Valve disorders

There are several different kinds of valve disorders, and each of them can be classified as mild, moderate or severe. Untreated, they may lead to dizzy spells, shortness of breath, faintness, irregular pulse or serious complications. Fortunately, many valve disorders are treatable with medications, surgery or other medical techniques. Read more about the different heart valves and how they work.

Heart valves are delicate but very durable. They open and close more than 100,000 times each day. In most people, the heart valves function perfectly, day after day and year after year, but age, heart problems and diseases such as congenital heart disease and rheumatic heart disease can damage or cause these valves to function improperly.

Symptoms
Diagnosis
Treatment

Types of valve disorders

Stenosis (narrowing)
Sometimes, age or disease can prevent heart valves from opening properly. The valves become narrower, and this narrowing is called stenosis. As the opening narrows, the heart cant push as much blood through as before. Valve stenosis makes the heart less efficient. Because stenosis makes the heart work harder to pump the same volume of blood, it may also lead to an increase in the size of the heart muscle. Unfortunately, larger doesnt mean stronger or more efficient when it comes to hearts. In fact, enlargement of the heart muscle may lead to serious complications.

There is another subtype of stenosis known as Pulmonary valve stenosis which is a narrowing or obstruction that partly or completely blocks the flow of blood. Obstructions can occur in heart valves, arteries or veins. The pulmonary valve (which lets blood flow from the right lower chamber of the heart to the lungs) is narrowed. As a result, the right lower chamber (right ventricle) must pump harder than normal to overcome the obstruction. This may cause stress on, and enlargement of, the right ventricle.

Prolapse (slipping out of place)
In valve prolapse, the valve flaps do not close smoothly or evenly. Instead, they collapse backwards into the heart chamber they are supposed to be sealing off. This sometimes makes a clicking noise and allows a small amount of blood to lea k backward through the valve. This group of conditions may be called mitral valve prolapse, click-murmur syndrome, Barlow's syndrome, balloon mitral valve and floppy valve syndrome.

Regurgitation (backwards flow)
Another common problem occurs when a heart valve doesnt close securely. This is called regurgitation (or sometimes called valvular insufficiency). This condition reduces the hearts pumping efficiency. When the heart contracts, blood is forced backwards through the damaged valve as well as forward in the proper direction. This not only limits the hearts ability to supply the body with blood but may cause problems with the lungs.

Symptoms

Angina  (chest pain) is often a sign that the heart muscle is not getting enough blood. This may be because a valve disorder is reducing the hearts ability to pump enough blood to supply the heart muscle. Excessive fatigue can result if the heart isnt able to supply the needs of the bodys cells.

Palpitations are irregular heartbeats caused by problems with the hearts electrical system. They can sometimes be the result of heart valve disorders that make the heart work harder and grow larger. As the heart becomes enlarged, its electrical system often begins to malfunction.

Shortness of breath is sometimes the result of a narrowing (stenosis) of the one of the hearts valves. The heart cannot pump the required amount of blood through the narrowed mitral valve, and so blood backs up into the lungs (something like a traffic jam "backing up" from a bottleneck). The result is a sensation of breathlessness. If untreated, this may result in a serious medical problem known as congestive heart failure.

Swelling swelling can also be a symptom of heart valve disorders. Sometimes, valve problems may cause blood to back up in other parts of the body. This may result in fluid buildup and cause swollen hands, wrists, feet or ankles.

How are valve disorders diagnosed?

Cardiac catheterization
Chest X-ray
Electrocardiogram (ECG/EKG)
Echocardiogram

Treatment

Medications
Several different types of medications are available to help relieve the symptoms caused by heart valve disorders.

ACE inhibitors
Anticoagulants
Beta blockers
Digoxin (Digitalis)
Diuretics

Surgical and other procedures
If your doctor thinks you need surgery for a heart valve disorder, he or she will discuss the operation with you. Then, you can decide whether to go ahead with surgery or not.

Valve repair

• Valvuloplasty In a valvuloplasty, surgeons "sew" the torn flaps of the damaged valve together, so that the valve can close properly again.
• Annuloplasty An annuloplasty is a surgical procedure which repairs the ring (in medical terms the annulus) which holds the valve in place.
• Valvulotomy A valvulotomy is the surgical repair of a valves flap or annulus.
• Percutaneous mitral balloon valvotomy A less intrusive procedure to open blocked (stenosed) mitral valves. A catheter is inserted into a vein in the right leg and guided up into the mitral valve. There, a small balloon on the end of the catheters tip is inflated, opening the blocked valve.

Valve replacement
If heart valves are too badly damaged to be repaired, doctors may recommend surgically replacing the damaged valve. This is a major operation, involving open-heart surgery. The actual operation can last three hours or longer, and takes several weeks to recover.

Human heart valves may be replaced with mechanical valves, or with specially prepared heart valves from human or animal donors (known as bioprosthetic or tissue valves).

• Mechanical valves were the first type used in valve replacement surgery. Made of long-lasting metal and plastic, their design has been refined and improved since their introduction in the 1960s. While mechanical valves are very durable, they do make a clicking noise and they can promote the formation of blood clots, which may lead to heart attack or stroke. To prevent clot formation, patients with mechanical valves must take blood-thinning medication every day for the rest of their lives. This might have implications for women of childbearing age. Please consult your doctor if this applies to you.
• Bioprosthetic valves are sometimes called tissue valves and made from specially treated natural valves. These valves come from two sources: human donors and animals. Valves from animal sources (usually cows or pigs) are very similar to those found in the human heart. They are well tolerated by the body, and do not promote clot formation to the same degree as mechanical valves. On the other hand, bioprosthetic valves from pigs or cows are usually not as durable as the mechanical kind. More than half develop problems within 15 years. In these cases, patients must undergo further surgery. Human heart valves are well tolerated and tend to last longer than animal valves.

Lifestyle
You can lower your risk of heart disease by knowing and controlling your blood pressure, diabetes and blood cholesterol. It is also important to lead a healthy lifestyle by being smoke-free and physically active, eating a healthy diet that is lower in fat, especially saturated and trans fat, achieving and maintaining a healthy weight, limiting alcohol use and reducing your stress.

Last reviewed April 2007.