Heart Valve Disease

Valvular heart disease is any process involving one or more of the four valves of the heart.  These are the aortic and mitral valves on the left side of heart, and the pulmonary and tricuspid valves on the right.

These conditions usually occur as a consequence of ageing, but may also be the result of congenital abnormalities or secondary to other conditions such as rheumatic heart disease and pregnancy.

Heart valves are responsible for the regulation of blood flow through, and out of, the heart. Valve dysfunction can result in diminished heart function, though the particular consequences are dependent on the type and severity of valvular disease. Broadly speaking, a valve can either be too tight (restricting flow across), or too leaky.

Diagnosis is by clinical examination detecting the presence of a murmur, which is then confirmed with an echocardiogram Once a valve is identified as damaged, monitoring with regular echocardiograms is usually required.

Treatment of damaged valves may involve medication alone, but often eventually requires surgical valve repair or replacement. Some of these procedures are now done without the need for open heart surgery. Left heart valve problems are commoner:

Aortic Stenosis (AS)

  • Restriction of the aortic valve resulting in a reduction of flow of blood leaving the heart
  • Typical symptoms of severe AS are chest pain, dizziness and blackouts, classically on exertion
  • The commonest cause of AS in younger people is a congenital bicuspid aortic valve. The normal aortic valve has 3 leaflets, a bicuspid valve has 2 & is prone to AS. The incidence is 2%, & the condition is commoner in males
  • The mortality rate of untreated symptomatic, severe AS is around 25% per year

Aortic Regurgitation (AR)

  • Insufficiency of the valve resulting in leakage of blood back into the left ventricle (main pumping chamber) every time the heart beats
  • Commonest symptom is breathlessness
  • If severe, invariably results in heart failure
  • Can occur with bicuspid valves, hypertension & previous or current valve infection (endocarditis) & connective tissue disorders

Mitral Stenosis (MS)

  • Restriction of the mitral valve resulting in a reduction of flow of blood into the left ventricle
  • Commonest symptom is fatigue and breathlessness
  • Classically as result of previous rheumatic heart disease, occasionally age-related

Mitral Regurgitation (MR)

  • Insufficiency of the valve resulting in leakage of blood back into the left atrium from the left ventricle
  • Commonest symptom is breathlessness
  • Causes include mitral valve prolapse (“floppy mitral valve”), rheumatic heart disease, endocarditis, connective tissue disorders, & as a result of a heart attack or cardiomyopathy
  • The incidence of mitral valve prolapse is 2%