An Overview of Heart Valve Disease

In heart valve disease, one or more of the structures that allow for the proper movement of blood through the four chambers of the heart become blocked or damaged, preventing blood from entering the heart (stenosis) or allowing it to leak backward (regurgitation). Sometimes both problems develop. Any type of heart valve disease can have serious cardiac complications, including heart failure.

Heart valve disease can be tricky to detect because until a fair amount of damage occurs it rarely causes symptoms. Fortunately, during routine medical exams, a doctor can hear through a stethoscope sounds that indicate a potential heart valve problem that can then be diagnosed and the cause pinpointed. Treatment for heart valve disease is almost always surgery to repair or replace the affected structures.

The Four Heart Valves

The human heart has four distinct sections, or chambers, through which blood is pumped: The right atrium and ventricle and the left atrium and ventricle. Each chamber has one opening, a fibrous ring called an annulus, to which two or three leaflets (sometimes called cusps) are attached. Each annulus and its accompanying leaflets make up a single heart valve.

The leaflets function much like one-way swinging doors: As the heart beats, the valve leaflets open and close. When they're open, blood can flow across the valve into the corresponding heart chamber. When the leaflets are closed, new blood can't enter the chamber; nor can the blood already inside the chamber flow backward.

This is key because blood flow through the heart follows a set pattern: The two ventricles propel the blood out of the heart. The right ventricle pumps blood to the lungs, and the left ventricle pumps blood to all other organs. The two atria hold the blood returning to the heart, and at just the right moment empty into the right and left ventricles. 

In order to facilitate this, the valves must open and close at specific times.

  • Tricuspid valve. Located between the right atrium and the right ventricle. When the right atrium contracts, the tricuspid valve opens to allow blood to enter the right ventricle. When the right ventricle contracts, the tricuspid valve closes to prevent blood from leaking back into the right atrium.
  • Pulmonary valve. Located between the right ventricle and the pulmonary artery, which takes blood to the lungs. When the right ventricle contracts, the pulmonic valve opens, allowing blood to flow to the lungs.
  • Mitral valve. Located between the left atrium and left ventricle. It opens when the left atrium contracts to allow blood flow to the left ventricle. When the left ventricle beats, the mitral valve closes and the aortic valve opens to direct the pumped blood into the aorta and out to the body’s tissues.
  • Aortic valve. Located between the left ventricle and the aorta and functions to prevent blood from entering the aorta prematurely. The aortic valve opens when the left ventricle contracts, allowing blood to move from the heart and start the journey to the rest of the body.

Given the intricate way in which the heart valves work in concert with each other and with the other structures of the heart, it's easy to see how damage to even one of them could set off the progression toward heart valve disease and, ultimately, heart failure.

Types of Heart Valve Disease

Any of the four cardiac valves can become either stenotic (blocked) or regurgitant (incompetent, or unable to adequately prevent the backward flow of blood). In extreme cases, a valve can develop both problems. These conditions can vary depending on the specific valves involved.

Valvular Stenosis

When a heart valve becomes stenotic, the cardiac chamber that must push blood across the narrowed valve has to work substantially harder, eventually causing the heart muscle to become hypertrophic. Over time this can lead to the muscle to fail.

Mitral stenosis, the mitral valve becomes thickened, immobile, and unable to open fully. When this occurs, the left atrium cannot empty completely into the left ventricle, producing an increase in left atrial pressure. Over time, significant heart problems can result from mitral valve stenosis.

Pulmonary stenosis most often is associated with congenital disorders including tetralogy of Fallot, Noonan syndrome (a genetic disorder with cardiac abnormalities, short stature, chest deformities, and learning problems), and congenital rubella. Pulmonary stenosis is usually diagnosed at birth or shortly thereafter. If severe, it can produce failure of the right side of the heart.

Tricuspid stenosis, partial obstruction of the tricuspid valve, is the least common of the major valvular diseases. It's most often seen in people who've had rheumatic heart disease and is accompanied by disease in other cardiac valves. Those with significant tricuspid stenosis fatigue easily and aren't able to tolerate physical exertion. Symptoms caused by disease in one of the other valves usually occurs well before tricuspid stenosis begins to produce symptoms.

Aortic stenosis. This partial blockage of the aortic valve makes it difficult for the left ventricle to eject blood out to the body’s tissues. Aortic stenosis leads to hypertrophy of the muscle of the left ventricle, and eventually to heart failure. In addition, if the amount of blood the heart can pump is decreased substantially, syncope (fainting) or even sudden death can occur.

Valvular Regurgitation

Heart valve disease can cause the valve to become incompetent, meaning it fails to close completely and allowing blood to flow backward. Regurgitation causes the affected ventricle to pump a greater volume of blood than normal, which can lead to dilation of the cardiac chambers, weakening of the heart muscle, and eventually heart failure.

