Definition and Overview

The heart has four valves (tricuspid, mitral, aortic, and pulmonary). They act as doors that open and close each time the heart beats. They allow the blood to flow through the atria and ventricles. They also ensure that the blood does not flow back.

The blood coming from the right and left atria flows through the tricuspid and mitral valves. When the blood reaches the right and left ventricles, these valves close so the blood will not flow back. From here, the blood flows through the aortic and pulmonary valves to the pulmonary artery and aorta.

Valve disorders can cause any of the valves to malfunction. They can narrow (stenosis) or not close properly. When this happens, less blood will flow through them or the blood will flow back (regurgitation). Both problems can greatly affect the heart’s ability to pump enough blood to the rest of the body.

Heart valve disorders can be mild, moderate, or severe. Mild cases do not usually cause any symptoms or serious health problems. But because these disorders can slow down blood flow, they can cause the blood to clot. Blood clots can travel through the bloodstream and block major arteries in the body. This can cause patients to suffer from stroke or heart attack.

Causes of Condition

Heart valve disorders can be present at birth (congenital). One example of a congenital valve disorder is bicuspid aortic valve (BAV) disease. Instead of three leaflets, the BAV only has two.

Heart valve disorders can also develop after birth (acquired). These can be caused by:

  • Abnormal growths

  • Aortic aneurysms

  • Bacterial infections

  • Cardiomyopathy

  • Connective tissue diseases

  • Coronary artery disease

  • Heart attack

  • High blood pressure

  • Radiation therapy

Key Symptoms

When the heart valves are narrowed or are leaking blood, they usually cause a heart murmur. This whooshing or swishing noise can be heard through a stethoscope. Other symptoms include:

  • Heart palpitations

  • Shortness of breath

  • Chest pain

  • Fatigue

  • Coughing

  • Fainting

  • Lightheadedness

  • Swelling of the feet and ankles

  • Excess fluid in the lungs

  • Water retention

Who to See and Types of Treatments Available

Many cases of heart valve disorders do not require treatment. Many faulty valves do not produce worrying symptoms. In fact, many patients are not even aware that they have them.

However, severe cases can severely slow down blood circulation. This increases the risk of life-threatening illnesses including stroke and heart attack.

Heart valve disorders are diagnosed and treated by a heart specialist (cardiologist). The condition is suspected if a heart murmur is detected during a physical exam. To confirm the diagnosis and rule out other heart disorders that cause the same symptoms, the doctor will order these tests:

  • Cardiac catheterisation - This test provides important information about the function and structure of the heart. For the procedure, the doctor threads a catheter through a blood vessel (usually in the arm or groin) to reach the heart area. A contrast medium is then injected into the catheter and an image is taken using an x-ray machine. The pictures will show if any of the blood vessels have narrowed or blocked.

  • Chest x-ray - This is usually the first imaging test used to get pictures of the inside of the chest. If it suggests any abnormalities, more sensitive imaging tests are performed. An example is magnetic resonance imaging (MRI). It provides clearer images and more detailed information than a regular chest x-ray.

  • Echocardiogram - A type of ultrasound test that creates moving pictures of the heart. It is often performed to look for the cause of heart murmur. It can be performed together with a stress test and electrocardiogram (ECG).

Treatment of heart valve disorders depends on the severity of the condition. If the patient is not showing symptoms, doctors advise active surveillance. With this method, no treatment is provided. Instead, the condition is closely monitored. The patient is also advised to make lifestyle changes. These include eating a healthy diet and maintaining an ideal weight. Smokers are also advised to stop smoking right away. If the condition progresses or if symptoms start to show, the doctor will initiate treatment.

Medicines are usually the first line of treatment for the disorder. These drugs are designed to open blocked blood vessels (vasodilators), reduce fluid retention (diuretics), and improve heart rate (beta-blockers and calcium channel blockers).

If the condition does not respond well to conservative treatments, surgery can be performed.

Narrowed valves can be widened through valvuloplasty. Valves that are damaged beyond repair should be replaced. Techniques that can be used are open-heart surgery or minimally invasive method. The former requires a long incision in the chest while the latter uses several small incisions. This technique is known to reduce the many risks of surgery, such as scarring, pain, and infection. It also shortens recovery time.

During the procedure, the damaged valve is removed and replaced using a mechanical valve. A valve made from the heart valve of a cow or pig can also be used. The procedure can be performed on a beating heart. Alternatively, the patient can be placed on a heart/lung machine that takes over the function of the heart for the duration of the procedure.

References:

  • Ruiz CE, et al. Transcatheter therapies for the treatment of valvular and paravalvular regurgitation in acquired and congenital valvular heart disease. Journal of the American College of Cardiology. 2015;66:169.

  • Getting support. American Heart Association. http://www.heart.org/HEARTORG/Caregiver/ReachOut/GettingSupport/Getting-Support_UCM_301847_Article.jsp#.WCn5QdgzXIU.

  • Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. The Journal of Thoracic and Cardiovascular Surgery. 2014;148:e1.

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