Stenosis and Heart Valve Disease
Valvular heart disease refers to any dysfunction or abnormality in one or more of the heart’s valves.
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The heart has four valves: the mitral, aortic, tricuspid and pulmonic valves, which function as check valves or gates in the heart to keep blood flowing correctly. The
valves have tissue flaps that open and close with each heartbeat, ensuring that
blood flows in the right direction through the four chambers of the heart so
that it can circulate through your body.
Three basic kinds of problems can occur with heart valves: regurgitation, stenosis and atresia.
Regurgitation, or backflow, occurs when a valve does not close tightly. Blood flows back into the chambers rather than flowing forward through the heart or into an artery.
Among Americans, regurgitation in the mitral valve is often due to mitral
valve prolapse, which occurs when the flaps of the valve flop or bulge back
into an upper heart chamber during a heartbeat. Mitral valve regurgitation, if
severe, can result in gradual enlargement of the left ventricular pumping
chamber and eventual failure of the heart to pump efficiently. Because of this,
the valve should be repaired before irreversible damage occurs.
The main symptoms of either mitral
or aortic regurgitation are shortness of breath on exertion or at rest, and
easy fatigability. Aortic regurgitation is caused either by damage to the heart valve, an infection
of the aortic valve or enlargement of the aorta.
Stenosis occurs when the flaps of a
valve thicken, stiffen or fuse together, preventing the heart valve from fully
opening. As a result, blood flow through the valve is restricted. Some valves
can have both stenosis and regurgitation problems.
The symptoms of mitral stenosis are typically progressive shortness of breath with exertion, which takes years to develop. Stenosis of the mitral valve in adults is almost always due to damage caused by an episode of rheumatic fever in childhood, commonly as
a result of strep throat. Occasionally, patients with mitral stenosis develop
sudden onset of an irregular heart rhythm that is also accompanied by severe
shortness of breath.
stenosis in adults is usually a slow and progressive degenerative process.
Aortic stenosis can result in chest pain on exertion, shortness of breath on
exertion or fainting on exertion. In severe cases heart failure can result.
Once aortic stenosis causes symptoms, the risk of death over the next few years
is high, and the valve should be replaced.
Valve problems may be congenital
(present at birth) or acquired (caused by infections, heart attacks, heart
disease or other damage).
Congenital heart valve disease usually involves
pulmonary or aortic valves that don’t form properly. These valves may not have
enough tissue flaps, they may be the wrong size or shape or they may have
atresia, which occurs when a heart valve lacks an opening for blood to pass
through and is a problem primarily in newborn children.
Acquired heart valve disease usually involves
the mitral or aortic valve. Although the valve may be normal at birth, disease
can create problems over time.
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