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Talk to DoctorHeart valve disease occurs when one or more of the valves in your heart fails to open or close properly, disrupting the vital flow of blood through the body.
H2 Overview
Patients often ask, what is heart valve disease? Simply put, the human heart contains four specific valves that regulate blood flow in a precise, one-way direction. If there is a problem in these valves that interferes with blood flow control, it becomes a heart valve disease. The disease occurs when at least one valve cannot open or close completely, disrupting the vital flow of blood from the heart to the rest of the body.
To understand the condition, it helps to know the four valves and what they do:
- Mitral Valve: Located between the left atrium and left ventricle. It ensures oxygen-rich blood moves forward into the main pumping chamber.
- Tricuspid Valve: Located between the right atrium and right ventricle. It manages blood returning from the body, directing it toward the lungs for oxygen.
- Aortic Valve: Positioned between the left ventricle and the aorta. It opens to allow oxygen-rich blood to exit the heart and flow to the rest of the body.
- Pulmonary Valve: Situated between the right ventricle and the pulmonary artery. It lets oxygen-poor blood travel to the lungs to pick up oxygen.
The severity of the disease, the specific type, and the treatment required depend heavily on which heart valve is affected.
Symptoms
Although heart valve disease can remain asymptomatic for many years, it can cause certain symptoms as follows:
- Heart murmur, which can be detected using a stethoscope
- Tightness in the chest
- Difficulty breathing, which tends to happen when a patient is doing activities or lying down
- Heart arrhythmia
- Swollen abdomen, which frequently occurs in those with advanced tricuspid regurgitation
- Swollen ankles and feet
- Loss of energy
- Dizziness
- Fainting
You are recommended to seek medical care if you suspect yourself of having heart valve disease. You might be referred to a cardiologist for further disease diagnosis.
Causes
There are four valves in the heart which are responsible for regulating blood flow, namely the mitral, tricuspid, pulmonary and aortic valves. Each valve has leaflets (flaps) which open and close one time per heartbeat to control the blood flow direction, and if the leaflets cannot open or close completely, the blood can flow in an irregular direction.
Many factors such as infections and certain heart conditions can cause heart valve disease among adults as well as congenital heart disease in babies.
Heart valve disease can cause many conditions, including the following:
- Regurgitation: Incomplete closing of the leaflets may cause blood to flow backward through the impaired valve. This condition, which is also called “regurgitant flow”, leads to insufficient blood supply throughout the body which pressures the heart to work harder to increase the blood flow. Most patients with mitral valve prolapse have this problem as the heartbeats cause their valve flaps to go back into the left atrium.
- Stenosis: The narrowing of a valve opening caused by the thickening, stiffening and/or fusing of valve leaflets. If this happens, less blood can go through the disordered valve.
- Atresia: In this condition, the valve is not present in the heart but is instead replaced by a sheet of tissue, which prevents blood from flowing through the heart chambers.
Risk factors
Heart valve disease can be induced by many factors, including:
- Aging
- Heart-affecting infections
- Having certain kinds of heart disease or heart attack in the past
- Hypertension, hypercholesterolemia, diabetes and some other disorder that are related to the heart disease
- Congenital heart disease
Complications
If left untreated, malfunctioning heart valves force the heart muscle to strain over time. This strain can lead to severe and life-threatening complications, including:
- Heart failure
- Stroke
- Blood clots
- Heart arrhythmia
- Death
Diagnosis
The doctor will perform a physical examination and inquire about your signs and symptoms, medical history, and family history. A heart murmur, which may be a sign of heart valve disease, will be heard by your doctor as they listen to your heart with a stethoscope.
Many tests are available for heart valve diagnosis, including:
- Echocardiography: A transducer is used to point sound waves towards the heart. This process is done to see the structure of the heart, the conditions and functioning of the heart, as well as the heart valves and blood flow. The results of echocardiography are shown as video images of the moving heart.
- A 3D echocardiogram: A 3D echocardiogram and a transesophageal echocardiogram are also available. In a transesophageal echocardiogram, a doctor will insert a tiny transducer into a tube, which is guided to the mouth and then to the stomach to see the heart valves more clearly.
- Electrocardiogram (ECG): A doctor can detect certain cardiac defects with an ECG, including an enlarged heart chamber, heart disease and heart arrhythmia. Pads of electrodes are attached on your skin to monitor electrical signals of the heart.
