Heart Valve Disease

The heart has four valves — mitral, aortic, tricuspid, and pulmonary — that regulate the flow of blood through the heart's four chambers. Each valve consists of flaps, or leaflets, that function like one-way swinging doors. With each heartbeat, the valves open widely to allow blood to flow to the next chamber, and then close tightly to prevent blood from flowing backward.

Valves can malfunction in two ways. One problem is leakage, or regurgitation, in which valves do not completely close, allowing blood to flow in reverse. The second valve disorder is stenosis, or blockage, in which the valve stiffens, limiting how wide it can open and thus how much blood can flow to the next chamber. Either regurgitation or stenosis can significantly limit the heart’s ability to pump blood. Sometimes, a valve can have both problems at once.

Common Heart Valve Disease

The most common heart valve diseases are aortic stenosis and mitral insufficiency. Triscupid valve disease is rare and usually secondary to other heart valve disease. Mitral stenosis is usually caused by rheumatic fever, which is unusual in developed countries. Pulmonic valve disease is generally caused by birth defects (congenital) and is usually diagnosed at birth.

Symptoms of heart valve disease include:

• shortness of breath
• palpitations (irregular, rapid heart beats)
• weakness, dizziness, or fainting
• edema, or swelling, of the ankles, feet, or abdomen
• pressure-like discomfort in the chest

In many cases, heart valve disease progresses slowly. The heart gradually adjusts (up to a point), so symptoms may go unnoticed for some time. It is important to note that symptoms do not always reflect the severity of heart valve disease. One may be symptom-free yet have serious heart valve disease requiring immediate treatment. On the other hand, one may experience frequent symptoms but have a minor valve leakage requiring no treatment at all.

In general, faulty valves create abnormal heart sounds, such as murmurs and clicks, that can be heard with a stethoscope. A more sophisticated, noninvasive test called an echocardiogram is typically used to confirm the diagnosis. Further diagnostic information can be obtained with CT-angiography and cardiac MRI (a noninvasive means of obtaining high-quality cross-sectional images of the heart and the great vessels), both of which are available at a handful of medical centers, including NYU.

Many valve problems — including the majority of cases of mitral valve prolapse — are minor and do not require any treatment. More serious heart valve disease can be effectively treated through valve repair or replacement. Generally, surgery is required. Recent advances have made it possible to repair or replace valves with minimally invasive procedures, in which the operation is performed without splitting the breast bone. Compared to conventional open-heart surgery, minimally invasive surgery is much less traumatic to the patient. It not only requires smaller incisions, but also leads to fewer blood transfusions, less postoperative pain, shorter hospital stays, and quicker recoveries.