Valve and Structural Heart Program
Lifespan Cardiovascular Institute

Structural Heart Diseases We Treat

Four valves — the aortic, pulmonary, mitral and tricuspid — control the flow of blood through the heart as it pumps to supply the body. The aortic valve controls blood flow between the heart and the aorta, the main artery of the body. The pulmonary valve manages blood flow between the heart and lungs. The mitral and tricuspid valves control blood within the upper and lower chambers of the heart.

The heart valves may become damaged over time and cease to function properly. In other cases, a defect can be present at birth and affect the heart’s ability to function. Any damage or disease of the heart can be serious and lead to further complications.

The Valve and Structural Heart Program at the Lifespan Cardiovascular Institute offers leading-edge treatments and comprehensive care to treat common and complex valve and structural heart diseases. Our team works closely to develop individualized treatment plans, offering patients the best possible options for their condition, including innovative techniques and participation in clinical trials.

Expand a condition below to learn about diagnosis and treatment at the Valve and Structural Heart Program at the Lifespan Cardiovascular Institute.

Aortic Stenosis

What is a structural heart disease? 

Structural heart disease happens when parts of the heart, like the valves or muscles, are damaged or have defects. People can be born with structural heart disease or it can develop over time as people age due to wear and tear and the impact of other disorders on the heart. Aortic valve stenosis, hypertrophic cardiomyopathy, and myocarditis are among the common types of structural heart disease. Risk factors for include high blood pressure, endocarditis, previous heart attacks, certain medications, and atherosclerosis. The Lifespan Cardiovascular Institute’s Valve and Structural Heart Program in New England specializes in treating these conditions, including aortic stenosis and atrial fibrillation.

How do you diagnose structural heart disease? 

Diagnosing structural heart disease often starts when a patient experiences symptoms like chest pain, migraines, fatigue, leg cramps, irregular heartbeat, or shortness of breath. During a routine check-up, a doctor may also detect signs, such as a heart murmur, which could indicate a heart valve problem. If these symptoms or signs are present, further tests like echocardiograms or MRIs might be needed to confirm a diagnosis. The Lifespan Cardiovascular Institute specializes in diagnosing and treating these conditions using the latest technology.

Diagnosis for Aortic Stenosis

Aortic stenosis occurs when a heart valve is too narrow or blocked. The valves of the heart

make sure blood flows in one direction. In aortic stenosis, blood doesn’t flow properly and becomes blocked. Symptoms can include fatigue, dizziness, irregular heartbeats, chest pain, shortness of breath, and fainting. Aortic stenosis can be congenital or it can develop over time. It can be mild, moderate, or severe and can worsen over time. It may also occur with other heart problems or conditions.


Treatment for Aortic Stenosis

Transcatheter aortic valve replacement (TAVR): This procedure offers a viable option to patients who have severe aortic valve stenosis, but who are not candidates for open heart surgery due to advanced age or existing medical conditions. The Lifespan Cardiovascular Institute was the first program in Rhode Island and among the first in New England to provide this less invasive alternative to open heart surgery, which was approved by the FDA in 2011. The Valve and Structural Heart Program is the leading implant program in Southern New England, having performed more than 1600 TAVR procedures.

Balloon valvuloplasty: This nonsurgical treatment can be used to treat pulmonary stenosis and aortic stenosis. A catheter with a deflated balloon at the end is guided into the narrowed heart valve. Once in place, the balloon is inflated to stretch the valve open, and allow blood to flow without blockage.

Mitral Valve Regurgitation

Diagn​osis for Mitral Valve Regurgitation

Mitral_Valve_Example.jpgThe mitral valve lies between the left atrium and the left ventricle of the heart and prevents blood from flowing back into the left atrium. In mitral valve regurgitation, some blood doesn’t flow forward and leaks back through the valve.

The heart must work harder to pump the blood out and if regurgitation worsens, blood can back up into the lungs.

Mitral valve regurgitation can be an acute or chronic condition. Symptoms can include shortness of breath, fatigue, palpitations, swelling in the legs or abdomen, and abnormal heartbeat.  


Images used with permission from the Abbott Group of Companies. Illustrations are artist’s representations only and should not be considered as engineering drawings of photographs.

Treatment for Mitral Valve Regurgitation

Post_Procedure_Sid.jpgTranscatheter mitral valve repair: A percutaneous mitral valve clip is used to repair the mitral valve and correct the direction of blood flow across the valve. Known as MitraClip, this treatment was developed in 2016.

