The heart’s four valves (tricuspid, pulmonary, mitral and aortic) have two important functions in keeping blood pumping throughout the body, both by opening so blood can empty from the heart’s chambers and closing so blood doesn’t flow the wrong way. For valves to work correctly, they must be flexible and properly formed, which allows them to open all the way and close tightly. Problems arise when valves don’t work the way they are supposed to.
The American Heart Association explains that valve issues usually are related to congenital birth defects, advancing age or illness. Heart valve abnormalities detected at birth include aortic valve stenosis, Ebstein’s anomaly and pulmonary valve stenosis, while age-related problems present as degenerative valve disease or valve calcification. Childhood cancer survivors who had radiation therapy to the chest may also experience valve problems later in life. Additionally, infective endocarditis, rheumatic fever and injury may also be responsible for causing valve disease.
The following conditions and factors may also contribute to valve problems:
- Autoimmune disorders (lupus, for example)
- Carcinoid syndrome
- Marfan syndrome
- Metabolic disorders
- Diet medicines (fenfluramine and phentermine)
Physicians often detect valve abnormalities when listening to the heart with a stethoscope, as a heart murmur can indicate problems. While some murmurs are harmless, others can indicate one of the following four types of valve issues:
- Stenosis: blood supply is limited due to a narrowing or stiffening valve
- Regurgitation: valves let blood flow back into the chamber
- Prolapse: a valve with leaflets that close improperly
- Atresia: a missing or improperly formed valve
Valve disease can be tricky because a person can be completely asymptomatic, or symptoms may progress so slowly that it’s difficult to notice a change. Symptoms such as chest pain, fatigue, shortness of breath, lightheadedness, fainting, or swelling in the ankles, feet or abdomen can indicate problems with heart valves, but their level of severity doesn’t necessarily indicate the extent of a person’s valve issue. Regular checkups with a primary care physician can be crucial in detecting issues like valve disease that aren’t always easy to spot.
While valve disease impacts people of all ages, it is more common in older adults and is increasing in incidence due to extended life expectancy. Calcium deposits that build up naturally can cause valves to thicken and become stiff, which can lead to problems. Other heart problems that are more likely to occur as we age such as heart attacks, heart failure, arrhythmia or previous congenital heart defects can lead to valve issues later in life.
Physicians have a range of diagnostic tests to detect heart valve problems, which are often initially discovered simply by listening to a patient’s heartbeat with a stethoscope. If a murmur is detected, a patient may then be sent for an echocardiogram, exercise test, chest x-rays, CT scan and/or exploratory cardiac catheterization, depending on what the medical team is looking for. Various tests and procedures are used to determine the appearance and function of and/or damage to a patient’s heart valves.
Depending on the severity of valve disease, a patient may be put on medication to help relieve symptoms and prevent further damage if their condition is mild. Since valve disease is usually progressive, however, a patient may eventually require valve repair or replacement surgery. Valve replacement is usually preferred but is a more difficult procedure to perform.
Surgeons can add tissue to patch damaged valves or provide more support at the valve’s base, as well as separate fused valve flaps and repair valves so they can close properly. Some patients may be candidates for catheter procedures, which are less invasive but not always as successful as surgery.
Patients who undergo valve replacement receive a man-made or biological valve made from pig, cow or human heart tissue. Biological valves must be replaced after 10 to 15 years while man-made valves are built to last, but patients with man-made valves must take blood thinners to prevent blood clots and are also at higher risk of infection. People needing aortic valve replacements may have their faulty valves replaced with a pulmonary valve, but this procedure is not without complications either. Patients should work with their health care team to evaluate the best strategy for managing their cardiac care.