Valvular Disease

Have you or a loved one been diagnosed with valvular heart disease or heart valve disease? Both describe a type of disorder in one or more of the four valves of the heart. These valves or channels normally ensure that blood flows in and out of the heart in the right direction at the right time, but when they don't work properly, problems can develop, including chest pain, lightheadedness, shortness of breath, and even heart failure.

Fortunately, with treatment, most types of valvular heart disease can be addressed with medications and surgery (if necessary) so that you can go on enjoying your life.

What Are Heart Valves?

You can think of heart valves like a series of canals that usher the blood flow through the heart in one direction. They open and close with each heartbeat, adjusting at just the right time to keep the blood moving forward, and to prevent backup.

These valves open and close in an ordered sequence to keep the blood flowing as it should. If something goes wrong with these valves, however, blood can leak and flow in the wrong direction, causing valvular heart disease. The four valves of the heart are described below.

Tricuspid Valve

As blood comes back from the body into the right atrium (upper chamber) of the heart, the tricuspid valve opens to allow blood to flow to the right ventricle (lower chamber). Once the right ventricle is full, the tricuspid valve closes to keep the blood from backing up into the right atrium. See a rotatable 3-D model of the tricuspid valve.

Pulmonary Valve

The full right ventricle contracts and pumps blood through the open pulmonary valve into the lungs via the pulmonary artery. Once the blood has gone, the pulmonary valve closes to keep it from coming back into the right ventricle. See a rotatable 3-D model of the pulmonary valve.

Mitral Valve

When newly oxygenated blood from the lungs fills the left atrium (upper chamber), the mitral valve opens, allowing that blood to flow into the left ventricle (lower chamber). Once the left ventricle is full, the mitral valve closes to keep blood from flowing back into the lungs. See a rotatable 3-D model of the mitral valve.

Aortic Valve

The left ventricle contracts, pushing oxygenated blood through the open aortic valve into the aorta, the main artery of the body. The blood then goes out to the rest of the body's organs. Once the left ventricle has emptied, the aortic valve closes to keep the blood from re-entering the heart. See a rotatable 3-D model of the aortic valve.

Problems Associated With Valvular Heart Disease

Many things can cause valvular heart disease, making it one of the most common heart problems. Degenerative diseases, birth defects, connective tissue diseases, trauma, and tumors can all affect the valves, as can coronary artery disease, pulmonary hypertension, infections, trouble with the aorta, or other issues. Rheumatic fever used to be the biggest cause of valvular heart disease, but with antibiotics now available to nip that condition in the bud, it is no longer a major concern.

Other common causes of the disease include a weakening of the valve tissue itself, which happens most often in elderly patients. As plaque buildup occurs in the arteries, it can also occur on the aortic or mitral valves, causing them to thicken. A heart attack can also damage the valves. Whatever causes the initial damage, the result is most commonly one of two types of problems that disrupt blood flow through the heart:

Regurgitation

Also called insufficiency or incompetence, regurgitation means a valve isn't closing properly and blood is leaking backwards. Less blood gets out to the body, so the heart works harder to try to compensate, but over time it will become enlarged and less efficient.

Stenosis

This occurs when the "leaflets" or doors of the valves do not open wide enough, so only a small amount of blood gets through. Again, the heart must work harder to pump enough blood to the rest of the body. Stenosis usually occurs because the leaflets get thick and stiff, or fuse together.

Symptoms of Valvular Heart Disease

As the heart works to overcome the reduced blood flow, symptoms usually result, including:

  • shortness of breath
  • fatigue
  • lightheadedness or fainting
  • chest pain
  • arrhythmias (irregular heartbeat)
  • pulmonary hypertension (high blood pressure in the lungs)
  • pulmonary/systemic edema (tissue buildup in the lungs or in other places on the body)
  • reduced exercise capacity
  • blood clots (which can lead to heart attack or stroke)
  • heart failure

Specific Types of Valvular Heart Disease

Although there are many different types of valvular heart disease, they can be broken down into categories according to which valve they affect. The most common valve problems happen in the mitral and aortic valves, while diseases of the tricuspid and pulmonary valves are more rare.

Mitral Valve Diseases

Mitral valve prolapse (MVP) is one of the most common forms of valvular heart disease, and occurs when one or both of the flaps or leaflets become enlarged, preventing the valve from closing properly. Most of the time, this is not a serious condition. Mitral regurgitation and mitral stenosis may also occur.

Aortic Valve Diseases

People with high blood pressure and certain birth defects may be at risk of aortic regurgitation. People born with bicuspid aortic valve or the elderly may also be at risk of aortic valve stenosis.

Tricuspid Valve Diseases

Tricuspid regurgitation (also called tricuspid insufficiency or incompetence) is usually caused by an enlarged right ventricle. This condition also often occurs in conjunction with mitral valve disease, or left ventricular dysfunction. Tricuspid stenosis can also occur, causing the right atrium to become enlarged.

Pulmonary Valve Diseases

Pulmonary hypertension, heart infections, or congenital valve problems can cause pulmonary regurgitation. Pulmonary stenosis, on the other hand, is most commonly caused by a birth defect.

Treatment for Valvular Heart Disease

Treatment for the various types of valvular heart diseases depends on how much the valve problem is affecting blood flow. People who show no symptoms or minimal symptoms may not need any treatment, while others may feel fine with medications that ease symptoms. If the problem gets worse, however, or the medications stop working, a balloon procedure to open narrowed valves or surgery may be required. Doctors usually recommend a healthy diet, regular exercise, and avoiding smoking and alcohol in order to help improve symptoms.