Heart Valve Diseases
What are heart valves?
The heart consists of 4 chambers--2 atria (upper chambers) and 2 ventricles (lower
chambers). Blood passes through a valve as it leaves each chamber of the heart. The
valves prevent the backward flow of blood. They act as one-way inlets of blood on
one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The
4 heart valves include the following:
Tricuspid valve. Located between the right atrium and the right ventricle.
Pulmonary valve. Located between the right ventricle and the pulmonary artery.
Mitral valve. Located between the left atrium and the left ventricle.
Aortic valve. Located between the left ventricle and the aorta.
How do the heart valves function?
As the heart muscle contracts and relaxes, the valves open and close, letting blood
flow into the ventricles and out to the body at alternate times. The following is
a step-by-step explanation of blood flow through the heart.
The left and right atrium contract once they are filled with blood. This pushes open
the mitral and tricuspid valves. Blood is then pumped into the ventricles.
The left and right ventricles contact. This closes the mitral and tricuspid valves
preventing back blood flow. At the same time, the aortic and pulmonic valves open
to let blood be pumped out of the heart.
The left and right ventricles relax. The aortic and pulmonic valves close preventing
backward blood flow into the heart. The mitral and tricuspid valves then open to allow
forward blood flow within the heart to fill the ventricles again.
What is heart valve disease?
Heart valve disorders can arise from 2 main types of problems:
Regurgitation (or leakage of the valve). When the valve(s) do not close completely, it causes blood to flow backward through
the valve. This reduces forward blood flow and can lead to volume overload in the
Stenosis (or narrowing of the valve). When the valve(s) opening becomes narrowed, it limits the flow of blood out of the
ventricles or atria. The heart is forced to pump blood with increased force to move
blood through the narrowed or stiff (stenotic) valve(s).
Heart valves can develop both regurgitation and stenosis at the same time. Also, more
than one heart valve can be affected at the same time. When heart valves fail to open
and close properly, the effects on the heart can be serious, possibly hampering the
heart's ability to pump enough blood through the body. Heart valve problems are one
cause of heart failure.
What are the symptoms of heart valve disease?
Mild to moderate heart valve disease may not cause any symptoms. These are the most
common symptoms of heart valve disease:
Palpitations caused by irregular heartbeats
Low or high blood pressure, depending on which valve disease is present
Shortness of breath
Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)
Symptoms of heart valve disease may look like other medical problems. Always see your doctor
for a diagnosis.
What causes heart valve damage?
The causes of heart valve damage vary depending on the type of disease present, and
may include the following:
Changes in the heart valve structure due to aging
Coronary artery disease and heart attack
Heart valve infection
Syphilis (a sexually-transmitted infection)
Myxomatous degeneration (an inherited connective tissue disorder that weakens the
heart valve tissue)
The mitral and aortic valves are most often affected by heart valve disease. Some
of the more common heart valve diseases include:
Heart valve disease
Symptoms and causes
Bicuspid aortic valve
With this birth defect, the aortic valve has only 2 leaflets instead of 3. If the
valve becomes narrowed, it is harder for the blood to flow through, and often the
blood leaks backward. Symptoms usually don't until the adult years.
Mitral valve prolapse (also known as click-murmur syndrome, Barlow's syndrome, balloon
mitral valve, or floppy valve syndrome)
With this defect, the mitral valve leaflets bulge and don't close properly during
the contraction of the heart. This lets blood to leak backward. This may result in
a mitral regurgitation murmur.
Mitral valve stenosis
With this valve disease, the mitral valve opening is narrowed. It is often caused
by a past history of rheumatic fever. It increases resistance to blood flow from the
left atrium to the left ventricle.
Aortic valve stenosis
This valve disease occurs mainly in the elderly. It causes the aortic valve opening
to narrow. This increases resistance to blood flow from the left ventricle to the
With this valve disease, the pulmonary valve does not open sufficiently. This forces
the right ventricle to pump harder and enlarge. This is usually a congenital condition.
How is heart valve disease diagnosed?
Your doctor may think you have heart valve disease if your heart sounds heard through
a stethoscope are abnormal. This is usually the first step in diagnosing a heart valve
disease. A characteristic heart murmur (abnormal sounds in the heart due to turbulent
blood flow across the valve) can often mean valve regurgitation or stenosis. To further
define the type of valve disease and extent of the valve damage, doctors may use any
of the following tests:
Electrocardiogram (ECG). A test that records the electrical activity of the heart, shows abnormal rhythms
(arrhythmias), and can sometimes detect heart muscle damage.
Echocardiogram (echo). This noninvasive test uses sound waves to evaluate the heart's chambers and valves.
The echo sound waves create an image on a monitor as an ultrasound transducer is passed
over the heart. This is the best test to evaluate heart valve function.
Transesophageal echocardiogram (TEE).This test involves passing a small ultrasound transducer down into the esophagus.
The sound waves create an image of the valves and chambers of the heart on a computer
monitor without the ribs or lungs getting in the way.
Chest X-ray. This test that uses invisible electromagnetic energy beams to produce images of internal
tissues, bones, and organs onto film. An X-ray can show enlargement in any area of
Cardiac catheterization. This test involves the insertion of a tiny, hollow tube (catheter) through a large
artery in the leg or arm leading to the heart to provide images of the heart and blood
vessels. This procedure is helpful in determining the type and extent of certain valve
Magnetic resonance imaging (MRI). This test uses a combination of large magnets, radiofrequencies, and a computer to
produce detailed images of organs and structures within the body.
What is the treatment for heart valve disease?
In some cases, your doctor may just want to closely watch the heart valve problem
for a period. However, other options include medicine, or surgery to repair or replace
the valve. Treatment varies, depending on the type of heart valve disease, and may
Medicine. Medicines are not a cure for heart valve disease, but treatment can often relieve
symptoms. These medicines may include:
Beta-blockers, digoxin, and calcium channel blockers to reduce symptoms of heart valve
disease by controlling the heart rate and helping to prevent abnormal heart rhythms.
Medications to control blood pressure, such as diuretics (remove excess water from
the body by increasing urine output) or vasodilators (relax the blood vessels, decreasing
the force against which the heart must pump) to ease the work of the heart.
Surgery. Surgery may be needed to repair or replace the malfunctioning valve(s). Surgery may
Heart valve repair. In some cases, surgery on the malfunctioning valve can help ease symptoms. Examples
of heart valve repair surgery include remodeling abnormal valve tissue so that the
valve works properly, or inserting prosthetic rings to help narrow a dilated valve.
In many cases, heart valve repair is preferable, because a person's own tissues are
Heart valve replacement. When heart valves are severely malformed or destroyed, they may need to be replaced
with a new valve. Replacement valves may be either tissue (biologic) valves, which
include animal valves and donated human aortic valves, or mechanical valves, which
can consist of metal, plastic, or another artificial material. This usually requires
heart surgery. But, certain valve diseases such as aortic valve stenosis or mitral
valve regurgitation may be managed using non- surgical methods.
Another treatment option that is less invasive than valve repair or replacement surgery
is balloon valvuloplasty. This is a non-surgical procedure in which a special catheter
(hollow tube) is threaded into a blood vessel in the groin and guided into the heart.
At the tip of the catheter is a deflated balloon that is inserted into the narrowed
heart valve. Once in place, the balloon is inflated to stretch the valve open, and
then removed. This procedure is sometimes used to treat pulmonary stenosis and, in
some cases, aortic stenosis.