This is a disease due to a heavy build-up of calcium on the valves render it from opening adequately. Most commonly, it occurs as part of aging. In younger patients, it is often developed in underlying abnormal valve that the patients are born with (bicuspid), or among immigrants who are more likely to be exposed to rheumatic fever in childhood, it is often caused by rheumatic valvular disease.

Regardless of the causes, surgery is recommended in the advance stage when the valve opening area is less than 1cm2 for an average size person,. The surgery requires the excision of the diseased valve and a replacement with an artificial or man-made valve.

Aortic Regurgitation

A leaky aortic valve is typically caused by degeneration due to old age, underlying aneurysm, infection, or acute dissection of the aorta. In certain situations, the defect can be repaired (such as in aortic dissection, endocarditis) and in others, it needs to replaced with a new valve (such as in degenerative disease, and underlying aneurysm).

Mitral Stenosis

The stenosis of the mitral can only be caused by rheumatic valvular disease and therefore, it is mostly seen among the immigrant population. In the very early stage a repair can be performed. If there is no associated regurgitation or leaks, a balloon can be inserted to stretch open the valve without open surgery. This procedure is called “balloon valvuloplasty” and is very successful in the experienced hands and may delay the needs for surgery for another 10 years. Ultimately, all patients with this disease will come to surgery in which the valve will be excised and replaced with an artificial one.

Mitral Regurgitation

The leaky mitral valve can be caused by a variety of associated heart disorders. The more common causes include degenerative diseases, leaflet prolapse, ischemic heart disease, cardiomyopathy, and rheumatic disease. The difference disease entities affect the mitral valve differently although the end result is the incompetence of the valve closure leading to a leakage of blood back into the lungs during the pumping phase of the heart.

The surgeons have an armamentarium of surgical techniques and devices that allow consistent and reproducible repair of the incompetent mitral valve. Unlike the other valves of the heart, the mitral valve is most amenable to be repaired. The success of a complex mitral valve program reflects the maturity of the heart surgery center.

In the most advanced anatomical defects, the mitral valve may need to be replaced with an artificial valve.

Artificial Valves used for replacement

The man made artificial valves can be placed into two categories:
(1) tissue or bioprosthetic valves, and (2) mechanical valves.
Tissue valves are made from treated animal tissues—pigs, cows and horse (porcine, bovine and equine respectively). The advantage of the tissue valves is that they do no require the long term use of an anticoagulant (blood thinner or Coumadin) which is associated with a small life time risk of hemorrhage.

The disadvantage of the tissue valve is that it does not last forever. Depending on the type used and the location where it is used, tissue valves are expected to last about ten (10) years. The latter generation tissue valves may last another 6-8 years longer. This situation is opposite for the mechanical valves. They may last a life time when the proper care is taken. However, the disadvantage of mechanical valves is that they require life long use of an anticoagulant, Coumadin.

In the addition to the potential bleeding complication of Coumadin, it cannot be taken during pregnancy because of it toxicity to the fetus.