Heart Valve Disease

Heart valves can become stiff and narrow, making it harder for blood to flow through. This condition, called valve stenosis, prevents the valve from opening fully and limits blood flow. In severe cases, the valve opening may become so small that the body doesn’t get enough blood.

• Pulmonary valve stenosis: A narrowed pulmonary valve restricts blood flow from the right ventricle to the lungs, making it harder for blood to pick up oxygen and increasing pressure in the heart. This is typically found in people with congenital heart conditions, which are usually present since birth.
• Mitral valve stenosis: A narrowed mitral valve limits blood flow from the left atrium to the left ventricle, leading to fatigue, shortness of breath and fluid buildup in the lungs. This usually occurs when young people have had a history of rheumatic fever or in older people with severe calcification.
• Aortic valve stenosis: A narrowed aortic valve restricts blood flow from the heart to the body, causing the left ventricle to work harder and eventually weaken.

When heart valves don't close properly, blood can flow backward instead of moving forward. This backward flow, called regurgitation, disrupts the heart's one-way blood flow system. It puts extra strain on your heart, making it harder to pump efficiently and reducing the oxygen-rich blood your body needs.

• Tricuspid valve regurgitation: If the tricuspid valve doesn't close fully, blood that's supposed to move from the right ventricle to the lungs leaks backward into the right atrium, causing the atrium to enlarge over time and fluid to build up in the liver, abdomen and legs.
• Pulmonary valve regurgitation: When the pulmonary valve doesn't close properly, blood pumped from the heart to the lungs can leak back into the heart. This mix of oxygen-poor and oxygen-rich blood reduces the amount of oxygen circulating in your body.
• Mitral valve regurgitation: In this condition, some blood leaks backward into the left atrium and then the lungs instead of flowing out to the body, increasing pressure and blood volume in the atrium, potentially causing it to enlarge and leading to fluid buildup in the lungs.
• Aortic valve regurgitation: If the aortic valve doesn't close completely, oxygen-rich blood flows backward into the left ventricle, making the heart work harder to compensate, which, over time, can lead to the left ventricle becoming enlarged, weakened, and increase the risk of heart failure.

Prolapse happens when the flaps (leaflets) of a heart valve move out of place or bulge, preventing the valve from closing properly. This can cause blood to flow backward through the valve, disrupting the heart’s normal one-way blood flow.

• Mitral valve prolapse: In mitral valve prolapse, the mitral valve doesn’t close evenly. Instead, part or all of the valve bulges upward into the left atrium when the heart pumps blood. This may allow a small amount of blood to flow backward (called regurgitation). Mitral valve prolapse is also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome. In most cases, mitral valve prolapse has favorable outcomes and rarely progresses into a more serious condition.
• Other valve prolapses: Prolapse of the tricuspid, pulmonary or aortic valves is much less common than mitral valve prolapse. However, they can also cause the valve leaflets to fail to close tightly, leading to a similar issue with blood flow.

Most valve conditions can't be treated with medication alone. However, if the condition isn't severe enough to need surgery but still causes bothersome symptoms or risks, medication may help manage it for a while.

Medications may be prescribed to:

• Ease uncomfortable symptoms of milder valve problems. Diuretics can reduce excess fluid in your body, decreasing the amount of blood the heart has to pump. This lowers your blood pressure and improves your volume status.
• Help maintain a steady heart rhythm if an arrhythmia (irregular heartbeat) is present
• Reduce the risk of blood clots and stroke

If your heart valve disease has a significant impact on your quality of life, your cardiologist may recommend having a heart valve repair or replacement surgery or procedure. In addition to open heart surgery, advances in technology and innovation have introduced minimally invasive robotic and transcatheter procedures as options.

Your doctor will walk you through your surgical options, which take the valve or valves needing care, your age, the severity of your heart valve disease and other health factors into consideration.

• Balloon valvuloplasty: During a balloon valvuloplasty, your surgeon uses a narrow, flexible catheter to guide a balloon to your heart valve, where the balloon is expanded to help open the flaps of the heart valve. This procedure is not common for aortic valve stenosis, but may be used if you are living with mitral valve regurgitation.
• Annuloplasty: An annuloplasty can be performed through open-heart surgery or minimally invasive surgery. During the procedure, your surgeon sews a band designed to reshape or reinforce the existing ring around your valve to improve its functionality and correct blood flow. This procedure is not used for aortic valve stenosis.
• Transcatheter aortic valve replacement (TAVR): TAVR is a minimally invasive surgery that allows your heart surgeon to repair a damaged aortic valve. Using a catheter, the surgeon guides a new valve to the site of the damaged valve and expands it, pushing the old valve out of the way.
• Transcatheter edge to edge repair (TEER): This procedure uses a similar approach to TAVR but serves to repair damage to the mitral valve. During the procedure, a catheter is used to guide a device that clips mitral valve leaflets together to improve valve closure and reduce leaking.
• Transcatheter tricuspid valve replacement (TTVR): TTVR is a minimally invasive procedure used to treat a damaged tricuspid valve in the heart. Instead of open-heart surgery, a catheter is inserted through a blood vessel (usually the vein in the upper area of your leg/hip) and guided to the right side of the heart to replace the valve.