The human heart has four valves — mitral, tricuspid, pulmonary and aortic. These valves have flaps that open and close with each heartbeat.

A problem with a valve, such as a valve that doesn’t close all the way or doesn’t open properly, can require medical intervention.

When a valve doesn’t close all the way, it causes valve “regurgitation,” where blood flows backward into one of the heart’s chambers (also called a “leaky” valve). When it doesn’t open properly, it results in “stenosis” or narrowing of the valve opening. Both regurgitation and stenosis cause the heart to work harder to provide your body the proper blood flow.

Aside from a heart murmur, symptoms of valve disease include fatigue, shortness of breath, chest discomfort, swollen ankles or abdomen, and lightheadedness.

Some people live long lives with valvular heart disease and never need surgery. However, when valve disease worsens it affects the heart’s ability to pump. In their most severe forms, valvular heart disease can lead to profound heart failure and death so intervention is often needed to repair or replace the faulty valve to prevent this.

Over the years, NorthShore – Edward-Elmhurst Health has been at the forefront of care, with early implementation of advances in the treatment of heart disease.

“The last two decades have seen an explosion in advancements in minimally invasive treatment of heart valve disease – interventions that are done without any incisions on the beating heart through catheters in the arteries or veins,” said Mark Ricciardi, MD, cardiologist with NorthShore University HealthSystem (NorthShore).

“NorthShore has been very involved in the early device clinical trials and device innovation, such as TAVR (transcatheter aortic valve replacement) and TEER (transcatheter edge to edge repair),” Dr. Ricciardi said. “In fact, the first TEER procedure in the country was done at NorthShore Evanston Hospital.”

The cardiologists at NorthShore – Edward-Elmhurst Health have been on the cutting edge of heart care, and continually look for better ways to treat heart disease using catheters instead of large incisions. These are some of the valve problems and the transcatheter innovations that Northshore cardiologists are using:

Mitral valve regurgitation

Catheter-based nonsurgical repair of the leaky mitral valve was first performed in 2003 at NorthShore Evanston Hospital and has led to 20 years of continued device investigation and innovation.

Starting in 2012, NorthShore Evanston participated in one of the critical trials that showed that mitral TEER for patients with a weakened heart not only improved quality of life, but dramatically reduced the risk of needing hospitalization and improved survival.

In 2019, NorthShore was the first hospital in the greater Chicago area and Illinois to use the most current generation device, called G4. Mitraclip® G4 use has resulted in not only better outcomes for patients but also allows physicians to treat more complex valvular issues with the new device. 

Despite the efficacy of these repair devices, there remain patients whose valves are not suitable for repair. Valve replacement devices for such patients, whereby a new mitral valve is implanted through a catheter in the vein may be an option.

Currently under investigation at NorthShore are dedicated transcatheter valves that can be implanted within the patients existing mitral valve. Years before this, NorthShore cardiologists were innovators in developing transcatheter valve replacement techniques for patients with severe calcification of their mitral valves and for patients who had previously undergone open surgical valve replacement or repair but developed surgical valve failure requiring treatment.

Tricuspid valve regurgitation

“The tricuspid valve has long been considered the forgotten valve, primarily because symptoms of tricuspid regurgitation can be confused with other heart or non-heart ailments. This can lead to a delay in diagnosis and, unfortunately, there are no good surgical options for tricuspid regurgitation,” Dr. Ricciardi said. “Medications may help but often don’t reduce the amount of leak. Historically, when medications failed, there was nothing much that could be done.”

Physicians are finding new ways to treat tricuspid regurgitation, including tricuspid transcatheter edge-to-edge repair (T-TEER) or “TriClip.” Using devices historically used for mitral repair has recently been found to be a safe way to reduce regurgitation.  NorthShore – Edward-Elmhurst Health cardiologists have done a number of these tricuspid repair procedures and recently completed the pivotal trial (the Triluminate Trial) showing great promise for this.

Recently our physicians at Evanston were the first in the upper Midwest to offer a new procedure to treat a patient with tricuspid regurgitation who was not a candidate for either edge-to-edge repair or valve replacement. This catheter-based procedure, called bi-caval valve implantation, which involves implantation of valves in the main veins that lead to the heart thereby improving cardiac output and protecting the liver and kidneys.

Aortic stenosis

Aortic stenosis occurs when the aortic valve narrows severely and restricts blood flow from the heart’s lower left chamber, requiring the heart to pump harder. It has a high mortality rate but can be treated with a minimally-invasive procedure called transcatheter aortic valve implantation (TAVI).

Of all the catheter-based valve procedures, TAVI is the most mature and the one most commonly performed. In fact, TAVI for aortic stenosis is now more commonly performed than open surgical aortic valve replacement with long term outcomes that are excellent.

The cardiologists at NorthShore continue to innovate and investigate treatments for aortic stenosis with new devices that will hopefully lead to even better long term outcomes and expand the number of patients who may benefit for this technology.

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