Heart Valve Defects

A heart valve defect – also called heart valve disease – occurs if one or more of your heart valves fail to function properly. The heart has four valves: the tricuspid, pulmonary, mitral and aortic valves. The tricuspid and mitral valves are located at the bottom of the heart’s two chambers, while the pulmonary and aortic valves are located at the top. These four valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through the heart's chambers and the rest of the body. Heart valves can have three basic kinds of problems: regurgitation, stenosis and atresia.

  • Regurgitation, or backflow, occurs if a valve fails to close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery. Backflow happens when the valve flaps bulge or flop back into an upper heart chamber during a heartbeat. This is called prolapse and mainly affects the mitral valve.
  • Stenosis occurs if 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 if a heart valve lacks an opening for blood to pass through.

Some people are born with a heart valve defect, while others acquire it later in life. Heart valve disease that is present at birth is called congenital heart valve disease. This can occur alone or with other congenital heart defects.

Congenital heart valve disease often 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 lack an opening that allows blood to flow properly.

Acquired heart valve disease usually involves aortic or mitral valves. With this defect, the valves are normal at first, but develop problems over time. Both congenital and acquired heart valve disease can cause stenosis or backflow.

 

Signs and Symptoms of Heart Valve Defects
The main sign is an unusual heartbeat sound called a heart murmur. 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 symptoms. Heart valve disease often worsens over time, so symptoms may occur years after a heart murmur is first heard. Many people who have this disease don't have any symptoms until they're middle-aged or older. Other common signs of heart valve disease include:

  • Unusual fatigue (tiredness)
  • Shortness of breath, especially when you exert yourself, or when lying down
  • Swelling in your ankles, feet, legs, abdomen and veins in the neck
  • Chest pain that may happen only when you exert yourself

You also may notice a fluttering, racing, or irregular heartbeat. Some types of heart valve disease, such as aortic or mitral valve stenosis, can also cause dizziness or fainting.

 

Causes of Heart Valve Defects
Heart conditions and other disorders, age-related changes, rheumatic fever or infections can cause heart valve diefects. These factors change the shape or flexibility of once-normal valves:

  • Heart Conditions and Disorders: certain conditions can stretch and distort the heart valves, such as:
    • Damage and scar tissue due to a heart attack or injury to the heart
    • Advanced, untreated high blood pressure and heart failure can enlarge the heart or the main arteries
    • Plaque build-up in the aorta, the main artery that carries oxygen-rich blood to the body
  • Age-related Changes: Men older than 65 and women older than 75are prone to developing calcium and other types of deposits on their heart valves which stiffen and thicken the valve flaps, limiting blood flow through the valve.
  • Rheumatic Fever: Untreated strep throat or other infections with strep bacteria that progress to rheumatic fever can cause heart valve disease.
  • Infections: Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves.
  • Autoimmune Disorders: Disorders such as lupus, can affect the aortic and mitral valves.
  • Carcinoid Syndrome: Tumors in the digestive tract that spread to the liver or lymph nodes can affect the tricuspid and pulmonary valves.
  • Radiation Therapy: Therapy to the chest area for treating cancer can cause heart valve disease.

 

Diagnosis for Heart Valve Disease
Your doctor can diagnose heart failure based on your medical and family histories, a physical exam and test results. Early diagnosis and treatment may help people live longer, more active lives. Typical procedures and tests include:

  • Electrocardiogram (EKG) – a painless test that records the heart’s electrical activity and can detect an irregular heartbeat, signs of previous heart attack and whether your heart chambers are enlarged
  • Stress Test or Chemical Stress Test – you may walk or run on a treadmill or pedal a bike to get your heart working hard and beating fast, this can show whether you have signs of heart valve disease and assess the severity
  • Echocardiography – uses sound waves to create a moving picture of the heart as it beats, providing information about the size and shape of the heart and how well the chambers and valves are working
  • Chest X-Ray – can determine if you have a valve defect, what type, how severe and whether you have any other heart problems
  • Cardiac Catheterization - a thin, flexible tube called a catheter is inserted into a blood vessel in your arm, groin or neck and threaded into your heart. Through the catheter, the doctor does diagnostic tests and imaging to see whether backflow is occurring through a valve and how fully it opens.

The Marshfield Clinic and Ministry Health Care heart care team currently operate a valve clinic three times per week, allowing patients the ability to be evaluated and diagnosed by multiple board-certified cardiologists, cardiothoracic surgeons and nurse practitioners during a single visit. Click here to schedule an appointment.

 

Treatments for Heart Valve Disease

The kind of treatment(s) you may receive depends on the severity of your condition. Possible treatments include:

  • Heart Surgery
  • TAVI/TAVR
  • Heart Catheterization-Balloon Valvuloplasty
  • Medical management
  • Dental hygiene (to prevent endocarditis)
  • Cardiac Rehab


Frequently Asked Questions

 

Can I live a normal life with a heart valve defect?
Many people have heart valve defects or heart valve disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems. For other people, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots or death due to sudden cardiac arrest.

 

Is there medication that can prevent heart valve defects?
Currently no medicines can cure heart valve disease. However, lifestyle changes and medicines can relieve or improve many of its symptoms and complications.

 

What causes a Heart Valve problem?
Several factors can cause heart valve problems. A heart valve may have a mild defect at birth that will slightly weaken the valve and affect blood flow. Over time, this leads to failure of the valve. Diseases like rheumatic fever or bacterial infections may scar or destroy the valve.

Aging, as well as normal wear and tear of tissues, will weaken or harden heart valves. Consider that a human heart beats more than 100,000 times a day. Your heart valves open and close with each heart beat for your entire life. So the valves must flex, stretch and hold back pressure hundreds of millions of times in an average lifetime.

The mitral and aortic valves on the left side of the heart are most commonly affected by aging because pressures are higher on the left side. The right heart valves can be damaged by infection or pressure from the lungs because of lung disease. When disease causes valves to harden and weaken, they won’t open properly and the blood flow is blocked.

 

What is Heart Valve Surgery?
Heart valves can either be repaired or replaced, depending on the damage. Today these operations are very common and performed to improve health, quality and longevity of life for those with heart valve disease.

Sometimes the surgeon can restore the valve to function normally by remodeling the tissue — removing stretched tissue or sewing the edges. Prosthetic or artificial rings are used to narrow a dilated valve and to reinforce repairs. One advantage of a heart valve repair is that a person’s own valve tissues are used.

Heart valves that are seriously deformed or degenerated cannot be repaired. The old valve is removed and replaced with a new valve mechanism. The new valve is attached by sewing it to a rim of tissue kept from the original valve.

 

What is TAVR?
TAVR stands for Transcatheter aortic valve replacement and is currently used for patients considered “high risk” for open-heart surgery.

TAVR is a procedure that allows heart teams to replace a diseased aortic heart valve without open-heart surgery. This procedure enables the placement of a balloon-expandable heart valve into the body with a catheter, which allows the valve to be inserted through a small cut in the groin into an artery or directly to the diseased valve through a small incision on the left side of the chest. A catheter is a thin, flexible tube that acts as a delivery system.

The Marshfield Clinic and Ministry Health Care heart care team was the first in the region selected to perform this revolutionary procedure.