Heart structure tests can measure heart chamber pressures and take x-ray pictures of the left ventricle to diagnose valve disease and other heart problems. The information gathered from heart structure tests helps doctors evaluate and treat valve and heart muscle problems. Certain tests use catheters to show problems within the valves or heart muscles and show the heart’s structure or function. In order to better diagnose or treat your heart condition, you may undergo these two specific heart structure tests: direct pressure measurement or ventriculography.
In adult cardiology, structural heart disease usually pertains to disorders of the valves of the heart or to holes in the heart that should have closed either during gestation or shortly after birth.
The most common forms of structural heart disease seen in adults in the United States are disorders of the aortic and mitral valves. Less commonly treated structural heart disorders include patent foramen ovale is and atrial septal defects.
The aortic valve is valve between the pumping chamber of the heart and the aorta, which is the main blood vessel that brings blood to the entire body. The function of the aortic valve is to keep blood from flowing back into the heart as the pumping chamber of the heart relaxes.
The most common aortic valve disorder his aortic stenosis, in which the leaflets of the aortic valve become calcified over time and don't allow the aortic valve to open appropriately. Less common, though just as important, his aortic regurgitation, in which the valve is leaky and allows blood to flow backward from the aorta back into the heart.
The most common symptoms of aortic stenosis are chest pain with exertion, shortness of breath with exertion, dizziness or passing out, particularly during or immediately after exertion, and fatigue.
Most of the time, aortic stenosis is either diagnosed because the patient has symptoms as noted above or your doctor hears a heart murmur. In these cases, your cardiologist we'll likely order an ultrasound of the heart called an echocardiogram.
There are no medications known to slow the progression of aortic stenosis. If you are diagnosed with aortic stenosis in a mild form, your cardiologist will follow the progression of aortic stenosis with regular ultrasounds of the heart. Once symptoms of aortic stenosis are present and/or the aortic stenosis is clearly severe on ultrasound, there are two main forms of treatment:
1) Aortic valve surgery. Up until 15 years ago, this was the only treatment available for patients with aortic stenosis. This usually involves open heart surgery, in which the chest is opened, the patient is put on cardiopulmonary bypass, the diseased aortic valve is removed, and a new aortic valve is sewn into place. Most patient spent 4-6 days recovering in the hospital following surgical valve replacement.
2) Transcatheter aortic valve replacement. In the last 15 years, there has been rapid advancement in technology that now allows us to implant a new aortic valve without open heart surgery. This is most commonly done via the large artery in the groin. Many patients go home the next day, and most go home within 2 days.
Because transcatheter aortic valve replacement is a relatively new technique, and because the very long-term outcomes of this form of valve replacement are somewhat unknown, surgical aortic valve replacement remains the standard of care for patients at low risk for surgery based on things like age and other medical conditions the patient might have. Patients who are intermediate or high risk for surgery are candidates for transcatheter aortic valve replacement.
Because transcatheter aortic valve replacement is still a somewhat new technique, a cardiac surgeon is always present during placement of the valve. In most centers, the procedure is performed by one interventional cardiologist and one cardiac surgeon.
Talk to your treating cardiologist and/or cardiac surgeon about whether you are a candidate for transcatheter aortic valve replacement. Currently, patients who are at low risk for surgery should undergo surgical aortic valve replacement. However, there are currently ongoing clinical trials to evaluate whether low risk patients should be offered transcatheter aortic valve replacement as well.
The mitral valve is the valve located between the pumping chamber of the heart and the left atrium, which is the chamber of the heart that collects blood from the lungs and holds it until the pumping chamber is ready to accept it. The mitral valve is important because it keeps blood from being forced back into the lungs when the pumping chamber of the heart pumps.
The most commonly seen mitral valve disorder in the United States is mitral regurgitation, in which the valve is leaky and allows blood to flow backward into the lungs when the main pumping chamber pumps. Mitral stenosis, in which the valve is narrowed, is becoming increasingly rare in the United States.
Most people with severe mitral regurgitation complain of shortness of breath, palpitations or a fluttering feeling in the chest due to an arrhythmia or fatigue.
Many times, mitral regurgitation is diagnosed because of symptoms noted above or because your doctor hears a heart murmur. Your cardiologist will likely order an ultrasound of the heart cold and echocardiogram which can definitively diagnose mitral regurgitation.
As with aortic stenosis, there are no medications that can slow the progression of mitral regurgitation. If mitral regurgitation is found in its mild or moderate form, your cardiologist will perform routine echocardiograms to evaluate for its progression, particularly if you have worsening symptoms. If you develop severe mitral regurgitation, a mainstay of treatment is open heart surgery. In many cases, the valve can be repaired, but in some cases it needs to be replaced. He should discuss which option is best with your cardiac surgeon. Also, in some cases, the surgery can be performed with minimally invasive techniques. There are emerging nonsurgical options for mitral regurgitation, including the MitraClip In this procedure, which is spared only for those who are not candidates for cardiac surgery, a clip is placed in the center of the valve to reduce the amount of regurgitation. This is done through the large vein in the groin.
A PFO is present in everyone at the time of birth. When you are a fetus, there is no need for blood to be sent to the lungs because you get all of your oxygen from her mother's blood. There is a flap between two chambers of the heart that allows blood to be diverted as it returns to the heart so that I can be sent back out to the body. At the time of birth, the pressures in the heart change rapidly, and this flap normally closes and scars over. In about 20% of people, however, the flap remains open. This is called a patent foramen ovale.
In the vast majority of people, PFOs are not dangerous and are usually detected when someone undergoes an ultrasound of the heart for another reason. However, in a very small subset of people with a PFO, a blood clot that forms in your leg can cross over this flap and cause a stroke. In people in whom a stroke is thought to have occurred because of a PFO, closure of the PFO is currently recommended.
Nearly everyone with a PFO is asymptomatic. As noted above, a small subset of people with PFO can develop strokes.
Howell my doctor diagnose a PFO?
PFOs are diagnosed with an ultrasound of the heart called an echocardiogram. Many patients will also undergo a second ultrasound of the heart to more closely evaluate the area of the PFO called a transesophageal echocardiogram. This is done under sedation in the hospital.
PFO closure should only really be performed in people who have a stroke thought to be related to the PFO in whom an extensive search for other causes of stroke has not revealed any other potential source of the stroke.
PFO closure is performed in the hospital. He devices implanted via the large vein in the groin while in ultrasound camera in the other large vein in the groin provides guidance. Most people go home the same day, and the procedure is usually very well tolerated. It is done under sedation. Patients will need to be on aspirin and a second blood thinner for at least a month and then on aspirin indefinitely.
As opposed to PFOs, ASDs are quite rare. These are never normal and occur due to problems with the development of the heart in which the wall between the atria of the heart does not fully form.
Most people with an ASD are asymptomatic until later in life. Sometimes, patients will develop shortness of breath.
ASDs are usually seen by echocardiogram. If you are diagnosed with an ASD, your cardiologist will most likely order a transesophageal echocardiogram. This is done in the hospital under sedation and gives a much better view of the ASD and the wall between the atria.
Not every ASD needs to undergo closure. If the ASD is quite small, most people can be followed with routine echocardiograms to evaluate for worsening problems with the heart. If it appears as though the right side of the heart is being affected by the flow of blood through the ASD, patients should have their ASD closed.
ASD closure is performed either severe open heart surgery or through the large vein in the groin. Many patients can be treated without having open heart surgery, but the approach depends largely on the shape and size of the ASD as well as its location in the wall between the atria. You should talk to your cardiologist about whether surgery or procedure is right for you.