- Chest X-ray: To see if you have an enlarged heart, which is a sign of heart valve disease of some types. Chest X-ray can also assist medical professionals in assessing the condition of the lung.
- Cardiac MRI: To diagnose the condition of heart valve disease and its progression. Cardiac MRI creates precise images of your heart using magnetic fields and radio waves and helps to assess the size and function of lower heart chambers.
- Exercise tests or stress tests: Shows how well the heart can deal with physical activities like exercising. For those who are about to undergo this test but cannot exercise, a doctor will prescribe medications that prompt the heart to beat as if you are exercising.
- Cardiac catheterization: In this process, your doctor will start by inserting a catheter into a blood vessel of the arm or groin, before guiding it to an artery of the heart. Sometimes dye is injected through the catheter to make clearer X-ray images of the heart and arteries to assess the blood pressure inside the heart chambers and to see if the organ and its arteries are functioning normally.
Treatment
A cardiologist will choose the best treatment approach plan by evaluating your specific symptoms, the severity of the valve damage, and whether your overall health is worsening.
Monitoring and Lifestyle
For mild cases, doctors may recommend regular follow-ups and self-monitoring. This approach includes:
- Adjusting your lifestyle for better cardiovascular health.
- Alleviating minor symptoms with medications.
- Taking blood thinners (especially for those with atrial fibrillation) to prevent the formation of blood clots.
Non-Surgical and Minimally Invasive Procedures
Thanks to modern medical advancements, open-heart surgery is no longer the only option. Doctors can now repair or replace valves using minimally invasive catheter procedures:
- Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR): This is a highly effective, minimally invasive alternative to open-heart surgery for aortic valve stenosis. A catheter is inserted into an artery (usually in the leg or chest) and guided to the heart. A fully collapsible replacement valve is delivered through the catheter and expanded directly over the old, impaired valve.
- Balloon Valvuloplasty: For stenotic (narrowed) valves, a doctor guides a balloon-tipped catheter into the valve and inflates it to widen the opening, then deflates and removes it.
- Catheter-Based Clips: For conditions like mitral regurgitation or prolapse, doctors can use specialized clips (such as the MitraClip) delivered via catheter to grasp the leaky valve flaps and help them close tightly.
Heart Valve Repair Surgery
Whenever possible, a doctor will recommend repairing the patient’s existing valve rather than replacing it. This preserves the heart’s natural tissue and muscle strength. Surgical repair includes:
- Patching holes in a valve.
- Separating fused valve leaflets.
- Replacing the cords that hold the valve in place.
- Cutting away excess tissue so the leaflets can seal firmly.
- Implanting an artificial ring (annuloplasty) to tighten or strengthen the base of the valve.
Sometimes a doctor might use robotic equipment for robot-assisted heart surgery. This is a minimally invasive approach where specialized instruments are utilized through smaller incisions.
Heart Valve Replacement Surgery
If a valve cannot be repaired, it must be surgically removed and replaced.
- Mechanical valves: Made from durable artificial materials. If you receive a mechanical valve, you will require lifelong blood-thinning medication to prevent blood clots.
- Biological/Tissue valves: Made from the heart tissue of a cow, pig, or human donor. While they often do not require lifelong blood thinners, biological valves can degenerate over time and may need to be replaced again after 10 to 15 years.
If a patient requires multiple heart treatments (such as a bypass alongside a valve fix), a surgeon may correct all of the disorders simultaneously during one open-heart procedure.
Prevention
Patients frequently ask how to prevent heart valve disease, especially as they age. While you cannot change genetics or congenital defects, proactive heart valve disease prevention revolves around protecting your heart from damage and reducing cardiovascular strain.
To lower your risk, focus on the following:
- Treat infections promptly: Seek immediate care for severe sore throats to prevent rheumatic fever, which can permanently damage valves.
- Maintain oral hygiene: Brush and floss regularly, and see your dentist. Good dental health lowers the risk of infective endocarditis, a severe valve infection.
- Adopt a heart-healthy lifestyle: Eat a balanced diet, exercise regularly, and maintain a healthy weight.
- Manage existing conditions: Keep your blood pressure, cholesterol, and diabetes strictly under control.
- Avoid smoking and recreational drugs: Tobacco and IV drug use drastically increase the risk of heart and valve infections.
