Valve Conditions

The heart has four valves—mitral, aortic, pulmonary and tricuspid—that open and close to regulate blood flow into, out of and through the chambers of the heart. Problems with the valves, which is considered a structural heart condition, can interrupt blood flow throughout the body.

Conditions that can affect any of the four heart valves include:

• Stenosis: One or more valves do not completely open, reducing blood flow into the next chamber or artery.
• Insufficiency (incompetence, regurgitation): One or more valves do not properly close, allowing blood to leak into the previous chamber.
• Prolapse: A valve does not close properly or closes unevenly, causing it to bulge (prolapse) and allowing blood to leak into the previous chamber.

Causes of Valve Problems

The heart’s four valves — pulmonary, tricuspid, mitral and aortic — open and close to regulate blood flow into, out of and through the chambers of the heart. Blood flow can be interrupted when valve conditions such as stenosis, insufficiency and mitral valve prolapse are present.

Stenosis — When one or more valves do not completely open, blood flow into the next chamber or artery is reduced.

Insufficiency (incompetence, regurgitation) — One or more valves do not properly close, allowing blood to leak into the previous chamber.

Mitral valve prolapse — The faulty mitral valve does not close properly or closes unevenly. Because of the uneven closure, the valve may “bulge” (prolapsed) and may allow blood to leak back into the upper chamber (atrium). When these issues result from birth defects, symptoms can occur in teenagers and people in their 20s, 30s, 40s and 50s.

Symptoms of Valve Conditions

Pediatricians and primary care physicians are often the first people to suspect heart valve conditions. When valves aren’t working properly and cause interruptions in blood flow, a sound called a heart murmur is often produced, which doctors can hear during regular checkups.

Some people with heart valve conditions experience no symptoms at all, or they simply don’t realize they are having symptoms because they come on slowly. In people who do experience symptoms of valve conditions, they may include:

• Heart murmur
• Shortness of breath
• Fatigue
• Heart palpitations
• Chest pain
• Loss of consciousness

When these issues are a result of congenital heart disease, symptoms can occur in teenagers and people in their 20s, 30s, 40s and 50s.

The most important symptom to watch for is a change in the way you feel when going about your normal activities. A subtle change, shortness of breath or unusual feeling when doing your everyday things is a signal from your body that it’s time to see your doctor.

When Should I Go to the Doctor?

The most important symptom for an adult to watch for is a change in the way you feel when going about your normal activities. That may be shortness of breath after a routine 30-minute run. It’s a subtle change or unusual feeling when are doing everyday usual things that signals it’s time to go see your doctor. Always listen to your body. No matter what your age, if doing your normal activities leave you short of breath or just feeling not quite right, see your cardiologist to make sure all is fine.

Diagnosing Valve Conditions

When a heart murmur is heard, further testing by a cardiologist is required to determine the type of valve problem and the extent of damage. Heart murmurs can also indicate heart conditions other than valve problems — another reason testing is important.

Physicians can diagnose about 98 percent of valve disorders with echocardiography. An echocardiogram ("echo") test — also known as cardiac ultrasound — uses standard ultrasound technology to produce 2- and 3-dimensional images of the heart.

Echocardiography is a type of cardiac imaging that uses sound waves to create moving pictures of the heart and its blood vessels at rest and during exercise. Echocardiogram images help cardiologists diagnose, evaluate and monitor many heart conditions. Types of echo tests include:

• Transthoracic 2-D echocardiography (TTE): This common, non-invasive echo study is performed externally, outside of the chest. TTE can be performed using bubbles (to identify problems with cardiac blood flow) or DEFINITY^® contrast (to further clarify imaging).
• Transesophageal echocardiography (TEE): This minimally invasive study can help cardiologists get a closer look at cardiovascular structures if more information is needed after a TTE study. This test requires patients to be sedated. A small flexible tube with an ultrasound device on its tip is advanced through the patient’s esophagus, emitting ultrasound waves so that images of the heart can be recorded.

WakeMed cardiologists use these sophisticated technologies to diagnose even hard-to-see valve disorders, such as those blocked by the chest wall.

In rare cases, cardiac computed tomography (CT) and magnetic resonance imaging (MRI) may be necessary to evaluate and/or diagnose heart valve conditions.

Heart Valve Replacement

While there are non-surgical treatment options, such as transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty, for select patients, the primary intervention for heart valve problems is cardiovascular surgery.

The need for and timing of treatment depends on the severity of the patient’s symptoms, as well as on the severity of the valve condition itself.

Depending upon the valves involved and the severity of the problem, heart valves can be repaired or replaced. When a heart valve must be replaced, heart surgeons can use a biological valve or a mechanical valve.

Age and lifestyle are important considerations for all patients facing heart valve surgery. Physicians prefer to do valve repairs whenever possible, but often replacement is necessary.

Biological Versus Mechanical Valve Replacement

Biological heart valves (those from pig, cows or humans) and mechanical valves (made of manufactured materials) each have benefits and drawbacks.

A mechanical heart valve can last a lifetime. However, because patients with mechanical valves run a greater risk of developing blood clots and stroke, they must take blood-thinning medication for the rest of their lives to decrease this risk. Blood thinners also reduce the risk of valve dysfunction.

Patients with biological valves do not need to take blood-thinning drugs, but they may face another valve surgery. Biological valves can last about 15 years and then must be replaced.

Unless a patient’s other health conditions point the cardiologist in a clear direction, the choice of which type of valve to choose is ultimately up to the patient. Physicians can help them make a choice by considering both their lifestyles and the experiences of other patients in their age group.

Make an Appointment

If you or someone you love one has or is suspected to have a valve condition, make an appointment today with one of WakeMed’s specialized cardiologists.

• Request a Heart and Vascular Appointment
• Refer a Patient (Physicians)