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Structural Heart Disease

  • Defects or disorders in the heart's structure that are present at birth or develop later
  • Sometimes no symptoms in the early stages, but chest pain and fatigue can be warning signs
  • While some cases still require open surgery, catheterization is making care easier for many patients
  • Involves structural heart disease program

Overview

If you are eating healthy and going to the gym, you’re doing important work toward preventing coronary heart disease, which is caused by plaque buildup in the arteries that can cause chest pain and even heart attack. Structural heart disease is a different problem. It’s a term commonly used to describe defects or disorders in the heart’s structure—its valves, for instance.

A heart problem that is structural may be congenital, meaning it was present at birth, or it can result from aging or underlying diseases causing wear and tear on the heart later in life.

The good news is that treatments for structural heart disease are improving. While open heart surgery may still be the best solution in some cases, minimally invasive catheter-based therapies have made care easier on patients, with fewer complications and quicker recoveries.

“Today, most people with serious structural heart disease can be treated effectively and afterward lead a normal life,” says Yale medicine cardiac surgeon Matthew Williams, MD.

How does structural heart disease affect the heart?

The heart beats 100,000 times a day. It delivers a constant supply of oxygen- and nutrient-rich blood to organs and tissues around the body, allowing them to function properly. With each beat, heart muscles contract and relax, and blood flows into and out of the heart, passing through its four chambers and onward to the rest of the body through a network of blood vessels. Inside the heart, four valves regulate the flow of blood between chambers, to the lungs, and to the rest of the body.

Structural heart disease occurs when there is an abnormality or defect in the structure of one of the components of the heart—that is, the valves, chambers, muscle, the walls that divide chambers from one another, or the major arteries that transport blood from the heart to the lungs and the body.

Structural heart disease makes it difficult for the heart to pump blood and can lead to serious heart problems like heart failure or heart attack.

What are some types of structural heart disease?

Structural abnormalities can affect the heart’s valves, chambers, chamber walls, muscle, and major arteries.

The heart has four chambers and four heart valves (the aortic, mitral, tricuspid, and pulmonary valves). They must open and close in harmony for blood to flow in the proper direction. When a structural abnormality affects the functioning of one of the heart’s valves, it is called heart valve disease.

There are two common types of structural defects that affect heart valves:

  • Regurgitation or “leaky” valve. Some structural abnormalities can interfere with a valve’s ability to completely close. In these cases, blood regurgitate, or leak, back into one of the heart’s chambers.
  • Stenosis. This refers to the narrowing of one of the heart’s valves, making it more difficult for blood to flow through it. This can reduce the amount of blood that is pumped to organs and tissue around the body.

Other common types of structural heart disease include:

  • Septal defects. The heart’s chambers are separated from one another by septa, or walls. A septal defect is one in which there is a hole in one of these walls. When a hole is present between the two upper chambers (the atria), it may be due to an atrial septal defect (ASD), or another birth defect called a patent foramen ovale. When there is a hole in the wall between the two lower chambers (the ventricles), it is known as a ventricular septal defect (VSD).
  • Coarctation of the aorta. The aorta—the largest artery in the body—delivers oxygen-rich blood from the heart to the body’s organs and tissues. Coarctation of the aorta is a birth defect in which the aorta is narrowed, which reduces the amount of blood that reaches organs and tissues.
  • Hypertrophic obstructive cardiomyopathy. In this condition, the heart muscle becomes thicker than usual, which can result in a reduction in the amount of blood that is pumped throughout the body.

What causes structural heart disease?

Structural heart disease can be congenital or acquired.

  • Congenital defects are those that are present at birth. They are sometimes called birth defects or congenital heart defects. They may be caused by genetic factors. Birth defects can also develop during pregnancy, such as when a woman takes certain medications or drugs, has a poor diet, or has becomes ill while pregnant. In many cases, the cause of a congenital heart defect cannot be determined.
  • Acquired defects. Adults also can develop a structural heart defect, sometimes due to another disease, such as atherosclerosis, high blood pressure, an infection, rheumatic fever, or bacterial endocarditis (an infection of the inner layer of the heart and valves). A defect may be associated with damage caused by a previous heart attack, or it may simply be a result of aging. 

How are structural heart defects diagnosed?

Structural heart problems in adults may have no symptoms in the early stages. As structural heart disease progresses, you may have one or more of the following signs and symptoms:

  • Chest pain
  • Irregular heartbeats
  • Shortness of breath
  • Lightheadedness or passing out
  • Swelling of the abdomen, ankles, or feet
  • High blood pressure
  • Fatigue
  • Kidney dysfunction

Many congenital heart defects can be detected at or before birth with a sophisticated imaging technique called fetal echocardiography that uses sound waves to create a picture of a baby’s heart. Most defects can be treated after the baby is born.

Structural heart disease can be more difficult to detect later in adulthood. Heart defects can run in families, so alert your doctor if a close relative had this type of heart condition. Sometimes a doctor will notice a problem, such as a heart murmur, by listening to the heart through a stethoscope.

When a doctor suspects structural heart disease in an adult, they will use a variety of tests to make the diagnosis. These may include an echocardiogram and/or a magnetic resonance imaging (MRI) study of the heart, a chest X-ray to look at the heart’s shape, and an electrocardiogram (known as an EKG or ECG) to assess the heart’s rhythm. In some cases, your doctor may perform a catheterization procedure to identify places where blood vessels are blocked or narrowed. 

How are structural heart defects and disorders treated?

Some structural problems may never require treatment, although they will need to be monitored throughout a patient’s life. Some patients may benefit from medication. For example, a doctor may prescribe warfarin, a common blood thinning medication, if blood clots pose a particular risk for a patient.

Often, people with structural heart disease are treated with surgery. Open-heart surgery may be necessary for some patients, such as those who need a heart transplant or who require a procedure called a myectomy, in which a surgeon removes part of thickened heart muscle. In other cases, a surgeon can treat the problem using a minimally invasive surgical procedure that requires smaller incisions than open-heart surgery and usually has a shorter recovery period.

Surgery may also be necessary for patients who require a pacemaker or an implantable cardioverter defibrillator, a device that can detect an irregular heartbeat and send an electrical impulse to the heart that corrects it. 

In a growing number of cases, however, cardiologists treat structural heart defects through catheter-based approaches, which provide a minimally invasive alternative to surgery. For these procedures, the doctor inserts a catheter into a blood vessel, often in the groin, though other areas of the body may be used. The doctor guides the catheter through the blood vessel to the heart. Through the catheter, the doctor is able to either repair or replace the defective valve.

How is Yale Medicine unique in the care of structural heart disease?

Yale Medicine’s Structural Heart Program was the first integrated program of its kind in Connecticut dedicated to the care of adult patients with complex structural heart and valve disease. It is the largest program of its kind in the state and has been recognized as a national leader in the field, treating an increasing number of complex cardiac conditions through catheter-based and minimally invasive procedures.

The program is known for its percutaneous (through the skin) valve program, including aortic, mitral, and pulmonary valve procedures. The physicians at Yale Medicine have led multiple national and international studies that have led to recent advances in the field, and they continue to pioneer new strategies for these transcatheter therapies.