What Is Heart Valve Disease?
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 backward 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. This 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 of your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.
Rheumatic fever. It’s caused by an untreated bacterial infection (usually strep throat). Luckily, this infection has been much less common since the introduction of antibiotics to treat it in the 1950s. The initial infection usually occurs in children and causes inflammation of the heart valves. But symptoms linked to the inflammation may not be seen until 20-40 years later.
Endocarditis. This 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 having endocarditis.
There are many changes that can occur to the valves of the heart. The chordae tendineae 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. But the condition rarely causes symptoms and usually doesn't need to be treated.
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:
- Shortness of breath and/or having a hard time 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 2 or 3 pounds in a 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:
By conducting some or all of these tests over time, your doctor can also see the progress of valve disease. This will help them make decisions about treatment.
How Is Heart Valve Disease Treated?
Heart valve disease treatment depends on the type of disease and how severe it is. There are three goals of treatment for heart valve disease: protecting your valve from further damage, lessening symptoms, and repairing or replacing valves.
Protecting your valve from further damage. If you have valve disease, you are at higher risk for developing endocarditis, a serious condition. People who have had their valve surgically repaired or replaced are also at higher risk for endocarditis.
To protect yourself:
- Tell your doctors and dentist you have heart valve disease. You may want to carry an identification card with this information. The American Heart Association website has a bacterial endocarditis wallet card that you may download; or call your local American Heart Association office or the national office at 800-AHA-USA1 (800-242-8721).
- Call your doctor if you have symptoms of an infection (sore throat, general body aches, fever).
- Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
- Your doctor may recommend that you take antibiotics before you have any procedure that may cause bleeding, such as any dental work (even a basic teeth cleaning), invasive tests (any test that may involve blood or bleeding), and most major or minor surgery. The recommendations for which procedures and which types of valve disease need antibiotics have recently changed, so make sure to ask your doctor about the latest recommendations.
Medications. You may be prescribed medications to treat your symptoms and to lessen the chance of further valve damage. Some drugs may be stopped after you have had heart valve surgery to correct the problem. Other medications may need to be taken all your life. Common heart disease drugs may include:
|Heart disease drugs||What they do|
|Diuretics ("water pills")||Remove extra fluid from the tissues and bloodstream; lessen the symptoms of heart failure|
|Anti-arrhythmic medications||Control the heart's rhythm|
|Vasodilators||Lessen the heart's work. Also encourages blood to flow in a forward direction, rather than backwards through a leaky valve.|
|ACE inhibitors||A type of vasodilator used to treat high blood pressure and heart failure.|
|Beta blockers||Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients|
|Anticoagulants ("blood thinners")||Prolong the clotting time of your blood, if you are at risk for developing blood clots on your heart valve.|
Follow your doctor's orders when taking these heart disease drugs. Know the names of your medications, what they are for, and how often to take them. Keep a list in your wallet or purse with this information.
Surgery and other procedures. The diagnostic tests your heart doctor orders help to identify the location, type, and extent of heart valve disease. The results of these tests, the structure of the heart, and your age and lifestyle will help determine the best treatment for you.
Surgical options include heart valve repair or replacement. Valves can be repaired or replaced with traditional heart valve surgery or a minimally invasive heart valve surgery.
Traditional heart valve surgery
You’ll get medicine to help you sleep, and a surgeon will make a cut down the center of your sternum (also called your breastbone) so they can reach your heart. They’ll repair or replace the heart valves that need it.
Minimally invasive heart valve surgery
It’s done through smaller cuts. This type of surgery lowers:
- Blood loss
- How much time you’ll spend in the hospital
Your surgeon will review your test results to see if you’re a candidate for this procedure.
Often, the surgeon and cardiologist will use something called a transesophageal echo before and after the surgery to see how the valve is working. It uses sound waves to give your doctor a real-time look at your heart and blood vessels.
Heart valve repair surgery
The mitral valve is the one repaired most often. But the aortic, pulmonic, and tricuspid valves may be helped this way, too.
