Care New England Advanced Valvular and Structural
Heart Disease Clinic

Valve Clinic

The Care New England Advanced Valvular and Structural Heart Disease Clinic at Kent Hospital features a local heart care team that are both affiliated with Kent Hospital and Brigham and Women's Hospital. These physicians evaluate and manage patients who have advanced valvular disease and structural heart disease with the opportunity to have expert care for these complex conditions in a locale close to home. Office visits, imaging studies, and diagnostic testing are performed in Rhode Island. Patients who require valve interventions such as transcatheter therapies or minimally invasive. or traditional open-heart cardiac surgery at Brigham and Women’s Hospital will have the convenience of receiving pre and post-procedure care locally.

Office visits, imaging studies, and diagnostic testing are performed locally in Rhode Island. Patients who require valve interventions such as transcatheter therapies or minimally invasive or traditional cardiac surgery at Brigham and Women’s Hospital will have the convenience of receiving pre and post-procedure care locally.

This unique link between the cardiologists at Care New England and the team at the Heart and Vascular Center at Brigham and Women’s Hospital has widely advanced the options available for patients in Rhode Island who need cardiac care.  

We believe in the practice of patient-focused and evidence-based care delivered by a regional heart team of clinical cardiologists, cardiothoracic surgeons, interventional cardiologists, cardiac imaging specialists, and cardiac anesthesiologists. We work together with the patient and their families in shared decision-making for optimal patient care, safety, and outcomes.

Location

Brigham and Women's Cardiovascular Associates
at Care New England

Kent Hospital Ambulatory Service Pavilion
455 Toll Gate Road
Warwick, RI 02886

Structural Heart Disease Program

Structural heart disease can be present at birth pexels-thevibrantmachine-2958113-1(congenital) or develop with age. It refers to defects in the heart’s valves, walls, or chambers. Atrial septal defect (ASD) is a congenital structural defect. Common valvular conditions that occur over time include aortic stenosis and mitral valve prolapse.

Historically, open-heart surgery has been the common method for treating valvular and structural heart disease; however, percutaneous valve replacement now provides a viable alternative to patients for whom conventional surgery is considered too risky—and offers the potential benefits of less scarring, less blood loss, less pain, and a quicker recovery.

The Care New England Advanced Valvular and Structural Heart Disease Clinic provides innovative, multi-specialty care for patients with advanced and complex valvular and structural heart disease. From evaluation to treatment, this unique program delivers the best possible outcomes for every patient. Our program specializes in interventional treatments for patients who do not qualify for conventional open procedures.

Our team has vast expertise in catheter-based structural heart procedures including transcatheter aortic valve replacement (TAVR) for aortic stenosis and Mitral Valve edge to edge repair for mitral regurgitation. The team will have access to new emerging precautious devices that allow patient treatment for those traditionally treated with open-heart surgery through clinical trials. Currently, we have over 15 participating studies, and we have successfully treated patients from Kent in the otherwise untreatable conditions through a catheter procedure.

We also offer minimally invasive valve surgery through a small incision. These patients recover faster than the traditional open surgery. We will assess whether you will be eligible for this approach if needed.

Our multidisciplinary team of specialists—board-certified cardiologists, interventional cardiologists, cardiac surgeons, cardiovascular radiologists, and cardiac anesthesiologists—work together in the region to provide the most informed and collaborative care to patients. With a vast diversity of medical expertise (delete under one roof) our team efficiently performs a multidisciplinary evaluation, collaborates closely to develop an individualized and specialized treatment plan and continuously works together to provide patients with expert cardiovascular care.

This clinical expertise is enhanced by the team’s access to the best in medical technology, in direct collaboration with the expert team at Brigham and Women’s Hospital.

Learn More About Our Advanced
Care From Our Team

Heart Valve Repair

The valves of the heart pump blood through the chambers of the heart and prevent blood from flowing backward. When heart valves do not function properly, they have to work harder to circulate blood through the body, which may weaken the heart and cause it to enlarge. While in some cases, heart valve disease may be managed with medication, very often surgery to repair the heart valves or heart valve replacement surgery is needed.

  • What are Heart Valves?
  • What is Heart Valve Disease?
  • Diagnosis
  • Procedures and Treatment

There are four chambers inside your heart: the two upper chambers are called atria and the two lower chambers are called ventricles. The heart muscle squeezes blood from chamber to chamber.

Your heart contains four valves, which open to allow blood to move forward through the heart and close to prevent blood from flowing backward.

