St. Luke’s Structural Heart Disease Program
What is Structural Heart
The term Structural Heart refers collectively to the heart’s valves, walls and muscle and arteries. This amazing organ pumps 100,000 times each day, pushing five to six quarts of blood throughout the body each minute, a total of 2,000 gallons daily. So, it’s vital that each of these components is healthy, so the heart can work efficiently pumping blood into, through and out of it to supply oxygen and vital nutrients.
Some hearts have problems that affect their pumping ability. These can be present at birth or develop over time, affecting the quality of a person’s life. The following conditions are common, unfortunately, but the good news is that St. Luke’s Structural Heart Specialists are experts at treating them using the latest medicines and techniques available.
Valves
The heart contains four single-direction valves that help blood to enter, leave and circulate through it as it prepares and sends this vital liquid throughout the body. A diseased or damaged valve cannot move blood in the right amount or direction, affecting a person’s breathing, energy level, thinking ability and level of physical activity. Valves can be replaced, and sometimes repaired, by open-heart surgery or new catheter-based techniques such as transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR) or Mitraclip. Following is a list of valves and purpose for each of them.
- Aortic valve: A valve through which blood leaves the heart and enters the aorta, the largest artery in the body.
- Mitral valve: A two-leaf valve connecting the upper and lower chambers on the left side of the heart. In a healthy heart, blood passes only through from the top (atrium) down into the ventricle.
- Tricuspid valve: This valve lies between the right atrium and ventricle, or the upper and lower chambers of the heart, through which blood flows.
- Pulmonary valve: Blood runs through this valve on its way to the pulmonary artery and lungs, where it gives off carbon dioxide and becomes enriched with oxygen.
Holes in Heart
In some people, the holes that are open in a fetus don’t close at birth as they should. This can create problems and symptoms as a person ages, requiring the closure of a hole, either with surgery or use of catheters and tiny devices. Here are the most common holes, symptoms and treatments:
- Ventricular-Septal Defect is a hole in the muscle (septum) between the two lower chambers. A person with this condition might feel short of breath when exercising, tire easily, have swelling of the legs, experience heart palpitations and possibly suffer a stroke. Treatments range from medications to surgery or the insertion of a ‘closure device’ using a catheter.
- An atrial septal defect is a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart. This condition can cause shortness of breath, easy fatigue, swelling of the legs, heart palpitations or irregular heartbeats, or stroke. Treatment options include open heart surgery or the insertion of a ‘closure device’ fitted onto a catheter.
- Patent Foramen Ovale (PFO) is a smaller hole between the upper heart chambers that doesn’t close at birth. It is usually found in adults, often following a stroke. PFO is treated with surgery or by insertion of a closure device with a catheter. In some cases, blood thinners prevent the formation of a blood clot.
Hypertrophic Cardiomyopathy (HCM) refers to an abnormally thick septum/wall muscle separating the heart’s lower right and left chambers. This can cause lightheadedness, fatigue during mild exercise and sometimes results in sudden cardiac death in athletes. Medications can treat the symptoms of HCM, but open-heart surgery to correct the septum is the only cure for this congenital defect.
Left Atrial Appendage Occlusion (LAAO)
Left atrial appendage is a pocket on the left side of the heart where blood can collect and clot. If this occurs, the blood clot can flow up to the brain and cause a stroke. Blood thinners can prevent clot formation and closing off the pocket with an implantable device can prevent the collection of blood in this location.
Patients with atrial fibrillation can be five times more likely to have a stroke because of the increased formation of blood clots. Blood thinners are the most common treatment for preventing the clots from forming. But many people with atrial fibrillation cannot tolerate them because they have bleeding issues, such as in their stomach, colon or brain.
In these instances, patients may qualify for a special transcatheter device which occludes the left atrial appendage and reduces the risk of stroke. The Left Atrial Appendage Occlusion (LAAO) device is implanted in a sterile, operating-room-like room. Physicians thread the device through a thin flexible tube into the patient’s heart and position a 2-3 cm cap-like device that expands and blocks the opening of the left atrial appendage. This procedure takes about an hour during which the patient is under anesthesia. Patients are discharged home the next day with just a small bandage on their groin, and they should feel back to normal immediately.
Heart Failure describes the heart’s decreased pumping ability. This develops mainly due to uncontrolled high blood pressure or it can occur following a heart attack. Medications are used to treat heart failure. The most advanced degrees of heart failure can require a transplant or dependence on an artificial device that helps the heart improve its pumping ability.
The St. Luke’s Structural Heart Team includes the following:
- Interventional cardiologists
- Cardiothoracic surgeons
- Medical cardiologists
- Cardiac imaging specialists