Experts in Interventional Treatment for Structural (Heart Valve) and Coronary Artery Disease

Structural (Heart Valve) Disease and Treatments

Structural heart disease is a defect of the heart that does not affect the blood vessels. Some of these heart conditions are congenital (present at birth) while other conditions develop over time due to aging and other disease processes. Congenital heart abnormalities include valve problems, defects in the walls between the heart chambers, and heart muscle deformities. It is estimated that 1 in 100 children are born with heart defects.

Valvular heart disease is a degenerative disease that affects the function of heart valves - flaps of tissues that control the flow of blood in and out of the heart and lungs. Aortic stenosis is the build-up of calcium deposits on the valve which causes it to narrow and reduce the flow to the rest of the body. About 12% of the U.S. population over the age of 75 develops aortic stenosis.

  • What are the symptoms of structural and valvular heart disease?

    Symptoms vary depending on the type and severity of the structural heart defect. People may experience any of the following symptoms:

    • Shortness of breath
    • Fatigue
    • High-blood pressure
    • Chest tightening or pain
    • Kidney problems
    • Heart attack
    • Stroke

    It is important to contact a medical professional for advice and treatment. Symptoms of a heart attack or stroke are a medical emergency. Don’t wait, call 911.

  • How is structural and valvular heart disease diagnosed and treated?

    Congenital heart defects are often first discovered during a pregnancy by echocardiography (ultrasound) or immediately after birth. Heart murmurs can be detected by physical examination. Diagnostic tests used to confirm heart valve disease include echocardiography, EKG, chest x-ray, cardiac catheterization, stress testing, and cardiac MRI. Treatment options for structural and heart valve conditions include:

    • Medication - Medications do not cure structural heart disease but are used to treat symptoms and delay the onset of complications. Medications are used to control irregular heartbeats, prevent blood clots, increase the heart’s pumping ability, and to prevent patient discomfort.
    • Heart valve surgery - Cardiac surgeons repair or replace heart valves using the latest surgical techniques.
    • Transcatheter Aortic Valve Repair (TAVR) - A minimal invasive surgical technique that involves inserting a catheter (tube) in the groin or between the ribs into the heart. The artificial valve is compressed and guided through the catheter to the aortic valve. The balloon inside the device is expanded and the catheter then removed. The successful outcome is the new valve increases the blood flow to the body.
    • Transcatheter Mitral Valve Repair (TMVR) - A minimal invasive surgical technique for patients with mitral regurgitation (leaky valves) where a mechanical clasp (Mitral Clip) is used to clamp the mitral valve leaflets together restoring proper blood flow through the heart.
    • Closure procedures - A “plug” is fed through a catheter into the heart to block leaks or to close holes for patients with atrial septal defects, ventricular septal defects, and patent foramen ovales.
    • Left arterial appendage closure - Atrial fibrillation patients are at increased risk of stroke caused by blood clots that can be collected in this small pouch in the muscle wall of the left atrium. A device is inserted to close off this area, thus preventing blood from gathering in the appendage.

Coronary Artery Disease and Treatments

What is Coronary Artery Disease (CAD)?

Coronary artery disease is the most common type of heart disease in the United States. The disease is often caused by atherosclerosis, a condition in which the arteries become narrow because of the buildup of plaque. A complete blockage can result in a heart attack or stroke.

  • What are the symptoms of CAD?

    As the coronary arteries narrows, less blood reaches the rest of your body. You may experience:

    • Chest pain (Agina)
    • Coronary artery spasm
    • Pain in your neck or left arm
    • Shortness of breath
  • What are the symptoms of a heart attack and how is it treated?

    A heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies. Symptoms may come on suddenly, or you may have them for days or weeks before a heart attack. If you experience any of these possible heart attack symptoms, call 911 immediately:

    • Chest pain, also known as angina, which can feel like a tightness or heaviness in the chest
    • Lightheadedness, dizziness, or anxiety
    • Nausea, vomiting, or severe indigestion or heartburn
    • Pain that spreads from the chest to the arms, neck, jaw, belly, or back
    • Excessive sweating, including a cold sweat
    • Trouble breathing

    Heart attack symptoms in women may be different than those in men. Though both men and women are likely to experience chest pain, women are slightly more likely than men to experience:

    • Fatigue
    • Heart palpitations, or fluttering, rapid heartbeats
    • Pain in the upper back or shoulder

    Emergency Heart Attack treatment - Primary percutaneous coronary intervention (PCI) is the protocol for taking a patient who presents with ST elevated myocardial infarction (STEMI) directly to the cardiac catheterization laboratory to undergo mechanical revascularization using balloon angioplasty, coronary stents, aspiration thrombectomy, and other measures.

  • How is CAD diagnosed?

