Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease.
Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).
A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously existed. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.
The severity of valvular heart disease varies. In mild cases, there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.
There are several types of heart valve disease:
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.
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 backwards 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.
Some people with heart valve disease might not experience symptoms for many years. Signs and symptoms of heart valve disease may include:
The main causes of heart valve disease are:
Your doctor may evaluate your signs and symptoms and conduct a physical examination. In a physical examination, your doctor will likely listen for a heart murmur, as this can be a sign of a heart valve condition. Your doctor may ask for several tests to be done to diagnose your condition.
Tests may include:
Echocardiography: In this test, sound waves directed at your heart from a wand-like device (transducer) held on your chest produce video images of your heart in motion. This test assesses the structure of your heart, the heart valves and the blood flow through your heart. An echocardiogram helps your doctor get a close look at the heart valves and how well they're working. Doctors may also use a 3-D echocardiogram.
Electrocardiogram (ECG): In this test, wires (electrodes) attached to pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
Chest X-ray: A chest X-ray can help your doctor to determine whether the heart is enlarged, which can indicate certain types of heart valve disease. A chest X-ray can also help doctors determine the condition of your lungs.
Cardiac MRI: A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and assess the size and function of your lower heart chambers (ventricles).
Exercise tests or stress tests: Different exercise tests help measure your activity tolerance and monitor your heart's response to physical exertion. If you are unable to exercise, medications to mimic the effect of exercise on your heart may be used.
Cardiac catheterization: This test isn't often used to diagnose heart valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity.
Treatment by Ballon Valvotomy: A balloon valvotomy is a treatment for mitral valve stenosis. It is a procedure that widens the mitral valve so that blood flows more easily through the heart.
A balloon valvotomy is a minimally invasive procedure. A doctor uses a thin flexible tube (catheter) that is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon device located on the tip of the catheter is quickly inflated. The narrowed or fused mitral valve leaflets are separated and stretched open as the balloon presses against them. This process increases the size of the mitral valve opening and allows more blood to flow from the left atrium into the left ventricle.