Heart Valve Disease: Symptoms, Causes & Treatment

Heart valve disease refers to conditions in which one or more of the heart’s valves do not open or close properly. Heart valves act as one-way doors that regulate blood flow through the heart chambers. When a valve is diseased, blood flow becomes disrupted, forcing the heart to work harder to maintain adequate circulation.

Valve disease may develop gradually over many years or appear more suddenly, depending on the cause. Some people remain symptom-free for long periods, while others develop significant limitations if the condition progresses.

How Heart Valves Normally Work

The heart has four valves—the aortic, mitral, tricuspid, and pulmonary valves. These valves open and close in a precise sequence with each heartbeat, ensuring that blood moves forward efficiently and does not leak backward.

Healthy valves open fully to allow unobstructed blood flow and close tightly to prevent regurgitation. Any disruption in this process alters normal heart function.

Types of Heart Valve Disease

Heart valve disease generally falls into two main categories, depending on how valve function is affected.

Valve Stenosis

Valve stenosis occurs when a valve becomes narrowed and does not open fully. This restricts blood flow and increases pressure within the heart chamber behind the valve. Over time, the heart muscle may thicken or weaken as it works harder to overcome the obstruction.

Valve Regurgitation

Valve regurgitation occurs when a valve does not close properly, allowing blood to leak backward. This backward flow reduces the efficiency of each heartbeat and may eventually cause the heart chambers to enlarge and weaken.

Some patients may have a combination of both stenosis and regurgitation affecting the same valve.

Types of Heart Valve Disease by Valve Involved

Heart valve disease is further classified based on which valve is affected, as each valve has unique features and treatment considerations.

Aortic Valve Disease

The aortic valve controls blood flow from the heart to the rest of the body. Disease of this valve often involves narrowing (aortic stenosis) or leakage (aortic regurgitation).

Aortic valve disease can significantly limit blood flow and may cause chest pain, shortness of breath, dizziness, or fainting. Severe aortic valve disease often requires valve replacement, either surgically or through catheter-based techniques in selected patients.

Mitral Valve Disease

The mitral valve regulates blood flow between the left atrium and left ventricle. Mitral valve disease commonly causes backward leakage of blood (mitral regurgitation) or impaired opening (mitral stenosis).

Symptoms may include fatigue, shortness of breath, and palpitations. Mitral valve disease is closely associated with atrial fibrillation. Valve repair is often possible and preferred when appropriate.

Tricuspid Valve Disease

The tricuspid valve lies between the right atrium and right ventricle. Disease of this valve is often caused by enlargement of the right side of the heart or long-standing pressure overload.

Tricuspid valve disease may lead to swelling of the legs and abdomen, fatigue, and liver congestion. Treatment focuses on addressing underlying causes, with repair or replacement considered in advanced cases.

Pulmonary Valve Disease

Pulmonary valve disease affects blood flow from the heart to the lungs. It is less common in adults and is often related to congenital heart conditions.

Symptoms depend on severity and may include shortness of breath or exercise intolerance. Many cases are monitored, while intervention is reserved for more significant dysfunction.

Symptoms of Heart Valve Disease

Symptoms often develop gradually and may initially be subtle. As valve dysfunction progresses, the heart’s ability to compensate diminishes.

Common symptoms include shortness of breath, fatigue, reduced exercise tolerance, chest discomfort, dizziness, palpitations, or swelling of the legs and ankles. Some people experience fainting, particularly with severe valve narrowing.

Because symptoms may appear late, regular follow-up is important once valve disease is diagnosed.

Common Causes of Heart Valve Disease

Valve disease can result from a variety of conditions. Age-related degeneration is a common cause, particularly affecting the aortic and mitral valves. Previous infections, including rheumatic fever, can damage valve structure and function.

Other causes include congenital valve abnormalities present from birth, heart attacks that affect valve support structures, cardiomyopathies, and infections of the heart valves known as endocarditis.