Since then, the Valve and Structural Heart Program has performed more than 160 of these procedures.

MitraClip is a catheter-based option for patients who have severe symptomatic degenerative mitral regurgitation, but whose conditions put them at too high a risk to undergo surgical valve repair or replacement.

Images used with permission from the Abbott Group of Companies. Illustrations are artist’s representations only and should not be considered as engineering drawings of photographs.

Septal Defects and Patent Foramen Ovale

Diagnosis for Septal Defects and Patent Foramen Ovale

Septal defects: A septum is a dividing wall between two chambers of the heart. A septal defect is an abnormal hole in this wall. The defect can occur in the atrial septum – the two upper chambers of the heart – or the ventricular septum – the two lower chambers of the heart. Septal defects are congenital conditions. While some heart defects are genetic, there is no clear reason why septal defects occur. Symptoms of a septal defect can include shortness of breath or trouble breathing, rapid breathing, fatigue, abnormal or rapid heartbeat, frequent respiratory infections, or poor weight gain or growth.

Patent foramen ovale: A patent foramen ovale (PFO) is a small opening between the two upper chambers of the heart. Normally, the wall separating these chambers prevents any blood from flowing between them. A patent foramen ovale allows abnormal blood flow between the chambers. Everyone is born with a PFO, but the hole should naturally close very soon after birth. There is no known reason why this hole stays open instead of closing in some cases. Patent foramen ovale raises the risk for stroke, as blood clots can form from the chambers and flow out to the blood vessels. If the clot blocks a blood vessel in the brain, it can cause a stroke or damage other organs. Typically, a PFO causes no symptoms. Symptoms can result from complications of PFO, such as a stroke.

Treatment for Septal Defects and Patent Foramen Ovale

Septal defect and patent foramen ovale closure: Septal defects and patent foramen ovales can be treated through a catheter-based procedure to close the hole and, in some cases, using a special device called a septal occluder to stop the blood from flowing.

Transseptal Puncture: A transseptal puncture is a technique used to gain direct access to the left side of the heart. A catheter with a needle is inserted into the right side of the heart, where the needle is then used to puncture the atrial septum and allow access to the left side.

Paravalvular Leak

Diagnosis for Paravalvular Leak

A paravalvular leak can occur after a valve replacement surgery, when gaps are left or formed between the edges of the new valve and the surrounding natural heart tissue. A paravalvular leak is when blood leaks through those spaces. Often paravalvular leaks do not occur until years after valve replacement surgery, due to natural wear and tear. Small paravalvular leaks will not often cause symptoms. Symptoms of a more severe leak can include shortness of breath, swelling, fatigue, rapid heartbeat, and other symptoms of heart failure.

Treatment for Paravalvular Leak

Transcatheter paravalvular leak closure: A paravalvular leak can often occur after a prosthetic valve has been implanted. Transcatheter paravalvular leak closure offers a viable, less invasive alternative to surgical intervention. This procedure uses a catheter to deliver and implant a closure device at the site of the leak.

Complications of Atrial Fibrillation

Diagnosis for Atrial Fibrillation

Patients who have atrial fibrillation are at higher risk of stroke due to clots that may form in the left atrial appendage. This is a small pouch extending from the left atrium that serves no apparent purpose. However, when AFib interferes with efficient pumping of the heart, blood may pool in the left atrial appendage and form clots. These may break free and travel to the brain, blocking an artery and causing a stroke. Patients with AFib often take blood thinners such as warfarin to prevent clots, but a new implantable device called WATCHMAN that closes off the left atrial appendage may be a better alternative for some.

Treatment for Atrial Fibrillation

Left atrial appendage closure is a procedure to protect against strokes in patients who have atrial fibrillation that is not related to heart valve disease. WATCHMAN is a state-of-the-art permanent implant that is used to reduce the risk of stroke by closing the left atrial appendage, where clots may form. WATCHMAN was approved by the FDA in 2015. The Valve and Structural Heart Program team began implanting the device in 2017, and since then has performed more than 500 WATCHMAN procedures.

In the news: Watch a story on WJAR NBC10's Health Check about our treatment to protect against blood clots due to atrial fibrillation »

How common is structural heart disease? 

Structural heart disease is relatively uncommon, but the possibility of structural heart disease increases with age. Heart valve disease is the most common type of Structural heart disease and affects about 2.5% of Americans. The likelihood of structural heart diseases increases to 10% for people 75 and older.