Love may be the figurative doorway to the heart, but valves are the literal doorways through which blood passes in its continual journey into and out of the heart’s four chambers.

“The heart has four valves that can either become leaky (valve regurgitation) or blocked (valve stenosis),” explains Dr. Brian Lindman, a cardiologist with Washington University Physicians who researches valvular heart disease.

“A malfunctioning heart valve may be discovered while a physician is listening to your heart with a stethoscope,” he continues. “A ‘murmur’ is the sound of turbulent blood flow across a valve and may indicate that it is functioning abnormally. Common effects of a malfunctioning heart valve— generally only when the stenosis or regurgitation is severe—are signs of heart failure: shortness of breath and decreased exercise capacity.”

Some heart valve abnormalities are congenital while others develop due to age, infection or other cardiovascular disease processes. Physicians test for heart valve problems with an echocardiogram, which shows how well each valve is functioning.

“A mild or moderate amount of leak in one of the valves can be managed without surgery,” says Dr. Michael Mauney, a cardiothoracic surgeon on staff at Missouri Baptist Medical Center. “That would be not unlike some heart failure therapies: diuretics, avoiding salt, etc.”

More severe regurgitation requires valve repair or replacement, most often to treat the aortic valve that is located between the left ventricle of the heart and the aorta, which is the largest artery in the body. Surgeons have performed successful valve replacement for decades, and even elderly patients are among the approximately 50,000 Americans each year who benefit from the surgery. “It offers more benefit in terms of symptom improvement, quality-of-life improvement and flat-out survival than not operating,” Mauney says.

While most patients are deemed healthy enough to undergo valve replacement surgery, those who are not good surgical candidates may benefit from a newer procedure that uses a catheter to deliver and place the new valve. The U.S. Food and Drug Administration recently approved transcatheter aortic valve replacement (TAVR) that uses a wiremesh valve. “The only indication for the transcatheter procedure is treatment of a patient with severe, symptomatic stenosis of the aortic valve who are non-operative candidates. These are patients who have no other option,” says Dr. Anthony Sonn, a cardiologist with Mercy Clinic Heart and Vascular.

Sonn works with a multidisciplinary team at the Mercy Center for Heart Valve Disease, and he notes that this team approach is an important aspect of care. “What makes it (TAVR) such a great procedure for patients is that you get true multidisciplinary care throughout the whole process,” he says. “You have primary-care physicians, interventional cardiologists, cardiac surgeons, radiologists, rehab physicians—many different people are involved in coming up with the plan, recommendations and follow-up with patients. I think that’s a new paradigm for medicine. You have many people collaborating together, and at the end of the day patients can only benefit.”


Although modern medicine continues to offer new techniques for treating cardiovascular disease, a healthy lifestyle helps prevent cardiac problems from developing.

“The human body is a wonderfully designed organic machine that is very efficient,” notes Forrest Boston, a personal trainer at J.O.E. Inc. “The heart muscle needs to continually be challenged, otherwise it will become very efficient at the current workload put to it and fail to get stronger and reach new levels of efficiency. The thing with the heart muscle is that it needs to have things changed up every time it is worked out.”

To achieve this, Boston recommends:

■ Circuit training using two or three different methods of cardio exercise to keep the heart challenged.

■ Interval training that uses the same mode of exercise at various intensity levels throughout the workout. Intensity can be adjusted by changing speed or resistance while exercising.

■ Tabata, a type of cardio interval training in which the individual alternates 20 seconds at maximum intensity with 10 seconds of rest for at least eight consecutive cycles.

Dale Huff, owner of NutriFormance, adds these suggestions:

■ Do something active every day. Even 10 minutes of cardiovascular exercise has an aerobic training effect.

■ If you have 30 minutes or less to dedicate to cardio on a given day, try intervals of a three-toone work-to-recovery ratio. On days you have extra time, complete a steady workout with perceived exertion between five and seven on a scale of 10.

■ Use either a heart-rate monitor or perceived exertion to guide your intensity and progress, progressing to more challenging exercise as you become more fit.