Heart Valve Disease

What are the heart valves?

The heart valves prevent the blood from going backwards through the heart and keep it flowing all in one direction. The heart has a left and a right side, each with two chambers, the atrium and the ventricle. Two valves are situated between the chambers of the heart - on the right the Tricuspid Valve and on the left the Mitral Valve. Another two valves lie between the heart and the major arteries the heart pumps into - on the right the Pulmonary Valve and on the left the Aortic Valve.

What can go wrong with the valves and what symptoms do they cause?

Abnormal valves can be either stenotic (narrowed) or regurgitant (leaky), sometimes a mixture of both. In narrowed valves the size of the opening reduces and can put pressure on the heart and vascular system behind - this is most commonly seen with the aortic
Failure in a valve on the left side of the heart (aortic or mitral valve) can lead to left heart failure with accumulation of fluids on the lungs (pulmonary oedema) causing breathlessness.
Whilst valve diseases of the right side of the heart (pulmonary and tricuspid) arev less of a problem they can lead to right heart failuirewith  fluid accumulation particularly in the legs (peripeherla oedema)

What are the particular valve problems?

These are listed here:

Aortic stenosis - narrowing of the aortic valve. Most commonly now due to calcification (build up of chalk in later life) though some people are born with an abnormal valve (two cusps instead of three) that narrow earlier in life. When severely narrowed the valve can cause angina symptoms, breathlessness and blackouts.

Aortic regurgitation - a leaky aortic valve. The aortic valve may not close properly and blood go back through the valve into the left ventricle - this may happen with a calcified valve. It may also happen when the start of the aorta dilates up stretching the valve. The aortic regurgitation can then cause enlargement of the ventricle and breathlessness.

Mitral regurgitation - a leaky mitral valve. The mitral valve may not close properly and instead of the main left ventricle pumping blood into the aorta some is pumped back into the left atrium. Mitral regurgitation may be caused by a dilated heart in the first place (for example after a heart attack), or by an abnormal valve such as a floppy mitral valve (see below). Severe mitral regurgitation can cause breathlessness.
Mitral stenosis - a narrowed mitral valve. This is less common nowadays in the UK but used to be due to rheumatic fever in childhood affecting the valve, causing breathlessness.

Tricuspid regurgitation - leaking of the tricuspid valve. Though commonly detected this does not usually cause problems, though may show that the blood pressures in the lungs are high (pulmonary hypertension) due to left sided heart problems, pulmonary emboli (clots to the lungs) or lung problems themselves (such as emphysema). Because it is on the right side of the heart it may lead to fluid collection in the legs (oedema).

Tricuspid stenosis - narrowing of the tricuspid valve is rare
Pulmonary stenosis or regurgitation - narrowing or leaking of the pulmonary valve is usual due to congenital problems and picked up at an early age.

What causes these valve problems?

Some of these have been listed under each particular valve lesion above but in general valves can be affected by congenital abnormalities or in later life by degeneration and calcium build up, damage from rheumatic fever, infection (endocarditis, see below), or secondary to a large heart or aorta.

What is endocarditis?

Endocarditis is infection of the heart valves, usually with a bacterial infection. It usually only occurs when the heart valve is abnormal in the first place. It is a serious infection that can d a lot of harm to the valves and may need prolonged hospitalisation and treatment with antibiotics and valve surgery.

Do I need antibiotics to prevent endocarditis?

In the past people with know heart valve problems were advised to take antibiotics before they had dental work to prevent bacteria released from their gums spreading to the valves and causing infection. In fact there is no evidence for this and the same bacteria are released into the blood stream every time teeth are brushed. The latest guidance is that for the majority of people antibiotics should not be used. There are some groups (e.g. in those with previous endocarditis) in who it might be sensible, and in those who have taken antibiotics for years and feel very uncomfortable stopping. If in doubt you should consult your dentists and doctor.

What is a 'floppy mitral valve'?

This is also known as mitral valve prolapse or Barlow's syndrome. A floppy mitral valve is a very common finding - as high as 1 in every 20. The valve leaflets are thickened and lengthened and can prolapsed backwards. However not all floppy mitral valves leak. If they do leak this can worsen putting pressure on the heart and causing breathlessness and he valve may need repair.

How is the problem diagnosed?

Valve problems may be detected because someone goes to their doctor with symptoms such as breathlessness and a murmur (the noise of turbulent blood in the heart) is heard. However quite often a murmur is detected during a routine medical or an assessment for an anaesthetic.
Not all murmurs indicate significant valve problems. The sound of the murmur will give some clues as to the type of valve problem but the common investigations to diagnose further are ECG, chest x-ray and an echocardiogram. The latter is particularly good at seeing the heart directly and looking for valve problems.

What medications can be used?

Diuretics or water tablets can help to get fluid off the chest and legs and can help symptoms. ACE-inhibitors (such as ramipril or perindopril) can be used to help the heart if it is struggling. Warfarin may be needed if there is an increased risk of clot formation, especially if there is atrial fibrillation.

What about surgery?

Damaged valves that are causing symptoms and / or are leading to heart muscle damage can be replaced or repaired by surgical operations. Whilst most of these operations  still entail having the chest opened in some cases surgeons can now use smaller incisions which allow a much quicker recovery time.

In addition some valves (particulary the aortic valve) are new replaced 'percutaneously' via tubes through the skin. This is a rapidly growing area, but at present only those who are felt not fit enough to withstand a full operation are considered. As more experience is gained and we know how these procedures compare in terms of safety and long term results they may well expand.

Please note:

Every effort has been made to ensure that the information on this website is up-to-date and accurate. However, it is intended to serve as a guide only. Symptoms may vary and if you have any medical concerns you should always consult a healthcare professional.