If your valve can be repaired, you’ll probably have one of these procedures:
Commissurotomy. The surgeon takes away calcium deposits and other scar tissue from the valve’s leaflets (sometimes called flaps). This is usually done for people who have severely narrowed valves and shouldn’t have balloon valvotomy.
Decalcification. Calcium deposits are removed to allow the leaflets to be more flexible and close properly.
Reshape leaflets. If one of the leaflets is floppy, a part of it may be cut out, and then the flap will be sewn back together. This lets the valve close more tightly. This is also called quadrangular resection.
Chordal transfer. If the anterior leaflet of your mitral valve is floppy (your doctor may say it has prolapse), the tendons that connect your valves -- called the chordae -- are moved from your posterior leaflet to your anterior leaflet. Then, the posterior leaflet is fixed by the reshaped leaflets procedure.
Annulus support. Your doctor may reshape or tighten the ring of tissue that supports your valve (called the valve annulus) if it’s too wide. They’ll sew a ring structure around it. The ring may be made of tissue or synthetic material.
Patched leaflets. Your surgeon may use tissue patches to repair any leaflets that have tears or holes.
The advantages of heart valve repair surgery include:
- You’ll have less need for lifelong blood thinner medication.
- Your heart muscle will stay strong longer.
Heart valve replacement surgery
When you have aortic or pulmonic valve disease, valve replacement surgery is usually done.
In rare cases, the aortic valve can be repaired. If your heart valves can’t be repaired, your doctor will replace them.
During the surgery, the damaged valve is removed and a new valve is sewn to the tissue that supported the original. The new valve can be:
Mechanical. It’s made totally of artificial parts that your body will accept. Something called a bi-leaflet valve is used most often. It’s two carbon leaflets in a ring covered by polyester knit fabric.
Their advantage is that they’re designed to last many years.
There are also potential drawbacks. People who get these have to take blood thinner medication for the rest of their life to prevent clots from forming in it. These clots can raise your chance of having a stroke. Also, some people hear a ticking sound. It’s the valve leaflets opening and closing.
Biological. Tissue valves (your doctor may call them biologic or bioprosthetic valves) are made of human or animal tissue. It may come from pigs or cows. The valves may have some artificial parts to help give it support and help its placement.
With these, most people don’t need to take lifelong blood thinners, unless they have other conditions (like atrial fibrillation) that make them needed.
Some of these valves can last as long as 17 years.
Homograft. Also called allograft, it’s a valve removed from a donated human heart that’s preserved and frozen under sterile conditions. One may replace a diseased valve.
Nonsurgical options for heart valve disease
Heart valves may also be repaired by other procedures, like percutaneous balloon valvuloplasty. It can make the opening of a narrowed (stenotic) valve wider. Also called balloon valvuloplasty, doctors sometimes recommend it for people who have:
- Mitral valve stenosis (narrowing of the mitral valve) with symptoms
- Aortic stenosis (narrowing of the aortic valve), but aren’t able to have surgery
- Pulmonic stenosis (narrowing of the pulmonic valve)
Transcatheter aortic valve replacement (TAVR) is a newer surgical option.
MitraClip is a less invasive procedure in which a clip helps the mitral valve close more completely. It restores a normal blood flow through the heart.
Living With Heart Valve Disease
When you have heart valve disease, it is important to protect yourself from future heart problems, even if your valve has been repaired or replaced with surgery. Here are some tips to stay healthy:
- Know the type and extent of your heart valve disease.
- Tell all your doctors and dentist you have valve disease.
- Call the doctor if you have symptoms of an infection.
- Take good care of teeth and gums.
- Take antibiotics before you undergo any procedure that may cause bleeding.
- Carry a wallet card that may be obtained from the American Heart Association with specific antibiotic guidelines.
- Take your medications. Drugs are used to control symptoms and help the heart pump blood more efficiently. Follow your doctor's instructions about how and when to take medications.
- See your heart doctor for regular visits, even if you have no symptoms. Appointments may be scheduled once a year or more often, if your doctor feels you need to be followed more closely.