How Do You Fix a Leaky Heart Valve?

A leaky heart valve allows blood to leak or flow in the wrong direction. The condition can place strain on the heart, affecting its ability to pump effectively. Medications and lifestyle changes can improve symptoms and delay surgery. But surgery is the only way to fix a leaky heart valve.

“Surgical procedures for valves are very well studied. They’re still the gold standard for treatment of most types of valve disease in most people — and the most durable approach,” says Ashraf Sabe, MD, a Mass General Brigham cardiac surgeon who cares for patients at Brigham and Women’s Hospital. “If you’re healthy and can tolerate a more invasive procedure, you may want to make that decision early. It will lessen the need for other procedures and medications down the line, and it will make it less likely to have problems with your heart as time goes on.”

Dr. Sabe explains how medications, lifestyle changes and surgery can all play a part in managing leaky heart valves.

What is a leaky heart valve?

Your heart has four valves — flaps that act as one-way gates that ensure blood flows in the right direction at the right time. A leaky heart valve, or valve regurgitation, is when a valve becomes dysfunctional and starts to leak backward.

This common condition has several causes:

• Age, because valves tend to become weaker over time as we get older
• Congenital heart defect present at birth
• Connective tissue disorders
• Genetic predisposition to weaker valves
• Infection (for example, IV drug use, IV or catheter use in a medical setting, surgery or dental procedures)
• Other heart conditions such as heart failure, coronary artery disease, and hypertension, which put extra pressure on the valves

Valve regurgitation can range from mild to severe, but it tends to get worse over time.

The worse the leak, the less effectively the heart can pump. More advanced valve regurgitation can cause symptoms such as fatigue, shortness of breath, and irregular heart rhythms (atrial fibrillation). It can limit your activities, diminish your quality of life, and lead to heart failure.

A person can have more than one leaky heart valve at a time. In fact, one leaky valve puts you at risk for more. “Imagine a river with several downstream dams. If one becomes dysfunctional, that can create a backup and put more pressure on the dam that’s upstream,” says Dr. Sabe. “So one leaky valve can result in a vicious cycle.”

Leaky heart valve symptoms

Dr. Sabe emphasizes that people with leaky valves require long-term management by a team of heart specialists. The team should include cardiologists, cardiac surgeons, anesthesiologists, heart imaging experts, and your primary care physician.

An expert team recommends a strategy for treatment that’s best for you based on your:

• Severity of regurgitation
• Goals, such as managing symptoms in the short term versus seeking a long-term cure
• Overall health and ability to recover from surgery
• Quality of life and ability to participate in things you enjoy
• Test results and how they change over time, such as ultrasounds and echocardiograms

Medications for leaky heart valve

The main types of medication doctors prescribe to manage leaky heart valves are diuretics and vasodilators.

Diuretics, also known as “water pills,” lessen the amount of fluid in bodily tissues and the bloodstream. They reduce the heart’s workload and can improve symptoms, but they don’t fix a leaky valve. Vasodilators relax the walls of the blood vessels, opening them wider and reducing blood pressure.

“What we’re trying to do is get volume off the heart and improve the efficiency of the pump,” Dr. Sabe explains. “When the heart handles less volume or weight, it can pump more efficiently."

Lifestyle changes to manage leaky heart valve

Dr. Sabe says heart-healthy lifestyle choices can be particularly effective at managing the symptoms of leaky heart valve. These include:

• Avoid salty foods
• Control cholesterol and blood pressure
• Get enough sleep, including following treatment for obstructive sleep apnea if your doctor prescribes it
• Limit alcohol
• Lose weight
• Manage stress
• Quit smoking
• Maintain an active lifestyle with regular exercise. Your care team can work with you to find safe and effective exercises for leaky heart valve

Body weight and exercise are particularly important. “If you’re carrying less body weight, then your heart has to do less work as a pump. All of the things that you hear about generally, as far as being active and healthy, really do relate to the function of your heart and your valves,” he says.

Surgery for leaky heart valve

Medications and lifestyle changes can delay the need for surgery, but they don’t cure a leaky valve.

“If you’re being medically managed and you’re still having symptoms beyond what would be expected, then it’s important to consider surgical treatment,” Dr. Sabe says. “Also, if tests start to show that you are losing heart function or that the heart is starting to dilate, these are early signs of heart failure. When we see that, we need to consider a more durable approach than just medicine.”

One minimally invasive option is a procedure where a surgeon threads a catheter into the groin and up to the heart to place a clip on a leaky valve. A more invasive option involves open surgery, where the surgeon places a plug or replaces the valve entirely with a man-made or animal valve.

Dr. Sabe says that surgery is often the best option for people in better overall health. “Sometimes a more invasive procedure is the right treatment for you, because it might be more immediately effective, and that investment may last a lifetime,” he says. “The less invasive procedures are sometimes reserved for the sickest patients.”