difference for people with
symptomatic AS treated with
Aortic Valve Replacement (AVR)
versus those not undergoing this
procedure is one of the most
striking in medicine1
AVR can be withheld in such
patients only when compelling
contraindications exist
1Schwartz
16
F, Bauman P, et al. Circulation 1982; 66: 1105-10.

17. Treatment: Surgical
Mechanical heart valve – 1960
First PVT animal
First Corevalve
implantation animal implantation
A. Cribier
JC. Laborde
Homograft – 1962
Porcine valve
–
1965
First Edwards/PVT
Transapical Beating
Heart AVR
Webb, Lichtenstein –
Nov 29, 2005
Pericardial tissue valve
–
1969
1960
2000
200
200
1
2
17
2007
First PVT Transcatheter AVR
CE approval of CoreValve
by Antegrade Approach 1,200 implants and Edward
Alain Cribier
- April (Sept2002 2007; 500 implan
16,
5,
Surgery
1Schwartz
2004
F, Bauman P, et al. Circulation 1982; 66: 1105-10.
First CoreValve
Transcatheter AVR by
Retrograde Approach
Laborde, Lal, Grube –
July 12, 2004
Adapted from P. Serruys

18. 18

19. Prosthetic Aortic Valves
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20. Aortic Valve Replacement Hospital Mortality
• 108,791
isolated AVR
patients
• STS Data
Registry
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Brown et al. JCTVS 2009;137:82-90

21. Conventional AVR Stroke Rate
J Thorac Cardiovasc Surg 2009;137:82-90
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22. Surgical Aortic Valve
Replacement remains the “Gold
Standard to which emerging
therapies will be compared”.
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23. Transcatheter Aortic Valve
Replacement (TAVR)

24. What is TAVR?
For patients who are either at high
risk or too sick for open-heart
surgery, TAVR may be an
alternative
This less invasive procedure allows
the aortic valve to be replaced with
a new valve while the heart is still
beating
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25. Characteristics of a TAVR Patient 17
TAVR patients may present with some of the following:
Severe, symptomatic native aortic valve stenosis
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26. Commercially Available Transcatheter Valves
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27. Risk and Benefits
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28. Risks
 Injury to blood vessels
 Stroke
 Heart rhythm problems
 Unplanned open heart surgery
 Kidney problems
 Death – Guaranteed if nothing is done
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29. Benefits
Return of functional status
 Less heart failure
 Improvement in activities of daily living
 Walking
 Showering/bathing
 Sleeping
 Social
 Sense of well-being
 “I have my mother back”
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30. For Appropriate Patients
TAVR is an excellent alternative to open heart
surgery.
TAVR is durable
Risk of stroke is elevated slightly
TAVR is cost effective
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31. Aortic Valve
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Mitral Valve

32. Mitral Regurgitation
“Mitral regurgitation is a disorder in which
the heart valve that separates the upper
and lower chambers on the left side of the
heart does not close properly.
Regurgitation means leaking from a valve
that does not close all the way”.
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33. Mitral Regurgitation (MR)
MR occurs when the mitral valve
fails to close completely, causing
blood flow to move backward
Symptoms may include:
• Shortness of breath
• Heart palpitations
• Fatigue
• Lightheadedness
• Cough
• Swollen feet or ankles
• Excessive urination
Mayo Clinic (www.mayoclinic.com)
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34. Mitral Regurgitation
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35. Moderate or Severe Valvular Disease Is
Common and Increases With Age
Mitral regurgitation is the most common type of heart valve insufficiency in the US1,2
Prevalence of Valvular Heart Disease by Age
Prevalence
increases from
0.5% for 18-44
year olds to
9.3% for ≥75
year olds
(p<.0001)
1. Heart Disease and Stroke Statistics 2010 Update: A Report From the American Heart Association. Circulation. 2010;121:e46-e215.
2. Nkomo VT et al. Lancet. 2006; 368:1005-1011.
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36. Mitral Regurgitation Causes
 Mitral Valve Prolapse
 Infection of the heart valve (endocarditis)
 Rheumatic Fever – Rare in developed
countries
 After a heart attack
 Enlarged Heart
 Abnormal valve anatomy
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37. Diagnosis of Mitral Regurgitation
Detailed Clinical History
Echocardiography
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Physical Exam
Heart Catheterization

38. Treatment of Mitral Regurgitation
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39. Mitral Valve Surgery
•
•
•
•
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Repair
Replacement
Minimally Invasive
Percutaneous

40. Mitral Valve Repair
Mitral Valve
Replacement
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41. Many patients are not considered appropriate
candidates for mitral valve surgery
Large portion of mitral regurgitation patients are left untreated—
ineligible for surgical treatment or denied surgical intervention1-2
Factors prohibiting
Surgery include6:
• Impaired LVEF
• High operative risk
• Multiple comorbidities
2%
Surgical Patients (30K)
49%
49%
High-Risk
Patients*,3-5
(860K)
Surgical
Candidates
(850K)
• Advanced age
* Note: High-Risk Patients are defined as any patient with an EF<35% or an age of 75+.
1.
2.
3.
4.
5.
6.
41
Lung B, et al. Eur Heart J. 2003;24:1231-1243.
Mirabel M, et al. Eur Heart J. 2007;28:1358-1365.
U.S. Census Bureau, Statistical Abstract of the U.S.
Nkomo et al. Burden of Valvular Heart Diseases: A Population-based Study, Lancet, 2006; 368: 1005-11.
Patel, et al. Mitral Regurgitation in Patients with Advanced Systolic Heart Failure, J of Cardiac Failure, 2004.
Rankin, et al, J of Thoracic and Cardiovascular Surgery, March 2006
Of surgical candidates,
up to 50% of patients
are not referred to
surgery, even if a
surgical indication
exists 2

42. MitraClip Therapy
Filling a Treatment Gap
Medical therapy is limited to symptom management
MV surgery has been the only option that reliably reduces MR
A significant gap exists between medical and surgical options
MitraClip therapy is a percutaneous option to reduce MR in select
patients*
Move Invasive
Medical Therapy
MitraClip
Increased MR Reduction
* Source: MitraClip Clip Delivery System Instructions for Use.
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MV Surgery

43. MitraClip System Overview
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45. Valve Clinic
 Multidisciplinary, one portal
Cardiologist, CT Surgeon
 Input from multiple specialties

 Echo, CTA available
 Research personnel participate
 Efficient for patients
 Not the most efficient for physicians
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46. Via Christi Heart Valve Clinic Team
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47. Hybrid Operating Room
Blends components of:
 Traditional operating room
 Cardiac catheterization lab
 Radiology suite
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48. Via Christi Hybrid Operating Room
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49. How to Contact Us
Heart Valve Clinic at Via Christi
316-268-8650
 929 N St Francis

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