Treating Pulmonary Valve Disease
The Structural Heart and Valve Disease team treats many patients with pulmonary valve disease. They have years of experience and are able to offer multiple therapies and procedures, including:
The Structural Heart and Valve Disease team will talk with you about these treatment options to determine the best approach for your specific needs.
Surveillance and Medical Management
The difference in the blood pressure between the ventricle and the pulmonary artery will determine the severity of your pulmonary disease. Mild pulmonary valve disease frequently does not produce any symptoms, so your doctor may want to monitor your condition during regular visits. If it is moderate and you begin to experience symptoms, your doctor may prescribe medicine to help control those symptoms. For example, you may take medicine to reduce fluid build-up, lower your blood pressure, slow your heart rate and/or control your heart’s rhythm. During this time, your doctor may also order repeat echocardiograms to track the progress of your pulmonary valve disease.
Eventually, as your symptoms worsen and they begin to affect your quality of life, your doctor may recommend surgery to repair or replace the damaged valve.
Open Repair or Replacement Surgery
Open-heart surgery is the most common treatment to repair or replace a damaged pulmonary valve in young and healthy adults. You will be under general anesthesia. Your heart surgeon will make a long incision (six to eight inches) in your chest and through your breast bone to allow access to the heart. Throughout the entire procedure your blood will circulate through a cardiopulmonary bypass (heart-lung) machine, which keeps blood circulating through your body, but diverts it around the valve that is being replaced. If your valve is very damaged, your surgeon will replace it with a mechanical (usually made out of titanium or carbon) or a bioprosthetic valve (an artificial heart valve made out of animal tissue, usually from a pig), rather than trying to repair it.
After surgery, you will recover in the hospital for a few days and then at home for several weeks or possibly a couple of months.
Elderly individuals and those who are very frail or have multiple medical conditions may not be eligible for open-heart surgery; however, other options may be available.
For more information about open-heart pulmonary valve surgery, go to Swedish Cardiac Surgery >
Minimally Invasive Pulmonary Valve Repair or Replacement
The Swedish team of heart surgeons is also able to repair or replace pulmonary valves using a minimally invasive approach. Your heart surgeon may choose to repair or replace the pulmonary valve using a procedure called a mini-sternotomy. It is similar to open-heart surgery, except the heart surgeon makes only a four- or five-inch incision in the upper part of the chest and only spreads the upper portion of the breast bone. In some cases, the incision can be even smaller, which helps speed up healing.
Another surgical option is a min-thoracotomy, which doesn’t require cutting through the breast bone. Instead, the surgeon makes a two-to-three inch incision and uses special instruments to access the heart through the ribs.
For more information about minimally invasive surgery for pulmonary valve repair or replacement, go to Swedish Cardiac Surgery >
Transcatheter Pulmonary Valve Replacement
Many individuals with advanced pulmonary valve disease cannot have open-heart surgery because of their age, they are too frail or sick, or they have multiple medical conditions. If you have severe pulmonary valve disease and cannot have surgery, your heart team may consider transcatheter pulmonary valve replacement.
Three-D imaging allows your cardiologist to analyze and evaluate your pulmonary valve in very fine detail before during and after the procedure. Rather than general anesthesia, the anesthesiologist uses conscious (twilight) sedation. This avoids the need for a breathing tube and makes it possible for you to move around sooner after the procedure.
Following the procedure, you will stay overnight in the hospital for a couple of days for monitoring and then recover at home.
Transcatheter Pulmonary Valve-in-Valve Replacement
Transcatheter pulmonary valve-in-valve replacement is a therapy for patients who have had a previous valve replacement procedure using a bioprosthetic valve (an artificial heart valve made out of animal tissue, usually from a pig), but the valve is no longer working properly. Bioprosthetic valves are made from animal valves or tissue, and usually last 10-20 years. That is why younger patients who have had a pulmonary valve replacement using a bioprosthetic valve may need to have it replaced at some point.
Depending on the pulmonary valve, this procedure may be done with general anesthesia or conscious (twilight) sedation. The new valve is implanted through a catheter that the cardiologist threads through a small incision in the groin and into the heart. Once the doctor sees that it is positioned correctly, a small balloon inflates to push the valve open. As soon as the new valve is open, it takes over responsibility for controlling the blood flow from the right ventricle to the pulmonary artery.
Typically, patients stay in the hospital for one to three days after the procedure.
Transcatheter Balloon Pulmonary Valvuloplasty
Balloon pulmonary valvuloplasty is a procedure to widen the opening in a valve that has narrowed due to pulmonary valve stenosis. Typically it is used in place of valve replacement in children, teens and young adults who have congenital stenosis. It may also be used as a “bridge” for older adults who are too sick to have a valve replacement procedure right away. In patients who have had balloon valvuloplasty the stenosis may return, which would then require a valve replacement procedure.
You may be awake, but your anesthesiologist will administer local anesthesia and other pain medicine to minimize pain and to ensure you are relaxed and not anxious. Your cardiologist will insert a catheter through a very small incision in either your groin, and will thread it through the artery into your heart and valve. After ensuring proper placement, your cardiologist inflates the balloon at the end of the catheter, which widens the opening. Patients usually stay in the hospital one day after their balloon procedure.