Tricuspid regurgitation. In tricuspid regurgitation, blood leaks back from the right ventricle back into the right atrium. Tricuspid regurgitation most often is caused by dilation of the tricuspid annulus that occurs as the result of pulmonary artery hypertension, heart failure, or pulmonary embolus.

Pulmonary regurgitation allows blood to leak across a closed pulmonary valve from the pulmonary artery into the right ventricle. The most common cause of pulmonary regurgitation is pulmonary artery hypertension, which can produce dilation of the pulmonary valvular annulus. If severe, pulmonary regurgitation can cause the right heart to become dilated, and heart failure can occur.

Mitral regurgitation. The most common type of heart valve disease because it has so many causes, such as mitral valve prolapse (MVP), mitral regurgitation produces a backflow of blood from the left ventricle to the left atrium. Mitral regurgitation can cause dangerous enlargement in both the left atrium and left ventricle, and unless it is treated can lead to irreversible heart failure.

Aortic regurgitation. With aortic regurgitation, the aortic valve becomes so leaky that blood washes backward from the aorta into the left ventricle, forcing this chamber to work much harder than it should. If the regurgitation is significant, the ventricle eventually becomes greatly dilated, often leading to heart failure.

Symptoms

In most cases, until actual damage is done to the heart, heart valve disease produces no symptoms. Only when it has progressed to the point of heart failure will discernible symptoms appear.

It follows therefore that once symptoms of heart valve disease develop, what a person is really experiencing are those of heart failure, including:

  • Dyspnea (shortness of breath)
  • Generalized weakness
  • Lightheadedness
  • Edema (swelling) of the ankles, feet, or abdomen

Heart valve disease also increases the risk of arrhythmias, particularly atrial fibrillation, bringing on additional symptoms such as heart palpitations and a low tolerance for physical exertion.

Causes

Heart valve disease can result from a number of different medical conditions. The most common include:

Valvular calcification. With age, calcium deposits can form on the heart valves for no apparent reason. Valvular calcification tends to be especially likely with the mitral valve and, to a lesser extent, with the aortic valve. In many cases, valvular calcification never causes any significant change in the function of the valve, but it can produce either stenosis or regurgitation. Anyone with heart valve calcification should be monitored regularly.

Cardiac dilation. If a heart chamber becomes dilated, it can eventually cause the annulus of the associated cardiac valve to also become dilated, preventing the valve leaflets from closing completely and leading to regurgitation. Cardiac dilation can occur with many kinds of heart disease. Commonly, the dilation that can occur after a heart attack, or with dilated cardiomyopathy, is accompanied by dilation of the mitral valve or tricuspid valve, leading to mitral or tricuspid regurgitation.

Congenital heart disease. Many types of congenital heart disease are associated with valvular deformities that can produce stenosis or regurgitation. The most common types of valve problems seen with congenital heart conditions are pulmonary stenosis, bicuspid aortic valve disease (in which the aortic valve has only two cusps instead of three, which can lead to aortic stenosis), and mitral valve prolapse (an excess of tissue on this particular heart valve).

Infectious endocarditis. An infection of the lining of the heart and especially of the heart valves, infectious endocarditis can lead to heart valve damage, usually regurgitation. This is one condition that may produce acute, and perhaps catastrophic, heart valve regurgitation.

Rheumatic heart disease. Rheumatic heart disease is a form of heart valve damage that can develop as a complication of rheumatic fever, a condition that can occur after an infection with the streptococcus bacteria. Although uncommon in the United States and other Western countries, it is still a major concern in many parts of the world.

Heart valve disease also can result from other medical conditions, including syphilis, connective tissue diseases (such as lupus), various tumors, aortic aneurysmcarcinoid, and radiation therapy of the chest.

Diagnosis

The sooner heart valve disease is diagnosed, the sooner it can be treated—and early treatment is key to preventing extensive and irreversible damage that can lead to heart failure. Given that early-stage heart valve problems aren't likely to cause symptoms, this can be a tall order.

Fortunately, although early heart valve disease is an asymptomatic medical problem, it usually can be detected with a stethoscope (a very good reason to get yearly physical exams). Both valvular stenosis and valvular regurgitation create turbulence of the blood flow that creates a discernible sound (a heart murmur).

In order to definitively diagnose heart valve disease in a patient who has a heart murmur, a doctor will order an echocardiogram, a non-invasive ultrasound test that can distinguish between a heart valve problem and an innocent murmur.

If valvular disease is present, the echocardiogram also can measure the extent of the problem. Several specific measurements can be made of blood flow patterns and cardiac chamber size, and these measurements can be compared to those from subsequent echo tests in order to determine how quickly the valve problem is worsening (if at all).