    Physicians take a detailed patient history, blood work, and perform a physical examination. They may also order one of more of the following tests:

    • Chest X-rays use a small dose of radiation to create pictures of the structures inside the chest, including the lungs, heart, and chest wall.
    • Cardiac computed tomography scan (Cardiac CT) uses X-rays to create three-dimensional images of your heart and blood vessels.
    • An echocardiogram uses high-frequency sound waves to create images of your heart.
    • An electrocardiogram, also known as an ECG, measures the heart’s electrical activity.
    • Fractional flow reserve, also known as FFR, is a measurement of how well blood can flow through the coronary arteries. Narrowing or blockages in these arteries can lead to a heart attack without treatment.
    • Magnetic resonance imaging, better known as cardiac MRI, is a combination of radio waves, magnets, and computer technology to create images of your heart and blood vessels.
    • Stress tests are used to assess how your heart works during physical activity. There are several types of stress tests, including treadmill or bike stress tests, nuclear stress tests, stress echocardiograms, and chemically induced stress tests.
  • How is CAD treated?

    Treatments for this disease can increase blood flow to your heart and slow the progression of the disease but are not a cure. Treating the disease involves reducing your risk factors, which may involve lifestyle changes. Your disease also may be treated with medication or surgical procedures, such as:

    • Balloon Angioplasty – A catheter is inserted in the wrist or groin then the interventional cardiologists will use X-ray images to guide the catheter through the artery to the blockage. A contrast dye will be injected to allow the narrowed area to be more clearly seen on an X-ray. A tiny balloon at the end of the catheter will be inflated, causing the plaque to mold against the artery wall. The physicians may insert stents which are small mesh tubes placed within the artery to prevent blockages and allow better blood flow.
    • Coronary Artery Bypass Surgery - restores normal blood flow through narrowed or blocked arteries by using a healthy blood vessel taken from your leg, arm, or chest to create a detour around the problem area.
  • Unexplained Chest Pain (Coronary Microvascular Dysfunction)

    Unexplained chest pain, clinically known as Coronary Microvascular Dysfunction, has historically been difficult to diagnose because these tiny arteries around the heart are not visible on an angiogram. In fact, an estimated 50 percent of all angina cases are now attributed to CMD, with women accounting for most incidences.

    MedStar Heart & Vascular Institute became one of only a few programs in the nation to use the Coroventis CoroFlow Cardiovascular System to detect CMD. It is an advanced software-based platform that, along with a special guidewire, can effectively measure the workings of the heart’s tiniest arteries, allowing physicians to confirm the cause of their patient’s unexplained chest pain.

    The assessment begins with an angiogram, followed by threading the guidewire through the left anterior descending artery. Once in place, the wire measures true blood flow and microvascular resistance, which the CoroFlow software then determines whether the heart’s smallest arteries are functioning properly.

    L-R: Drs. Itsik Ben-Dor, Brian Case, and Hayder Hashim

    After a diagnosis, CMD patients are returned to their referring physician for treatment and management. CMD is often treated with medications and/or lifestyle changes to control risk factors and reduce symptoms.

    Doctors Hayder Hashim, Brian Case, and Itsik Ben-Dor are the only specialists in the area to offer this approach to diagnosing CMD. Combined, they have performed 150+ of these procedures since its debut last year. They are also creating a CMD registry to follow patients long-term and further advance understanding of the disease.

    For more information, please call 202-877-5975

Nationally recognized patient care team

Baltimore Region

  • Interventional Cardiology

    Fady H. Iskander, MD

    Antony Kaliyadan, MD

    David B. Peichert, MD

    Nauman Siddiqi, MD

    John C. Wang, MD

  • Cardiac Surgery

    Brian Bethea, MD

    Rachel Harrison, MD

    Ricardo O. Quarrie, MD

Washington Region

  • Interventional Cardiology

    Nelson L. Bernardo, MD

    Brian Case, MD

    Itshac Itsik Ben-Dor, MD

    Hayder Hashim, MD

    Toby Rogers, MD

    Lowell Satler, MD

    Ron Waksman, MD

  • Cardiac Imaging

    Gaby Weissman, MD

  • Cardiac Surgery

    Ammar S. Bafi, MD

    Jeffrey E. Cohen, MD

    Yuji Kawano, MD

    Christian Shults, MD

Why choose us

When something is wrong with your coronary arteries or inside your heart – like a valve problem or a structural or congenital heart defect you want the region’s leading cardiac physicians at your side. We offer the full range of surgical and minimally-invasive treatment options. Plus, access to the latest treatments, clinical trials, and research. Our team has treated the most patients in the Baltimore-Washington region for these cardiac conditions. We have the experience you can trust.

To learn more about the MedStar Heart & Vascular Institute, please view our To learn more about the MedStar Heart & Vascular Institute, please view our “2021-2022 Capabilities Performance and Outcomes” booklet.

Our locations

MedStar Union Memorial Hospital

201 E University Pkwy, Baltimore, MD 21218

MedStar Washington Hospital Center

110 Irving St NW, Washington, DC 20010

Aortic stenosis: Martin Schwartzberg's story

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When Martin Schwartzberg needed a heart valve replacement, he learned he was a good candidate for a minimally-invasive procedure called Transcatheter Aortic Valve Replacement (TAVR)

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