  • The mitral valve allows blood to move from the left atrium into the left ventricle.
  • The aortic valve allows blood to move out of the left ventricle.
  • The tricuspid valve allows blood to move from the right atrium into the right ventricle.
  • The pulmonary valve allows blood to move from the right ventricle to the lungs.

Heart valves can be abnormally formed as birth defects or damaged by rheumatic fever, bacterial infection, and calcific degeneration. Valves can also degenerate with the normal aging process.

Two common types of valve disease are:
  • Stenosis, which occurs when a valve does not open completely, causing blood to flow through a narrower opening.
  • Regurgitation, which results when a valve does not close completely, allowing blood to flow backward through the valve.

 To compensate for these disorders, your heart pumps harder, which can result in inadequate blood circulation to the rest of your body.

In addition, this excess work can weaken the heart, causing it to enlarge and produce the following symptoms:

  • Increased shortness of breath
  • Chest pain
  • Swelling of the ankles and legs
  • Increased fatigue
  • Dizziness
  • Fainting

Diagnostic tests are used to determine treatment, which may include:

  • Chest x-ray 
  • Electrocardiogram (EKG) — This test records the changes of electrical activity occurring during your heartbeat. It helps to diagnose any irregularities in your heart's rate and rhythm, as well as in heart muscle enlargement or damage.
  • Echocardiogram — This test uses ultrasound to examine and measure the structure of your heart. An echo demonstrates the performance of the heart valves and provides information on heart muscle function.
  • Cardiac catheterization (coronary arteriogram) — This test allows visualization of your blood vessels and measurement of pressures inside your heart chambers following injection of a contrast dye. An angiogram evaluates heart pumping function and any obstruction of the coronary arteries that supply blood to your heart muscle. If your coronary arteries have significant blockages, your cardiac surgeon will perform coronary artery bypass surgery at the time of your valve surgery.

Heart valves can sometimes be repaired so that they open and close more efficiently. Heart valve repair procedures include:

  • Ring annuloplasty - this procedure tightens the annulus (the ring supporting the valve) by inserting a prosthetic ring made of metal, cloth, or tissue around the valve.
  • Valve repair - this procedure reconstructs the damaged or weakened flaps, muscles, and tendons that function to open and close the heart valves.

Patients today requiring mitral valve or aortic valve surgery have a number of heart valve replacement options. Bioprosthetic valves involve heart valves and tissue taken from animals. Mechanical valves are made of metal, carbon, or synthetics. And replacement surgery with biologic valves uses human tissue from organ donors or from the patient's own pulmonary valve. While heart valve replacement is major surgery, advances in surgical techniques and technology have greatly reduced the risks and recovery time. 

For valve replacement, there are several types of artificial valves that can be used:

  • Bioprosthetic valves are from animals specially treated with chemicals to avoid rejection.
  • Mechanical valves are made of metal, carbon, and/or synthetics. Anticoagulation is required to prevent blood clots.
  • Biologic valves are human heart valves obtained from donors after death and frozen for later use (homograft). In the Ross procedure, the patient's own pulmonary valve replaces the diseased aortic valve and in turn, is replaced by a homograft valve.

Minimally invasive heart valve replacement surgery is performed in two different ways:

  • Aortic valve replacement incisions are performed through an upper mini-sternotomy, in which an incision is made from the sternal notch to the third intercostal space.
  • Mitral valve replacement / mitral valve repair incisions are performed through a lower mini-sternotomy, in which a 6-8 cm incision is made at the lower end of the sternum upward to the second intercostal space and extending into the interspace on the right.

A Personalized Approach
To Cardiac Care

Seeing a cardiologist for regular checkups can help reduce the risk of diseases that affect your heart and blood vessels. When heart disease is particularly complex or requires a procedure, our world-renowned specialists and surgeons are here to care for you.

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Procedures and Treatment

  • Transcatheter aortic valve edge to edge repair and replacement
  • Transcatheter mitral valve repair/replacement
  • Minimally Invasive Valve Surgery using small incision
  • Cutting edge new transcatheter valve devices through clinical trials
  • Alcohol septal ablation
  • Catheter-based closure of septal defects
  • Catheter ablation

More Information About
Heart Valve Diseases and Conditions

 

Aortic Stenosis and Aortic Insufficiency

Aortic valve stenosis is the most common cause of left ventricular outflow obstruction in children and adults, or narrowed valves.

Main symptoms include heart failure, angina, and syncope, but some also may be nonspecific, such as the decreased ability to exercise, dizziness, or dyspnea on exertion. Immediate medical attention is required when even mild symptoms develop in a patient with severe aortic stenosis.

