The heart functions as a powerful pump, circulating blood throughout the body, delivering oxygen and nutrients. Four specialized valves maintain the proper direction of blood flow. Valvulopathy refers to any condition affecting the normal function of these heart valves. When compromised, the heart’s pumping efficiency is impaired, potentially leading to various health issues.
What is Valvulopathy?
The heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The tricuspid valve is between the right atrium and right ventricle, the pulmonary valve between the right ventricle and pulmonary artery. On the left side, the mitral valve separates the left atrium from the left ventricle, and the aortic valve is between the left ventricle and the aorta. These valves have flaps (leaflets or cusps) that open and close with each heartbeat, ensuring blood flows forward and preventing backflow.
When a valve malfunctions, it leads to two primary types of valvulopathy: stenosis or regurgitation. Stenosis occurs when the valve opening narrows, stiffens, or thickens, restricting blood flow. This forces the heart to work harder, leading to structural and functional changes in the heart chambers. For example, aortic valve stenosis, common in older adults, narrows the opening from the left ventricle to the aorta, increasing blood flow resistance.
Regurgitation, also called insufficiency or a “leaky valve,” happens when a valve does not close completely, allowing blood to leak backward. This backward flow reduces the amount of blood effectively pumped forward, making the heart work less efficiently. Mitral valve regurgitation is a common type of backflow, affecting the valve between the left atrium and left ventricle. Sometimes, a valve can have both stenosis and regurgitation, or multiple valves can be affected.
Common Causes
Valvulopathy arises from various factors, some present at birth and others developing over time. Congenital defects, such as a bicuspid aortic valve (two flaps instead of three), are a cause of valvular disease. These defects may not cause symptoms until adulthood.
Age-related degeneration is another common cause, as valve tissues thicken or stiffen over time due to calcium deposits. Conditions like rheumatic fever, an inflammatory disease from untreated strep throat, can scar and damage heart valves. Infective endocarditis, an infection of the heart’s inner lining, can also damage the valves.
High blood pressure can strain the heart and lead to valve issues. Certain autoimmune diseases, such as lupus, and genetic disorders like Marfan syndrome (affecting connective tissue), can also predispose individuals to valve problems. Radiation treatment for cancer, particularly high-dose chest exposure, may cause thickening and narrowing of heart valves.
Symptoms and Diagnosis
Symptoms of valvulopathy vary widely, with some individuals experiencing no noticeable signs for years, especially in mild to moderate cases. When symptoms appear, they often include shortness of breath (at rest, during activity, or when lying down). Fatigue, general weakness, or dizziness are also common. Chest pain, particularly with exertion, and palpitations (skipped beats or a rapid, irregular heartbeat) are also common. Swelling in the ankles, feet, or abdomen (edema) can indicate fluid buildup due to the heart’s reduced pumping ability.
Diagnosis typically begins with a physical examination, where a healthcare professional may detect a heart murmur—an abnormal sound from turbulent blood flow through a narrowed or leaky valve. Several imaging and electrical tests then confirm the diagnosis and assess severity.
Diagnostic Tests
Echocardiogram (echo): Uses sound waves to create moving images of the heart’s chambers and valves, showing blood flow and function.
Electrocardiogram (ECG or EKG): Records the heart’s electrical activity, identifying abnormal rhythms or enlarged heart chambers.
Chest X-ray: Can reveal an enlarged heart or fluid accumulation around the lungs.
Cardiac Catheterization: Involves inserting a thin tube into a blood vessel to obtain detailed images of the heart and blood vessels, helping determine valve damage.
Magnetic Resonance Imaging (MRI): Provides detailed images of heart structures using magnetic fields and radio waves.
Stress Tests: Involve physical activity while monitoring the heart to assess its response to exertion and symptom development.
Treatment Options
Managing valvulopathy involves a combination of approaches, tailored to the specific type and severity of the condition, as well as the patient’s overall health. Initially, lifestyle modifications like a healthy diet and avoiding strenuous exercise may be recommended. While medications cannot cure valvulopathy, they help manage symptoms and prevent the condition from worsening. Diuretics reduce fluid retention and swelling, while blood thinners prevent blood clots, especially if irregular heart rhythms are present. Beta-blockers or other medications regulate heart rate and control irregular heartbeats.
When lifestyle changes and medication are insufficient, surgical interventions are considered.
Valve Repair
Heart valve repair preserves the patient’s existing valve and leaflets. This can involve:
Sewing valve flaps together
Reshaping them
Patching tears
Splitting fused flaps
Repair is often performed for mitral or tricuspid valve regurgitation and is often preferred when feasible due to better outcomes and faster recovery times.
Valve Replacement
Valve replacement surgery removes the damaged valve and implants a prosthetic one. Prosthetic valves are classified into mechanical valves and biological (bioprosthetic) valves.
Mechanical valves: Durable, made from synthetic materials, and can last over two decades. They require lifelong blood thinners to prevent clot formation.
Biological valves: Made from animal tissue (e.g., porcine or bovine pericardium). They generally do not require long-term blood thinners but have a limited lifespan (often 10-15 years).
Surgical replacement can be performed through open-heart surgery or minimally invasive procedures, such as transcatheter aortic valve replacement (TAVR) for aortic stenosis, which involves threading a catheter through a blood vessel to the heart.