“Two steps forward and
one step back” isn’t an
efficient way for blood
to move through the
heart. But that pretty well
describes what happens
when either of the two
valves in the heart fails
to close completely after
blood goes through.
The valves are designed to keep blood
flowing steadily in the same direction. If they
don’t close properly, some of the blood can
reverse course and cause stagnation.
That can happen with both the mitral valve,
which regulates blood flow from the lungs
to the heart, and the aortic valve, through
which blood flows from the heart to the aorta.
The aorta is the large artery that feeds all the
others in the body.
The aortic valve can have trouble opening
as well as closing. If it becomes stiff, it can
stick, like a door you have to pull hard to
“Working that hard causes the heart, like
any muscle, to become bigger and thicker,
which makes it more prone to failure,” says
John Streitman, M.D., of Pinehurst Surgical
and a cardiac surgeon at FirstHealth Moore
When the sticky valve problem becomes
serious enough, the valve can be replaced with
one made of metal and plastic or one made of
pig or cow tissue. The mechanical valves last
indefinitely, but patients have to take bloodthinning
medication for the rest of their lives
because of the risk of clotting.
Clotting isn’t a problem with the cow and
pig valves, but they last only 15 to 20 years.
While some people have aortic valves that
don’t open smoothly, others have valves that
fail to close properly.
“The heart squeezes and then relaxes, and
if the valve doesn’t close completely when the
heart relaxes, some of the blood backwashes
into the ventricle,” Dr. Streitman says. “That
is very inefficient and, over time, can lead to
heart failure symptoms.”
The cause of the backwash, which Dr.
Streitman calls “aortic regurgitation,” is a
weakening and distension of the rim of the
valve. When that happens, the leaflets of the
valve, which are the parts that open and close,
no longer meet in the middle.
“There are repair techniques we can use to
shrink the rim back down to a normal size so
that the leaflets are touching again and the
value closes all the way,” Dr. Streitman says.
Sometimes, the aortic valve is so stiff with
calcium deposits that it can’t be repaired. In
those cases, the valve has to be replaced.
Aortic valve disease is more common than
mitral valve disease, but heart surgeons at
Moore Regional routinely treat problems with
both types of valves.
If the mitral valve becomes enlarged or if a
cord that supports one of the leaflets gets torn
so that it doesn’t close tightly, blood can flow
in the wrong direction. The most common
symptom is shortness of breath during
exertion, which is caused by blood backing up
into the lungs.
A faulty mitral valve also can cause atrial
fibrillation, an electrical disturbance that
causes the heart to beat erratically. (See the
story on atrial fibrillation on page 28.)
“If blood is going in the wrong direction,
it increases the volume of blood in the left
atrium, so the left atrium gets bigger, and that
interferes with electrical conduction,” says
Andy Kiser, M.D., who is also a Pinehurst
Surgical and Moore Regional cardiac surgeon.
Depending on the exact nature of the mitral
valve problem, there are different surgical
procedures for correcting it, but most of the
procedures are similar, Dr. Kiser says.
“We can open the heart and take out part
of the valve and repair it with sutures,” he
says. “Then we can put a ring around the
valve to tighten the circumference so that the
leaflets are meeting and the valve is closing
Until recently, mitral valve surgery always
involved dividing the breastbone and opening
the chest. Now Dr. Kiser performs many of
these operations through a relatively small
incision between the ribs on the right side of
the chest. The heart still has to be stopped,
however, and the patient is on a heart-lung
machine until the surgery is finished.
The main advantage of the less-invasive
procedure is a shorter recovery period.
“Patients are often back at work in three
weeks, and one of my patients was playing
softball four weeks after surgery,” Dr. Kiser
As with aortic valves, some mitral valves
are in such bad condition that they can’t be
repaired. Instead, they have to be replaced
with either a mechanical or pig valve.
It isn’t always known what causes heart
valve problems. Some are due to congenital
abnormalities while others may be caused by
infections. According to Dr. Kiser, a heart
attack can also damage tissue in the area
of the mitral valve and cause the valve to
When Steve Baxter had a routine physical
exam in May 2006, his doctor detected
a heart murmur. An electrocardiogram (EKG) indicated he
might have a mitral valve problem.
Another EKG three months later showed there had
been no change, so there seemed to be little cause for
worry. But three months after that, an EKG showed
severe mitral valve regurgitation.
The valve wasn’t closing properly, and blood was
backing up in his heart. Baxter’s cardiologist, Joseph
Hakas, M.D., of Pinehurst Cardiology, said he needed
“I couldn’t believe it,” says Baxter, who was only 48.
“I felt fine. I was energetic. I walked, ran, fished, played
golf—all the things I like to do. I would get a little tired at
work in the afternoon, but I figured that was normal.”
One of the leaflets in Baxter’s mitral valve had
somehow gotten torn and wasn’t opening and closing
properly. With each beat of his heart, the valve allowed
blood to back up into the left atrium. That was causing
his heart to enlarge and forcing it to work harder than
it was meant to.
On March 21 of this year, Andy Kiser, M.D., a cardiac
surgeon at FirstHealth Moore Regional Hospital, repaired
Baxter’s faulty heart valve using a relatively new procedure
that doesn’t involve cracking open the chest. Instead, he
operated through a 5-inch incision between the ribs.
It was still major surgery, however, and Baxter was in
the hospital for six days. Barely a week after going home,
he was walking four miles a day. Five weeks after the
surgery, he was back on the golf course.
“I thought I felt good before the surgery, but I feel
so much better now,” he says. “I guess I had sort of
accepted a deterioration of my mental and physical
energy, because it was so gradual. Now I feel 20 years
younger. My mental energy is that much better. And that
makes sense, because I’m getting all the blood to my
head and the rest of my body that I wasn’t getting before.
I hate to use the phrase ‘new lease on life,’ but I feel like
that’s what I’ve got.”