How Heart Valve Disease Is Diagnosed

Diagnosis begins with a physical examination, where abnormal heart sounds or murmurs may be detected. Echocardiography is the most important diagnostic test, allowing detailed assessment of valve structure, motion, and severity of dysfunction.

Additional testing may include electrocardiography, chest imaging, exercise testing, or advanced cardiac imaging to further evaluate heart function and guide treatment decisions.

Treatment Options for Heart Valve Disease

Treatment of heart valve disease depends on which valve is affected, the type and severity of dysfunction, the presence of symptoms, and the overall condition of the heart. The goal is to relieve symptoms, protect heart function, and prevent long-term complications.

Monitoring and Medical Management

Mild valve disease may require regular follow-up without immediate intervention. Periodic echocardiography is used to monitor valve function and detect progression before symptoms develop.

Medications are often prescribed to control symptoms or associated conditions. These may include drugs to manage blood pressure, reduce fluid buildup, control heart rate, or treat arrhythmias such as atrial fibrillation. While medications can significantly improve symptoms and reduce strain on the heart, they do not correct the structural valve abnormality.

Valve Repair Procedures

When feasible, valve repair is preferred over valve replacement because it preserves the patient’s own valve structure and normal heart mechanics.

Valve repair techniques aim to restore normal valve motion and prevent leakage. Surgical repair may involve reshaping valve leaflets, tightening or reinforcing the valve ring (annuloplasty), or correcting abnormal supporting structures such as chordae tendineae.

In selected patients, catheter-based valve repair techniques can be used without open-heart surgery. One well-established example is transcatheter edge-to-edge repair, commonly performed with devices such as MitraClip, which reduces mitral valve leakage by bringing the valve leaflets closer together. Similar catheter-based approaches are increasingly used for selected tricuspid valve diseases.

Valve repair is most commonly performed for mitral and tricuspid valve disease and, when successful, can significantly improve symptoms while reducing the need for long-term anticoagulation.

Valve Replacement Procedures

When a valve is too damaged to be repaired, valve replacement becomes necessary. In this procedure, the diseased valve is replaced with either a mechanical valve or a biological (tissue) valve, each with specific advantages and considerations.

Valve replacement can be performed through traditional open-heart surgery or, in selected patients, using transcatheter valve replacement techniques that avoid open surgery. A widely used example is Transcatheter Aortic Valve Replacement (TAVR), in which a new valve is implanted through a blood vessel, most commonly to treat severe aortic stenosis.

Similar catheter-based replacement techniques are being developed and used for other valves in carefully selected cases. These minimally invasive approaches can reduce recovery time and procedural risk in appropriate patients.

The choice between surgical and transcatheter valve replacement, as well as the type of valve used, depends on the valve involved, patient age, symptom burden, anatomical considerations, and overall health status.

Timing of Intervention

One of the most important aspects of valve disease management is timing. Intervening too early may expose patients to unnecessary risk, while intervening too late may result in irreversible heart damage.

Decisions are based on symptom status, valve severity, heart chamber size, and heart function, and are best made through careful follow-up and shared decision-making.

Heart Valve Disease and Heart Rhythm Disorders

Valve disease increases the risk of arrhythmias, particularly atrial fibrillation. Enlargement of heart chambers and changes in pressure create an environment that favors rhythm disturbances, which may further worsen symptoms and outcomes.

Managing both valve disease and associated arrhythmias is often essential for optimal care.

Living With Heart Valve Disease

Many people with heart valve disease live active lives with appropriate monitoring and timely treatment. Regular follow-up, adherence to medical advice, and prompt reporting of new symptoms are key to preventing complications.

Early diagnosis and advances in valve therapies have significantly improved outcomes and quality of life for patients with valve disease.

In Summary

Treatment of heart valve disease ranges from careful monitoring to advanced procedural and surgical interventions. Modern repair and replacement techniques allow individualized treatment tailored to valve type, disease severity, and patient needs. Early diagnosis and appropriate timing of intervention are essential to preserving heart function and improving long-term outcomes.

Reference: Heart valve diseases