HEART VALVE DISEASES

Heart Valve Diseases

Heart valve disease occurs when the heart valves do not work the way they should.

How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage. Blood flows from your right and left atria into your ventricles through the open tricuspid and mitral valves. When the ventricles are full, the tricuspid and mitral valves shut. This prevents blood from flowing backward into the atria while the ventricles contract. As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles.

Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery, and blood from the left ventricle passes through the open aortic valve into the aorta and the rest of the body. When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves shut. These valves prevent blood from flowing back into the ventricles. This pattern is repeated over and over with each heartbeat, causing blood to flow continuously to the heart, lungs, and body.

What Are the Types of Heart Valve Disease?

There are several types of heart valve disease:

Valvular Stenosis: This occurs when a heart valve doesn’t fully open due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can develop stenosis; the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis, or aortic stenosis.
Valvular Insufficiency: Also called regurgitation, incompetence, or “leaky valve,” this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation.

What Causes Heart Valve Disease?

Heart valve disease can develop before birth (congenital) or can be acquired sometime during one’s lifetime. Sometimes, the cause of valve disease is unknown.

Congenital Valve Disease: This form of valve disease most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached correctly. Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly).
Acquired Valve Disease: This includes problems that develop with valves that were once normal. These may involve changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.
Rheumatic fever is caused by an untreated bacterial infection (usually strep throat). Luckily, this infection was much more common before the introduction of antibiotics to treat it in the 1950s. The initial infection usually occurs in children and causes inflammation of the heart valves. However, symptoms associated with the inflammation may not be seen until 20-40 years later.
Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis can enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve disease can be at higher risk for developing endocarditis.

There are many changes that can occur to the valves of the heart. The chordae tendinae or papillary muscles can stretch or tear; the annulus of the valve can dilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified.

Mitral valve prolapse (MVP) is a very common condition, affecting 1% to 2% of the population. MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart’s contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. However, the condition rarely causes symptoms and usually doesn’t require treatment.

Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy (heart muscle disease), syphilis (a sexually transmitted disease), high blood pressure, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs, and radiation.

What Are the Symptoms of Heart Valve Disease?

Symptoms of heart valve disease can include but not limited to shortness of breath and/or difficulty catching your breath. You may notice this most when you are active (doing your normal daily activities) or when you lie down flat in bed. You may need to sleep propped up on a few pillows to breathe easier.

Weakness or dizziness. You may feel too weak to carry out your normal daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.
Discomfort in your chest. You may feel a pressure or weight in your chest with activity or when going out in cold air.
Palpitations. This may feel like a rapid heart rhythm, irregular heartbeat, skipped beats, or a flip-flop feeling in your chest.
Swelling of your ankles, feet, or abdomen. This is called edema. Swelling in your belly may cause you to feel bloated.
Rapid weight gain. A weight gain of two or three pounds in one day is possible.

Symptoms of heart valve disease do not always relate to the seriousness of your condition. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have noticeable symptoms, yet tests may show the valve leak is not significant.

How Are Heart Valve Diseases Diagnosed?

Your heart doctor can tell if you have heart valve disease by talking to you about symptoms, performing a physical exam, and performing other tests.During a physical exam, the doctor will listen to your heart to hear sounds the heart makes as the valves open and close. A murmur is a swishing sound made by blood flowing through a stenotic or leaky valve. A doctor can also tell if the heart is enlarged or if your heart rhythm is irregular. The doctor will listen to the lungs to hear if you are retaining fluid there, which shows the heart is not able to pump as well as it should. By examining your body, the doctor can find clues about circulation and the functioning of other organs. After the physical exam, the doctor may order diagnostic tests.

These may include:

Echocardiography
Transesophageal echocardiography
Cardiac catheterization (also called an angiogram)

By conducting some or all of these tests over time, your doctor can also see the progress of valve disease. This will help him or her make decisions about treatment.

Treatment for Valve Disease will Include a Plan to:

Protect your heart from further damage.
Assess your need for medication to help manage symptoms.
Repair the valve problem if needed.
Surgery
Communicate steps for management, self-care and the importance of follow-up care. Generally, once it’s determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement:
Valve repair — which preserves the patient’s valve and leaflets. Sometimes repairs require a minimal surgery procedure and other times repairs need a more extensive surgery. Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation.
Valve replacement — which may include TAVR (or TAVI) or other minimally invasive procedure. In many cases, the best long-term solution may require a more involved surgery such as the Ross procedure or the insertion of a new tissue or manufactured valve.

HEART VALVE DISEASES