Valve Disease

Heart valve disease is a condition in which one or more of your heart valves don't work properly. The heart has four valves: the tricuspid (tri-CUSS-pid), pulmonary (PULL-mun-ary), mitral (MI-trul), and aortic (ay-OR-tik) valves.
These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body. Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.

• Heart valve disease is a condition in which one or more of your heart valves don't work properly. The heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves.
• These valves have tissue flaps that open and close with each heartbeat. These flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body.
• Heart valves can have three basic kinds of problems:
• Regurgitation, or backflow, occurs when a valve doesn't close tightly. Blood leaks back into the heart chamber rather than flowing forward through the heart or into an artery.
• Stenosis occurs when the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening, and not enough blood flows through the valve.
• Atresia occurs when a valve lacks an opening for blood to pass through..
• Heart valve disease can make your heart work harder and affect its ability to pump blood. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or sudden death due to sudden cardiac arrest
• You can be born with heart valve disease or develop it later in life. It's not known what causes the type of valve disease that people are born with. Heart conditions and other disorders, age-related changes, rheumatic fever, and infections can cause heart valve disease that develops later in life.
• The major risk factors for acquired heart valve disease are age, having risk factors for heart disease, and having risk factors for the heart infection endocarditis (infection of the heart valves).
• Many people don't have signs or symptoms of heart valve disease until they're middle-aged or older.
• The main sign of heart valve disease is a heart murmur (an unusual heart sound). Other common signs and symptoms are unusual fatigue (tiredness), shortness of breath, and swelling of your ankles, feet, or abdomen.
• Heart valve disease is diagnosed based on your symptoms, a physical exam, and the results from tests and procedures.
• Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay complications for many years. Eventually, you may need to have your faulty valve repaired or replaced with a man-made or biological valve.
• When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk for endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.
• To prevent heart valve disease caused by rheumatic fever, see your doctor if you have signs of a strep infection. This infection can cause rheumatic fever, which can damage the heart valves. If you do have a strep infection, take all medicines as prescribed.
• Heart valve disease is a lifelong condition. If you have the condition, it's important to have ongoing medical care. See your doctor regularly. Call your doctor if your signs or symptoms worsen or if you have signs or symptoms of endocarditis. Take all your medicines as prescribed.
• Mild to moderate heart valve disease during pregnancy usually can be managed with medicines or bed rest without posing heightened risks to the mother or fetus. Your doctor can advise you on which medicines are appropriate during pregnancy.
• Severe heart valve disease can make pregnancy or labor and delivery riskier. If you have severe valve disease and/or its symptoms, consider having your heart valves repaired or replaced before getting pregnant. Such repair or replacement also can be done during pregnancy, if needed. But this surgery poses danger to both the mother and fetus.

Heart Valve Problems
Heart valves can have three basic kinds of problems:
• Regurgitation or backflow, occurs when a valve doesn’t close tightly. Blood leaks back into the chamber rather than flowing forward through the heart or into an artery.
• In the United States, backflow is most often due to prolapse. "Prolapse" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve, but it can affect the other valves as well.
• Stenosis occurs when the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening, and not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.
• Atresia occurs when a heart valve lacks an opening for blood to pass through.

Symptoms
Major Signs and Symptoms
The main sign of heart valve disease is an unusual heart sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. However, many people have heart murmurs without having heart valve disease or any other heart problems. Others may have heart murmurs due to heart valve disease, but have no other signs or symptoms. Heart valve disease often worsens over time, so signs and symptoms may develop years after a heart murmur is first heard. Many people who have heart valve disease don't have any symptoms until they're middle-aged or older. Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can eventually cause. These symptoms include:
• Unusual fatigue (tiredness)
• Shortness of breath, especially when you exert yourself or when you're lying down
• Swelling of your ankles, feet, or sometimes the abdomen