Treatment

Heart valve disease is fundamentally a mechanical problem and so when treatment is required, surgery to repair or replace the damaged valve is usually the only effective option. Some types of valvular disease can be monitored, however, and only require surgery if they progress.

There also are medications that can be used to alleviate symptoms associated with heart valve disease.

Surgery

Mitral valve stenosis. Treatment is surgical repair or replacement of the mitral valve. Once the need for surgery is established, the optimal type of mitral stenosis surgery needs to be determined for each individual.

Mitral valve regurgitation. The optimal timing of surgical treatment depends on the stage of the regurgitationSeveral surgical approaches are available for treating mitral regurgitation.

Aortic valve stenosis. Mild aortic stenosis needs to be observed closely over time. If the condition becomes advanced enough, surgery may be necessary.

Syncope due to aortic stenosis should be treated as a medical emergency since it indicates that the aortic valve is critically narrowed.

Aortic valve regurgitation. Significant aortic regurgitation requires surgical replacement of the aortic valve.

Tricuspid valve stenosis. Surgical treatment of tricuspid stenosis (which consists of valvular repair rather than replacement) almost always happens as an “add-on” procedure, when surgery is necessary to treat a more severely affected heart valve.

Tricuspid valve regurgitation. Often this condition is relatively mild. One exception: When caused by Ebstein anomaly (a form of congenital heart disease), tricuspid regurgitation often produces severe cardiac problems and requires surgical treatment.

Pulmonary valve stenosis. Mild pulmonary stenosis can be a benign condition that requires no therapy. If the condition is more serious, it can often be treated with balloon valvuloplasty, a minimally invasive catheterization procedure.

Pulmonary regurgitation. The typical treatment for pulmonary regurgitation is to take steps to reduce pulmonary artery pressure. Surgery is not often needed.

Medication

In some cases of heart valve disease, in particular, certain types of valvular regurgitation, in which the valve problem is caused by the dilation of a cardiac chamber, medication can help stabilize the heart and slow progression of damage.

Aggressive medical treatment directed at treating underlying hypertension or dilated cardiomyopathy, or to prevent ventricular remodeling after a heart attack, or even to control the heart rate in atrial fibrillation, for instance, also may lower the risk of significant mitral or tricuspid regurgitation.

You should talk to your doctor about whether you need to take antibiotic prophylaxis for endocarditis.

Living With Heart Valve Disease

If you have heart valve disease, managing your condition is vital to living a long and healthy life. Start by learning everything you can about the type of valvular disorder you have, and the extent of your valve problem. If you are on medications to help your heart work more efficiently, take them regularly and report any trouble with them to your doctor.

Since valvular heart disease often progresses over time, it's vital to keep your regular appointments with your doctor whether you're experiencing problems or not.

Finally, since you have a heart condition, you should do everything you can to reduce your odds of developing other kinds of cardiovascular disease: Don’t smoke; follow a healthy diet and maintain a healthy weight; get plenty of exercise; and, if you have hypertension or diabetes, make sure you have these conditions under control.

A Word From Verywell

Valvular heart disease can be a very serious problem. But with early detection, regular medical follow-up, and the availability of modern medical and surgical care, today most people with heart valve disease can expect to live long and healthy lives.

Was this page helpful?

Article Sources

  1. American Heart Association. Problem: Heart Valve Stenosis. Updated May 31, 2016.

  2. American Heart Association. Problem: Mitral Valve Stenosis. Updated May 31, 2016.

  3. American Heart Association. Problem: Pulmonary Valve Stenosis. Updated May 31, 2016.

  4. American Heart Association. Problem: Tricuspid Valve Stenosis. Updated May 31, 2016.

  5. American Heart Association. Problem: Aortic Valve Stenosis. Updated May 31, 2016.

  6. American Heart Association. Problem: Heart Valve Regurgitation. Updated May 31, 2016.

  7. American Heart Association. Problem: Tricuspid Valve Regurgitation. Updated May 31, 2016.

  8. American Heart Association. Problem: Pulmonary Valve Regurgitation. Updated May 31, 2016.

  9. American Heart Association. Problem: Mitral Valve Regurgitation. Updated May 31, 2016.

  10. American Heart Association. Problem: Aortic Valve Regurgitation. Updated May 31, 2016.

  11. American Heart Association. Symptoms of Heart Valve Problems. Updated May 31, 2016.

  12. American Heart Association. Heart Valve Diagnosis Criteria. Updated May 31, 2016.


  13. American Heart Association. Understanding Your Heart Valve Treatment Options. Updated March 31, 2016.


  14. American Heart Association. Ebstein's Anomaly.


Additional Reading

  • Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the Management of Valvular Heart Disease (version 2012). Eur Heart J 2012; 33:2451.

  • Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.


  • Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation — A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. JASE. Published online: March 14, 2017. doi.org/10.1016/j.echo.2017.01.007