Valve problems

Symptoms and causes

What is it?

The heart has four cardiac valves: the aortic valve, the mitral valve, the pulmonary valve and the tricuspid valve.

Left side:

The mitral valve is between the left chamber (ventricle) and the anterior chamber (atrium). They facilitate blood flow from the anterior chamber to the chamber.
The aortic valve carries the blood from the left chamber to the aorta. The oxygen-rich blood is brought from the aorta to the entire body.

Right side:

The tricuspid valve is between the right anterior chamber and the chamber. It directs the blood from the right anterior chamber to the right chamber.
The pulmonary valve is between the right chamber and the pulmonary artery. It directs the blood flow of oxygen-depleted blood from the right chamber to the lungs.

By opening and closing on time, the heart valves ensure that the blood flows at just the right moment. If one or more of the cardiac valves fail, the blood cannot be circulated properly. This is referred to as valve problems.

The failing valve can be constricted (allowing less blood through) or leaking (blood flow back).

Valve problems have various causes: The most common causes are congenital defects, age-related calcification or degeneration, connective tissue diseases, heart attack, infection, trauma, medication or drugs.

Symptoms

With valve problems, symptoms only tend to arise once they are at an advanced stage. Many people have no or few symptoms initially.

Possible symptoms include:

shortness of breath
pain or tight feeling in your chest
dizziness (sometimes fainting) with exertion
fluid accumulation in the legs
heart palpitations
fatigue

Causes

Valve problems have various causes: The most common are:

age-related calcification or degeneration
congenital defects (e.g. bicuspid aortic valve)
connective tissue disease (e.g. Marfan's Syndrome)
heart attack
infection
trauma
medication/drugs
other

Diagnosis and treatment

How is the diagnosis made?

Cardiac valve function is analysed in various ways:

Ausculation with a stethoscope
Electrocardiogram
Ultrasound via the chest (transthoracic ultrasound)
Ultrasound through the oesophagus (transoesophageal ultrasound)
Diagnostic cardiac catheterisation

Treatment

Treatment depends on multiple factors, particularly on the type of valve function and the nature of the abnormality.

Medication

Cardiac valves cannot be repaired using medication. The symptoms, such as shortness of breath and/or palpitations, can be (temporarily) controlled or alleviated. Medication makes it so that your heart has to work less hard.

Unblocking or widening the cardiac valve

During a cardiac catheterisation, a narrowed (calcified) valve can be stretched open using a balloon. This treatment is temporary, however, and the disease will return if no definitive treatment follows.

Balloon dilation is the least invasive technique for treating a narrowed (usually calcified) cardiac valve, but is definitely not always the first treatment option, precisely for that reason. Your cardiologist can determine if this is the appropriate treatment for you.

Repair or replacement of the cardiac valve

Surgical procedure

The heart surgeon can repair or replace the failing valve. A valve can be replaced with either an biological or mechanical artificial valve. The choice depends mostly on the patient's age.

Non-surgical aortic valve implantation or transcatheter aortic valve implantation (TAVI)

Approximately 15-20% of the patients with aortic valve stenosis are not candidates for a surgical procedure because they are too old, have a serious secondary disease or have already had a prior treatment. In these patients, it is just in the past few years that an aortic valve operation can be performed via the groin.