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Diagnosis
Your primary care provider may detect a heart murmur or other signs of heart valve disease. He or she also will do a physical exam and look at the results of medical tests and imaging.
Physical Exam: Your doctor will listen to your heart with a stethoscope to find out if you have a heart murmur that's likely caused by a heart valve problem. Your doctor also will listen to your lungs as you breathe to check for fluid buildup. He or she will check for swollen ankles and other signs that your body is keeping in water.
Electrocardiogram: This is a simple test that detects and records the electrical activity of your heart. It can detect an irregular heartbeat and signs of a previous heart attack. It can also show whether certain chambers of your heart are enlarged.
Chest X Ray: This test can show whether certain sections of your heart are enlarged, whether you have fluid in your lungs, or whether there are calcium deposits in your heart. This test helps your doctor learn which type of valve defect you have, how severe it is, and whether you have any other heart problems.
Echocardiography: The test uses sound waves to create a moving picture of your heart as it beats. A wand that's placed on the surface of your chest transmits the sound waves. Echoes from the sound waves are converted into pictures of your heart on a computer screen. An echocardiogram can show the size and shape of your heart valves and chambers, how well your heart is pumping blood, and whether a valve is narrowed or has backflow.
Your doctor may recommend a transesophageal echocardiogram, or TEE, to get a better image. For a TEE, the sound wave wand is put on the end of a special tube. The tube is passed down your throat and into your esophagus (the tube leading from your mouth to your stomach). You will be given medicine to relax you during this procedure.

Cardiac Catheterization: For this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, upper thigh (groin), or neck and threaded into your heart. Your doctor uses x-ray images to guide the catheter. Through the catheter, your doctor does diagnostic tests and imaging that show whether backflow is occurring through a valve and how fully the valve opens. You're given medicine to help you relax, but you're awake during the procedure. Your doctor may order a cardiac catheterization if your signs and symptoms of heart valve disease aren't in line with your echocardiography results. The procedure also can help your doctor assess whether your symptoms are due to specific valve problems or coronary artery disease. All of this information helps your doctor decide the best way to treat you.
Stress Test: During stress testing, you exercise to make your heart work hard and beat fast while heart tests and imaging are done. If you can't exercise, you'll be given medicine to make your heart work hard and beat fast. A stress test can show whether you have signs and symptoms of heart valve disease when your heart is working hard. It can help your doctor assess the severity of your heart valve disease.
Cardiac MRI: Cardiac MRI uses a powerful magnet and radio waves to make detailed images of your heart. A cardiac MRI image can confirm information about valve defects or provide more detailed information. This information can help your doctor plan your treatment. An MRI also may be done before heart valve surgery to help your surgeon plan for the surgery.

Treatment
The goals of heart valve disease treatment are to:
• Prevent, treat, or relieve the symptoms of other related heart conditions.
• Protect your valve from further damage.
• Repair or replace faulty valves when they cause severe symptoms or become life threatening. Man-made or biological valves are used as replacements.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay complications for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
Repair or Replace Heart Valves: Your doctor may recommend repairing or replacing your heart valve(s), even if you do not yet have symptoms of heart valve disease. This can prevent lasting damage to your heart and sudden death. Having heart valve repair or replacement depends on a number of factors, including how severe your valve disease is, your age and general health, and whether you need heart surgery for other conditions, such as bypass surgery to treat CAD. Bypass surgery and valve surgery can be done at the same time.
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk for endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives. However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic or pulmonary valves often have to be replaced.

Other Approaches for Repairing and Replacing Heart Valves: Some newer forms of heart valve repair or replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery are usually 3 to 5 days, compared to 5 day stays for traditional heart valve surgery. New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2 to 4 weeks versus 6 to 8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring procedures that use cardiac catheterization to thread clips or other devices in a tube through your blood vessels and into the faulty valve in your heart. The clips or devices are used to reshape the valve and stop the backflow of blood. It's not yet known how effective these procedures are.

Written by Dr. Mark Steiner, Cardiologist in Orlando