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Understanding Valve Disease

Common questions about valve disease:

What is valve disease?
diseased mitral valve. Medical illustration for St. Francis Hospital & Health Centers, IndianapolisValve disease occurs when there is a change in the structure of one of the heart valves that results in a valve no longer functioning the way it should. There is a change in the mechanics and structure of the valve that leads to the dysfunction in the way the valve opens and closes. If it doesn't close properly, the valve will leak; if it doesn't open properly, the valve can impede the flow of blood.

Valve disease can be caused by either stenosis or regurgitation:

Stenosis occurs when the valve(s) opening becomes narrowed or valves become damaged or scarred, inhibiting the flow of blood out of the heart’s ventricles or atria (the chambers of the heart). A narrowed or “stenotic” valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body.

Regurgitation, or a “leaky valve,” occurs when leaflets on the heart valves do not close completely, letting blood move backward through the valve. This backward flow is referred to as “regurgitant flow.”

How do the heart valves function?
Every time your heart beats, blood flows into, through and out of your heart. Your heart moves about 100 gallons (379 liters) of blood through your body every hour.

Blood is pumped through your heart in only one direction. The four heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like "doors“ (called cusps or leaflets) at just the right time, then close then tightly to prevent a backflow of blood.

The valve is made of strong, thin pieces or flaps of tissue called leaflets. The leaflets are attached to and supported by a ring of tough fibrous tissue called the annulus that helps support and maintain the proper shape of the valve. The valve leaflets can be compared to doors opening and closing. The annulus functions as the doorframe.

What are the different types of heart valves?
Valves are one-way doors that protect the heart chambers from overloading. The heart consists of four chambers, two atria (upper chambers) and two ventricles (lower chambers). There is a valve through which blood passes before leaving each chamber of the heart. The valves prevent the backward flow of blood. These valves are actual flaps that are located on each end of the two ventricles (lower chambers of the heart). They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. Normal valves have three flaps, except the mitral valve, which has two flaps.

How do I know if I have valve disease?
Symptoms of valve disease are:

  • Shortness of breath or difficulty catching your breath: You may notice this most when you are doing normal daily activities or when you lie flat in bed.
  • Palpitations: This may feel like a rapid heart rhythm, irregular heart beats, skipped beats or a “flip-flop” feeling in your chest.
  • Swelling of the ankles, feet or abdomen: This is called edema. Swelling may occur in your stomach, causing you to feel bloated.
  • Weakness or dizziness: You may feel too weak to carry out daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.
  • Quick weight gain: A weight gain of two or three pounds in one day is possible.
  • Discomfort in your chest: This may feel like a pressure or weight in the chest with activity or going out in cold air.

If the onset of valve disease is severe and sudden, symptoms can occur quickly. If the disease develops slowly, you may barely notice symptoms. Patients experiencing these symptoms are encouraged to visit the St. Francis Heart Valve Center.

How is valve disease diagnosed?
Your physician, by talking with you about your symptoms and medical history, and by performing a physical exam can help diagnose valve disease. A physical examination may reveal fluid in the lungs, an enlarged heart or a heart murmur, which is the sound made by blood moving through a stenotic or a leaky valve.

Additionally, performing diagnostic tests can help evaluate the extent of valve disease and the best form of treatment. The following are some diagnostic tests a patient may receive:

  • Echocardiogram (echo) - An "echo" is a graphic outline of the heart's movement. High frequency sound-waves are used to provide pictures of the heart's valves and chambers and to look at the pumping action of the heart. Echo is often combined with Doppler ultrasound to detect changes in the blood flow across the heart valves and within the chambers.
  • Transesophageal echocardiogram (transesophageal echo or TEE) - TEE is similar to a Doppler echo. During a TEE, a sound-wave transducer is placed on the end of a special tube (called an endoscope) and passed into the mouth and down the esophagus (food pipe). This allows doctors to get a closer look at the valves, the heart chambers and the back of the heart.
  • Cardiac catheterization (cardiac cath or angiogram) - A catheter is inserted into the patient’s arm or leg and is guided to the heart, contrast dye is injected, and X-ray movies of the coronary arteries, heart chambers and heart valves are taken. 
  • Electrocardiogram (EKG or ECG) - The electrical activity of the heart is recorded on graph paper, using small electrode patches attached to the skin that transmit information to a computer.

Does age affect your risk for valve disease?
Not necessarily. A family history of valve disease and a previously diagnosed heart murmur are two indicators of a possibility of valve disease. If someone has a family history of valve disease, they will need to be evaluated at an earlier age. If someone is told they have a murmur, then they will need to be investigated with an echocardiogram. If patients have one of these two indicators, they should see their physician as soon as possible.

What are the treatment options for valve disease?
Repaired mitral valve - for St. Francis Heart Center, IndianapolisAt the St. Francis Heart Valve Center, physicians and staff use state-of-the-art procedures to determine the type and severity of heart valve disease and plan treatment. The decision to prescribe medical treatment or proceed with surgical repair or replacement is based on the patient’s type of heart valve disease, the severity of damage, the age and medical history.

The surgeons at the St. Francis Heart Valve Center advocate valve repair over valve replacements whenever possible. Valve repair surgery preserves the patient’s own heart valve so blood-thinning medications are not required.

Clear advantages of mitral valve repair versus replacement include: 

  • Lower at the time of operation.
  • Significantly lower long-term risk of stroke and infection.
  • Improved long-term survival.
  • After mitral valve repair, blood thinners are not required, in contrast to the life-long requirement for blood thinners after mechanical mitral valve replacement.