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Heart Valve Disease (Structural Heart Disease)

Valvular heart disease refers to any dysfunction or abnormality in one or more of the heart’s valves.

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About Heart Valves

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.

Types of Heart Valve Problems

Three basic kinds of problems can occur with heart valves: regurgitation, stenosis and atresia.

Regurgitation

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

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.

Mitral Stenosis

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.

Aortic Stenosis

Aortic 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.

Congenital vs. Acquired Heart Valve Problems

Valve problems may be congenital (present at birth) or acquired (caused by infections, heart attacks, heart disease or other damage).

Congenital Heart Valve Disease

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

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.