Valvular heart disease is the name given to any dysfunction or abnormality of one or more of the heart’s four valves, including the mitral valve and aortic valve on the left side, and the tricuspid valve and pulmonic valve on the right side. In a normally functioning heart, the four valves (flaps made of tissue) keep blood flowing in one direction and only at the right time. They act as gates that swing open to allow blood to flow through and then tightly shut until the next cycle begins.

According to the American Heart Association’s 2006 Heart and Stroke Statistical Update, valvular heart disease is responsible for nearly 20,000 deaths each year in the United States and is a contributing factor in about 42,000 deaths. The majority of these cases involve disorders of the aortic valve (63 percent) and the mitral valve (14 percent). Deaths due to pulmonic and tricuspid valve disorders are rarer (0.06 percent and 0.01 percent, respectively).

Valvular heart disease in women may pose a greater risk of complications in pregnancy – to the mother and to the fetus. This is largely due to the normal increase in the amount of blood flow to the body from the heart (cardiac output) during pregnancy. Some heart valve conditions, like mitral valve prolapse, are not typically associated with pregnancy complications. Severe aortic stenosis, though, should be corrected before a woman becomes pregnant. Depending on the type of valve disorder, women will be advised to have regular visits to a cardiologist during the course of their pregnancy.

There are a number of types of valvular heart disease, including:

• Atresia of one of the valves. A serious condition in which one of the valves has failed to develop properly and is completely closed at birth. Depending on which valve is affected, the diagnosis may be aortic atresia, mitral atresia, pulmonary atresia or tricuspid atresia.
  
  
• mitral valve prolapse. A common and rarely serious condition in which the two flaps of the mitral valve (located between the left atrium and the left ventricle cannot close properly, and may result in blood leaking back into the left atrium (mitral valve regurgitation). It is due to either one (or both) of the flaps being too large, or because the muscle “hinges” of the flaps are too long.

People who slowly develop valvular heart disease may not notice any symptoms because the heart is given time to adjust. However, valve disease that develops suddenly can cause a variety of symptoms including palpitations, chest pain and edema (swelling) in the ankles, feet or abdomen. Weakness, dizziness and rapid weight gain may also occur. The severity of a patient’s symptoms does not always reflect the severity of their condition. Patients with severe valvular heart disease may have no symptoms and those with severe symptoms only have a minor valve problem that does not require treatment. As a general rule, patients experiencing any new symptoms, or symptoms that are more frequent or severe, should contact a physician.  

The diagnosis of valvular heart disease is usually performed by one of the following tests:

• Physical examination may reveal a murmur, evidence of heart enlargement and fluids within the lungs.
  
  
• An electrocardiogram (EKG) may reveal arrhythmias and chamber enlargement.
  
  
• Echocardiography and a Doppler ultrasound are the most widely used methods, and are very useful in assessment of presence and severity of valve disease.
  
  
• MRI can provide clear three-dimensional images of the heart and its valves.

Treatment for valvular heart disease depends on the type and severity of the diagnosis. People with minor valve problems may not require treatment. Those with more serious disorders can often be treated successfully with medications such as the following:

• ACE inhibitors. Widen blood vessels, lower blood pressure and decrease the workload of the heart (in the case of valvular regurgitation).
  
  
• Antiarrhythmics. Maintain a regular heartbeat and slow rapid heart rhythms. Therefore, the heart beats less frequently but more effectively, pumping more blood through the body.
  
  
• Antibiotics. Help prevent or treat infection.
  
  
• Anticoagulants. Help prevent the formation of blood clots.
  
  
• Diuretics. Lower excess fluid levels in the body.
  
  
• Inotropes. Increase the force of the heart’s contractions.

If medications are not successful or a valve condition worsens interventional procedures and/or surgery may be necessary. These may include heart valve repair or replacement. A heart valve repair may be done by one of the following procedures:

• Percutaneous balloon valvuloplasty. A nonsurgical, catheter-based procedure to treat valvular stenosis.
  
  
• Valvulotomy. A type of open-heart surgery in which the surgeon cuts into a valve to repair valvular damage. One such type is a commissurotomy, a procedure in which narrowed valve leaflets are widened by carefully opening the fused leaflets or commissures with a scalpel. This procedure is mostly used to correct mitral stenosis.
  
  
• Minimally invasive heart valve surgery. A surgical repair of a defective heart valve performed through a small incision (3.5 inches) and partial removal of the upper breastbone (sternum) that involves less risk, fewer complications, less pain, less bleeding and faster recovery by the patient.

If heart valve repair is not an option, a heart valve replacement could be performed. This is an open–heart surgery in which a biological or mechanical valve is used to replace a defective heart valve.