I just received an interesting question from Tanya about calcified heart valve leaflets.

Tanya writes, “Dear Adam – I am hoping you can help me better understand my diagnosis of mitral stenosis. The doctor mentioned that I am moderate-to-severe and could be facing surgery soon. The cardiologist also said that my valve may be calcified. I’m curious…. Do you have any pictures of a calcified valve? Thanks! Tanya”

Calcified Mitral Valve

Like Tanya, I also wanted to know what a calcified heart valve looked like when I was diagnosed with aortic stenosis – prior to my heart valve replacement surgery.

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One of the primary exams used to detect heart valve disease involves the stethoscope.

While this diagnostic device, invented by Rene Laennec in 1816, is not as technologically advanced as 3D-MTEE imaging, stethoscopes can help cardiologists and surgeons quickly identify variable forms of heart valve disease.

The two most common forms of heart valve disorders are aortic stenosis and mitral regurgitation. That said, have you ever wondered what stenosis and regurgitation sound like through a stethoscope?

When I was diagnosed with severe heart valve disease, I was curious. So, I located three audio files, posted by Dr. Solanki, which contain the sounds of hearts beating with (i) normal heart valves, (ii) aortic valve stenosis and (iii) mitral valve regurgitation. If you are interested, I have provided these audio clips below.

First, here is the sound of a normal heartbeat. You can hear the traditional “lub-dub” as the four heart valves open and close.

Next, here is the sound of a heart with aortic stenosis.

Finally, here is the sound of heart with mitral valve regurgitation.

I hope this helps you better understand the different sounds of hearts with normal valves and diseased heart valves – especially aortic stenosis and mitral regurgitation.

Keep on tickin!

I just received a very appropriate email from Phil about age groups and heart valve surgery.

Phil writes, “Hi Adam – On Friday, I was diagnosed with severe aortic stenosis due to a bicuspid aortic valve. I’m 48 years old with three great kids and a loving wife. This was a complete shock to me and I’ve spent the weekend digesting the uncomfortable news that open heart surgery awaits me. It’s odd. Although I knew about the murmur, I was told this wouldn’t impact my heart for 10 or 20 years. Now, the doc says the valve is calcified and surgery is a must. Is heart valve surgery common for my age group? Thanks, Phil”

Phil raises some excellent points in his question. In fact, Phil’s story brings back several memories specific to my own diagnosis and surgery. Like Phil, my valve disease rapidly progressed from moderate to severe aortic stenosis. Like Phil, I had a bicuspid aortic valve. Like Phil, I was told surgery would not occur until I was in my 50′s. (FYI, at the time of my surgery… I was thirty-three.)

Picture Of Calcified Heart Valve Leaflets

Still, as we have discussed before… Every patient case is unique. As shown in the chart below, heart valve disease can impact all age categories – from newborns, to teens, to seniors, to elderly patients.

For this reason, it is critical that all patients diagnosed with valvular disorders – aortic stenosis, mitral valve prolapse – get regular examinations to monitor the progress of their heart valve disease.

However, specific to Phil’s original question, it should be noted that the most common congenital abnormality of the heart is the bicuspid aortic valve. According to Absolute Anatomy, the condition can be undiagnosed until the person develops calcified heart valve leaflets. Aortic stenosis due to a bicuspid valve usually occurs in patients during their 40s or 50s, an average of over 10 years earlier than people with normal aortic valves.

In light of that reference, it appears that Phil is, unfortunately, in the age category for developing severe aortic stenosis which, if left untreated, could:

• damage his heart – via dilation (heart enlargement, thickening of the heart muscle)
• lead to congestive heart failure over time.

As we now better understand the timing of Phil’s diagnosis, I would strongly encourage Phil to get a second opinion to confirm the diagnosis prior to any surgical treatment or invasive, diagnostic testing (e.g. angiogram).

I hope this helps Phil (and perhaps you) learn a little more about heart valve surgery.

Keep on tickin!

I just received a roller coaster email from Sarah about endocarditis, swine flu (H1N1 virus) and heart valves that made my head spin. In the end, Sarah raises some great points for patients and caregivers about endocarditis, swine flu, fevers, false tests and dental work. Here is what she writes:

Adam,

I just returned from a very scary 36 hours that landed me in the hospital with fears of endocarditis.

Last Friday, I called my primary care doctor because I had been fighting a cough, congestion and fever for over a week. She did a quick test for the flu, it came up negative. I told her that I had dental work to put on a crown about 10 days earler, two days before the fever started. Well, that set up a red flag for the possibility of a heart valve infection (endocarditis) even though I had used amoxicillin as advised by my doctor before the dental work.

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The University of Michigan Cardiovascular Center just released a rather troubling study about patients who are  diagnosed with mitral regurgitation and do not receive surgical treatment. I guess this is one more reason why second opinions are so valuable. Here are the details:

Overblown fears about (i) surgical risk and (ii) lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study by doctors at the University of Michigan Cardiovascular Center.

Mitral Valve Repair (Annuloplasty)

A leaking mitral valve, known as mitral regurgitation or mitral insufficiency, can lead to fatigue, abnormal heart rhythms with irregular heart beats, and congestive heart failure. The longer the leak continues, the more likely there will be permanent heart damage.

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