Complications from aortic stenosis may include heart failure, pulmonary hypertension, arrhythmias, endocarditis, embolic events, bleeding, or sudden cardiac arrest.

Diagnosis is primarily done through an echocardiogram and a physical examination whereupon a systolic ejection murmur is presented. additional testing may include exercise stress testing, computed tomography for quantitation of valve calcification, transesophageal echocardiography for better visualization of valve anatomy, or serum markers such as B-type natriuretic peptide levels.

Mitral Regurgitation and Mitral Stenosis

Mitral regurgitation, or leaky valves, is a common valvular disorder that can arise from abnormalities of any part of the mitral valve structure. These include the valve leaflets, annulus, chordae tendineae, and papillary muscles.

There are two forms:

  • Primary – causes include degenerative mitral valve prolapse, rheumatic heart disease, infective endocarditis, trauma, certain drugs, cleft mitral valve, and mitral annular calcification
  • Secondary – causes include coronary heart disease and cardiomyopathies (eg, dilated or hypertrophic cardiomyopathy). Ischemic MR primarily occurs in patients with a prior myocardial infarction. 

Many patients are asymptomatic, but symptoms may include dyspnea on exertion and fatigue, and atrial fibrillation, or a brisk arterial pulse in someone with chronic mitral regurgitation.

Echocardiograms are primarily used to diagnose, and criteria to determine severe mitral regurgitation is a vena contracta width of greater than 0.7 centimeters, a regurgitant fraction of greater than 50 percent, and a regurgitant jet area of greater than 40 percent of the left arterial region.

Complex Valvular Disease

Multiple valvular, vascular, and ventricular maladies have interactions with one another where physical impacts associated with each amplify the effects on the cardiovascular system.

Congestive Heart Failure Population Health Management

Care New England was awarded a Centers for Medicare and Medicaid Innovation Grant to develop a system-wide infrastructure that allows for improved communication and technology use between providers related to the care of patients with congestive heart failure. The goal of the program is to reduce hospital readmissions for congestive heart failure.

Atrial Septal Defects

Atrial septal defects are the most common congenital heart lesion in adults and are often asymptomatic until adulthood. They are associated with shunts, or holes, that cause a volume overload of the right heart chambers.

Most patients with an atrial septal defect and significant shunt flow will have symptoms such as atrial arrhythmias, exercise intolerance, fatigue, dyspnea, and heart failure and require the closure of the shunt. The evaluation of the shunt relies extensively on the size, location, and direction, and can be diagnosed using an echocardiogram.

Patent Foramen Ovale

Patent foramen ovale is a very common congenital cardiac lesion that can persist through someone’s lifetime. They can also be associated with cryptogenic strokes. The prevalence of the condition decreases with age, but the size of the lesion increases over time, however.

Rarely are there signs of the condition, but testing may need to be performed after certain medical events, including cerebral ischemia or air embolism.

An echocardiogram can diagnose the condition, along with an agitated saline contrast, which is when the saline solution is administered intravenously to provide an air microbubble contrast in the right part of the heart.

Congenital and Acquired Ventricular Septal Defects

Ventricular septal defects are one of the most common congenital heart defects but account for only 10 percent of congenital heart defects in adults because many close spontaneously over time. They vary in size, location, and number. They can occur as isolated defects or they can be part of complex congenital heart defects. 

Most small ventricular septal defects close during childhood and most rarely require any intervention, although there is a very low risk of complications such as double-chambered right ventricle and sinus of Valsalva dilatation or aneurysm. Those with a persistent septal defect are in danger of developing pulmonary hypertension and endocarditis.

Some patients who have a worsening prognosis may require a surgical procedure such as aortic valve surgery.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a genetically determined heart muscle disease most often caused by mutations in one of several genes which encode parts of the mechanical system of the heart.

It manifests as left ventricular hypertrophy and can develop into one of the following abnormalities:

  • Left ventricular outflow obstruction
  • Diastolic dysfunction
  • Myocardial ischemia
  • Mitral regurgitation

Symptoms include:

  • Fatigue
  • Dyspnea
  • Chest pain
  • Palpitations
  • Presyncope or syncope

This condition can lead to heart failure and stroke. There may be a family history as well, and an echocardiogram is used to diagnose hypertrophic cardiomyopathy. Stress testing may also be used, and genetic testing is also available.

Meet the Team

Alice Y. Kim, MD, FACC

Director, Care New England Advanced Valvular Heart Disease Clinic
Care New England

Tsuyoshi Kaneko, MD

Cardiac Surgeon