Valve regurgitation: aortic, mitral, pulmonary, or tricuspid

Congenital heart valve regurgitation, in which blood is able to flow back through the valve, is caused by an abnormally formed valve that does not close properly. In the case of the pulmonary and tricuspid valves, if the defect is mild to moderate and the patient has no symptoms, regular medical checkups to carefully monitor the heart valve and pump function may suffice. More severe regurgitation may cause the right ventricle to enlarge, requiring repair or replacement of the valve (see below). Mitral and aortic valve regurgitation can lead to irreversible heart damage and therefore are surgically treated. In many patients, regurgitation is associated with other congenital heart defects that may largely determine the course of treatment for an individual. While no medication can correct valve regurgitation, certain drugs can minimize the symptoms by easing the heart's workload and regulating the heart's rhythm. Depending on the nature of the heart valve defect, any of the following medications may be prescribed:

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• Digitalis to strengthen the heart muscle contractions.
• Diuretics to reduce swelling and ease the heart's workload.
• Anticoagulants to prevent blood clots.
• Beta-blockers to control the heart rate and lower blood pressure.
• Calcium channel blockers to lower blood pressure and reduce the heart's workload.
• ACE inhibitors to lower blood pressure and decrease the heart's workload.

Read more in the section on medications.

If the valve defect is significant and medications do not control the symptoms, surgery to repair or replace the valve may be necessary. In general, most surgeons agree that heart valves should be repaired when possible and replaced only when necessary. Valve regurgitation can be resolved in a variety of ways depending upon the circumstances of the structural defect.

Valvuloplasty, or surgically modifying the original valve, can effectively eliminate regurgitation in some people. Surgeons can shorten or replace the cords that support the valves; when the cords and muscles are the right length, the valve leaflet edges meet and eliminate the leak. Alternatively, the ring of tissue that supports the valve leaflets can be made smaller. By decreasing the size of the opening, the leaflets of the valve are able to close tightly, preventing regurgitation. Sometimes, surgeons will implant an annuloplasty ring to downsize an abnormally enlarged valve opening. Surgeons can also repair the valve by removing excess tissue to help the valve close snugly and prevent back flow. Valve replacement requires open-heart surgery. The surgeon removes the faulty valve and replaces it with an artificial one, also known as a prosthetic valve--either a mechanical prosthetic valve or a biological prosthetic valve. Approximately 95 percent of all valve replacements are performed on mitral or aortic valves. The key to selecting the right prosthetic valve involves weighing the advantages and disadvantages of certain valves with the risk of anticoagulation therapy.

Mechanical prosthetic valves, made of synthetic materials, are more durable and reliable than tissue valves. However, blood tends to stick to mechanical valves, causing blood clots; therefore, patients receiving mechanical valves must take a blood-thinning drug (anticoagulant), such as warfarin, for the rest of their lives. People who take anticoagulants must have their blood tested regularly to ensure that their blood has not gotten too "thick" or "thin." This constant monitoring can be especially challenging in children. In addition, blood thinners are not recommended for people who play contact sports and pose risks for a developing fetus. Women who wish to become pregnant or young adults participating in contact sports should discuss in detail the choice of valves with their congenital cardiologist and cardiovascular surgeon.

Biological prosthetic valves are made from animal tissue or human tissue taken from a donated heart and do not require blood thinners. However, they are not are not as durable as mechanical valves and may require replacement within 10 years. In general, patients younger than 70 receive mechanical valves; those over 65 receive biological prosthetic valves. For some younger people, a bioprosthetic valve may be used with the understanding that an additional surgery will be necessary in the future to replace it with a mechanical valve at a future date.