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What is Valvular Heart Disease?
The valves are doors in the heart that lead from chamber to chamber. There are four of them, the pulmonic, the aortic, the tricuspid and the mitral valves. When these doors do not open or close properly, the patient is said to have valve disease. Valve disease has a wide range of severity. Valve disease may be mild, not causing any symptoms, or may be severe enough to be life threatening. Valve problems can generally be broken down into two categories; stenosis (stiffening) and insufficiency (leaking.) Any of the four valves can develop either of these problems. These two terms are often mentioned in the discussion of valve disease. Stenosis means that the opening in the valve is narrowed. This prevents normal blood flow through the valve and causes the heart to have to work harder to pump. Valve insufficiency means that the valve is not closing all the way and the blood can leak back through the valve (regurgitation.)
Causes of Valvular Heart Disease
There are several reasons why a patient may develop valve disease but they can generally be grouped into two categories, Congenital Valve Disease and Acquired Valve Disease. Congenital disease means that the valves in the heart were not formed correctly in fetal development. The most commonly seen congenital heart valve defect is called a bicuspid aortic valve. A normal aortic valve has three leaflets that come together when it closes. A bicuspid aortic valve has only two. This valve may be more likely to become stiff or to leak when the person gets older. Often it causes no problems at all.
Acquired Valve Disease means that the valve disease was not present at birth but developed over time. Some examples of acquired valve disease include ischemic problems (caused by heart attacks), degenerative calcification of a valve, and infection.
Heart attacks can cause damage to the heart muscle or structures near the valve, and thus cause the valve to not work properly. Degenerative calcification results when the valve leaflets become too thick (from the buildup of calcium on the structures) and don't move as well. This is usually due to wear and tear on the valve leaflets and is usually seen in older patients. Many infections can lead to valve disease. Although not as common in children today, Rheumatic Fever used to cause a significant amount of valve disease. This infection would cause the valve leaflets to become inflamed. They became scarred, which caused permanent damage to the function of the valve.
Endocarditis is an infection of the heart valve or muscle that causes damage to the valve. In some cases bacteria can enter the blood stream and colonize on the heart valves. This can lead to holes in the valves and impaired valve function.
Signs and Symptoms of Valvular Heart Disease
The most common symptoms of valve disease are shortness of breath, chest pain and feeling faint or light headed especially during periods of exertion. Signs that your doctor may observe in a clinical evaluation may include a heart murmur, lung congestion, and peripheral edema.
Diagnosis of Valvular Heart Disease
Using the data gathered during the physical examination in combination with tests, your doctor will be able to diagnose valve disease. Some of the tests that may be helpful in making a diagnosis include echocardiography, transesophageal echocardiography, cardiac catheterization and magnetic resonance imaging. These tests will provide you and your doctor with information about how blood flows through your heart. These tests can indicate if valves are blocking blood flow or if it is leaking back into the other heart chambers. Depending on these test results a course of treatment will be recommended that fits your individual needs.
Valvular Heart Disease Treatments
Many times, no treatment other than monitoring is necessary. In other cases medical or surgical management may be advised in order to improve the patient's quality of life. Sometimes valve disease can be treated by the use of medications designed to improve heart pumping strength or reduce water retention. If drugs are advised it is important to take them as directed and to call with any questions that you may have. For severe cases of valve disease, surgery may be required to either repair or replace the diseased valve. Several of the surgeons IHI believe that repair of a person's own valve may be preferable to replacing it with an artificial one. There are many techniques available that allow the surgeons at IHI to repair patient's valves without having to introduce a foreign valve into the heart. When repair is not possible, the surgeons can replace the diseased valve. The replacement valves can either be mechanical, cryopreserved (frozen) human valves or porcine (pig) valves. All of these replacement valves have advantages and disadvantages that you and your surgeon will discuss in order to choose the best option for you personally.
Links
Heartpoint
National Institutes of Health
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