Valvular Heart Disease

The goal of the heart is to supply the body with oxygen and nutrients. For this to be accomplished, the blood must pass through the lungs picking up oxygen, deliver oxygenated blood to the body and return the blood to the lungs to release carbon dioxide. There are four valves within the heart that open to allow blood to move forward and close to prevent blood from flowing backward. The valves are named the aortic, mitral, tricuspid, and pulmonic valve. The aortic and pulmonic valves lie between the ventricles and the major blood vessels leaving the heart. The mitral and tricuspid valves lie between the atria (upper heart chambers) and the ventricles (lower heart chambers).

What is valvular heart disease?

Valvular heart disease occurs when the hearts valves do not function appropriately. Valve dysfunction may result in stenosis (narrowing of the valve) or regurgitation (leaky valve). Some common valvular diseases include bicuspid aortic valve, aortic stenosis and regurgitation, mitral regurgitation and stenosis, mitral valve prolapse, and tricuspid regurgitation. Common causes of valve disease include rheumatic fever, degenerative changes as one ages, myxomatous degeneration, damage after a heart attack, congenital defects, and infection.

What are the symptoms of valvular heart disease?

Mild valve disease generally does not cause any symptoms. As the process progresses, symptoms may occur. The type of valvular dysfunction significantly affects what symptoms may be felt. Common symptoms include: chest pain, palpitations, edema (swelling of the ankles, feet or abdomen), unexplained weight gain, fatigue, dizziness, low or high blood pressure, shortness of breath, and abdominal pain.

Symptoms of valvular heart disease may resemble other medical conditions and patients may be treated for asthma, bronchitis, or a lung infection when they actually have heart failure caused by valvular heart disease. Always consult your physician.

How is valvular heart disease diagnosed?

Valvular heart disease may be suspected both from obtaining a medical history as well as findings on the physical exam. Frequently murmurs (heart sounds) can be heard through a stethoscope. Some hearts sounds are normal and others suggest valvular abnormalities. To better define the type of valve disease and extent of the valve damage, a number of diagnostic tests may be ordered. These tests may include a chest x-ray, echocardiogram, stress echocardiogram, transesophageal echocardiogram (TEE), cardiac catheterization, or cardiac MRI.

What is the appropriate treatment?

In some cases, the only treatment for heart valve disease may be careful medical supervision. However, other treatment options may include medication, balloon valvuloplasty, surgery to repair the valve, or valve replacement surgery. The appropriate treatment will be determined based on:

  1. disease severity including findings on echocardiogram
  2. which valve is affected
  3. symptoms
  4. age
  5. expectations for the course of the disease
  6. overall health and medical history
  7.  tolerance for specific medications

Medication

In some cases, medication alone is successful in the treatment of heart valve disease. Some medications control the amount of fluid in your body (diuretics), others help regulate blood pressure and heart rate (beta-blockers, digoxin, Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors), Angiotensin Receptor Blockers (ARBs), while others dilate vessels decreasing pressure on the heart and lungs (nitrates).

Balloon Valvuloplasty

In certain cases, a non-surgical technique called balloon valvuloplasty can be used to open a narrowed or stenotic valve. The technique requires a procedure in the cardiac catheterization laboratory inserting a catheter into the leg vessels to get to the heart (no cutting required). A balloon is then advanced into the heart and across the damaged valve which is then “stretched open” by the inflated balloon so that blood can flow without obstruction. Only specific valvular conditions such as aortic, mitral, and pulmonic stenosis can be considered for this procedure.