While metaphors about the heart are common, "unclogging the pipes" illustrates best what surgeons specializing in circulation disorders do to keep blood flowing freely through the hearts and bodies of their patients.

Heart and circulation disorders are the topic of today's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. James Orford and Dr. Ed Miner, both cardiologists at the Utah Heart Clinic at Intermountain Medical Center, will answer questions by phone. Call 801-236-6061 or 1-800-925-8177.

Treatments for opening narrowed arteries have evolved in recent years, and in some cases surgery is no longer required, Orford said, noting the advent of a nonsurgical repair using catheters for aortic valves in hearts, which can become weak and leak.

The procedure has been available for a number of years, though it was developed mostly overseas and in Europe and is still in the medical trial phase in the United States. That means candidates for the procedure must be screened to determine their suitability for participating in a clinical trial.

Those who are eligible "are at high operative risk," with a potential death rate that exceeds 15 percent were they simply to undergo surgery.

Patients selected for the trial then are randomized into either surgery or the nonsurgical catheter procedure. The chances of receiving either procedure is 50 percent, Orford said.

To date, surgeons at the Utah Heart Clinic have done three aortic valve procedures using the nonsurgical catheter. Problems with the aortic valve are "unpredictable and not strongly associated with any particular lifestyle practice," such as lack or exercise, smoking or diet, he said.

Surgeons can also do a nonsurgical procedure to repair mitral regurgitation, the abnormal leaking of blood through the mitral valve from the left ventricle into the left atrium of the heart.

The procedure has become commonplace to repair the mitral valve in a way that doesn't require surgeons to open a patient's chest.

Patients with a "floppy valve" are the most common candidates for the procedure. Symptoms of the condition include shortness of breath, pulmonary edema and decreased exercise tolerance.

When patients initially visit the doctor complaining of chest pain and get a diagnosis, the majority of their questions involve treatment options, including the use of stents — small metal coils implanted in the artery to help prop the artery open and increase the size of narrowed passageways.

Coronary angioplasty is also used, where surgeons temporarily insert and blow up a tiny balloon at the point where the artery is clogged to help widen it.