Heart valve disease

• Article
• 2021-02-03

Heart valve disease occurs when one or more of your heart valves are not working properly. The heart has four valves: the tricuspid valve, the pulmonary valve, the mitral valve, and the aortic valve.

These valves have tissue flaps that open and close with each heartbeat. The flaps ensure that blood flows in the right direction through the four chambers of your heart and to the rest of your body.

Healthy heart cross section

Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or cause blood to leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.

Overview

How the heart valves work

At the beginning of each heartbeat, blood returning from the body and lungs fills the atria (the two upper chambers of the heart). The mitral and tricuspid valves are located at the bottom of these chambers. As blood builds up in the atria, these valves open to allow blood to flow into the ventricles (the two lower chambers of the heart).

After a short delay, as the ventricles begin to contract, the mitral and tricuspid valves close tightly. This prevents blood from flowing back to the atria.

As the ventricles contract, they pump blood through the pulmonary and aortic valves. The pulmonary valve opens to allow blood to flow from the right ventricle into the pulmonary artery. This artery carries blood to the lungs for oxygen.

At the same time, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. The aorta carries oxygenated blood to the body. As the ventricles relax, the lung and aortic valves close properly. This prevents blood from flowing back into the ventricles.

For more information on how the heart pumps blood and detailed animations, see the Health Topics How the Heart Works article.

Heart valve problems

Heart valves can have three basic types of problems: regurgitation, stenosis, and atresia.

Regurgitation or backflow occurs when a valve does not close properly. Blood leaks back into the chambers instead of flowing forward through the heart or into an artery.

In the United States, backflow is usually due to prolapse. "Prolapse" is when the flaps of the valve fold back or protrude into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve.

Stenosis occurs when the flaps of a valve become thicker, stiffer, or fuse together. This prevents the heart valve from opening completely. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.

Atresia occurs when a heart valve does not have an opening for blood to pass through.

Some people are born with heart valve disease, while others get it later in life. Heart valve disease that develops before birth is called congenital heart valve disease. Congenital heart valve disease can occur on its own or with other congenital heart defects.

Congenital heart valve disease often involves pulmonary or aortic valves that do not form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening that allows blood to flow properly.

Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.

Both congenital and acquired heart valve disease can cause stenosis or reflux.

Symptoms

Important signs and symptoms

The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope.

However, many people have a heart murmur without heart valve disease or other heart problems. Others may have a heart murmur as a result of heart valve disease, but have no other signs or symptoms.

Heart valve disease often worsens over time, so signs and symptoms can appear years after a heart murmur is first heard. Many people with heart valve disease don't have symptoms until they are middle-aged or older.

Other common signs and symptoms of heart valve disease relate to heart failure, which can cause heart valve disease. These signs and symptoms include:

• Unusual tiredheid (fatigue)
• Shortness of breath, especially when you exercise or when you lie down
• Swelling in your ankles, feet, legs, abdomen and veins in the neck

Other signs and symptoms

Heart valve disease can cause chest pain that can only occur when you exercise. You may also notice a fluttering, fast, or irregular heartbeat. Some types of heart valve disease, such as aortic or mitral valve stenosis, can cause dizziness or fainting.

Therapy

Currently, no drugs can cure heart valve disease. However, lifestyle changes and medications can often successfully treat symptoms and delay problems for years. Ultimately, however, you may need surgery to repair or replace a faulty heart valve.

The goals of heart valve disease treatment can include:

• Medicines
• Repair or replacement of faulty valves
• Heart-healthy lifestyle changes to treat other related heart conditions

Medicines

In addition to changes to your heart-healthy lifestyle, your doctor may prescribe medications to:

• Lower high blood pressure or high blood cholesterol.
• Prevent arrhythmias (irregular heartbeat).
• Thin the blood and prevent blood clots (if you have a man-made replacement valve). Doctors also prescribe these drugs for mitral stenosis or other valve defects that increase the risk of blood clots.
• Treat coronary heart disease. Medicines for coronary heart disease can reduce the workload on your heart and relieve symptoms.
• Treat heart failure. Medicines for heart failure dilate blood vessels and remove excess fluid from the body.

Repair or replace heart valves

Your doctor may recommend repairing or replacing your heart valve (s), even if your heart valve disease isn't causing any symptoms. Repairing or replacing a valve can prevent permanent damage to your heart and sudden death.

The decision to repair or replace heart valves depends on many factors, including:

• The severity of your valve disease
• Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease. Bypass surgery and valve surgery can be performed at the same time.
• Your age and general health

If possible, heart valve repair is preferable to heart valve replacement. Valve repair maintains the strength and function of the heart muscle. People with valve repair also have a lower risk of infective endocarditis after surgery, and they don't need to take blood-thinning medications for the rest of their lives.

However, heart valve repair surgery is more difficult than valve replacement. Also, not all valves can be repaired. Mitral valves can often be repaired. Often aortic and lung valves need to be replaced.

Repairing heart valves

Heart surgeons can repair heart valves by:

• Add fabric to close holes or tears or to increase support at the bottom of the valve
• Remove or reshape tissue so that the valve can close more tightly
• Separating fused flaps

Sometimes cardiologists repair heart valves using cardiac catheterization. While catheter procedures are less invasive than surgery, they may not work as well for some patients. Work with your doctor to decide if repair is appropriate. Then your doctor can advise you on the best procedure.

Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valve plastic. This procedure is also known as a balloon fall votomy.

During the procedure, a catheter (thin tube) with a balloon on the end is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to increase the opening of the valve. Your doctor will then deflate the balloon and remove both it and the tube. You are awake during the procedure, which usually requires an overnight stay in a hospital.

Balloon fall vuloplasty relieves many symptoms of heart valve disease, but may not cure them. The condition can worsen over time. You may still need medication to treat symptoms or surgery to repair or replace the faulty valve

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