Harvard Heart Letter

Choosing the right replacement heart valve

The decision involves a trade-off between durability and the need to take an anticoagulant for life.

Four small valves open and close with each heartbeat. Their coordinated movements direct blood in a seamless, life-sustaining cycle. Each contraction of the powerful left ventricle drives oxygen-rich blood through the aortic valve and on to all parts of the body. Blood depleted of oxygen returns to the right atrium and passes through the tricuspid valve into the right ventricle. From there it is pumped through the pulmonary valve and into the lungs, where it gets recharged with oxygen. The next stop is the left atrium, then on through the mitral valve to the left ventricle, where the cycle begins again.

For the average American, each heart valve opens and closes nearly 3 billion times. Most valves last a lifetime. But some wear out, break, or become damaged by infection or inflammation. In 1950, doctors couldn't do much for a failing heart valve beyond trying to relieve the problems it caused, such as shortness of breath, fatigue, or swelling. Today, damaged or dysfunctional valves are routinely repaired or replaced.

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