Heart valve disease

What is heart valve disease?

Heart valve disease occurs when the heart's valves do not work correctly. The heart has a total of four valves that ensure that the blood only flows in one direction, i.e. from the atria to the ventricles, from where the blood is pumped out of the heart, either to the lungs or to the rest of the body.

Heart valves can be narrowed (heart valve stenosis) or they can become unable to close properly (regurgitation), and the heart muscle has to work harder to compensate for these defects. Over time, this excess strain may lead to heart failure. In a particularly high number of cases, it is the valves on the left side of the heart that are affected: the aortic valve, which is situated between the left ventricle and the aorta, and the mitral valve, which is situated between the left atrium and the left ventricle.

What are the main symptoms?

Patients with mild valve disease often remain asymptomatic. As a result, the disease is usually only found by chance: either during a cardiac ultrasound examination, or because distinctive heart sounds are detected during auscultation with a stethoscope. Advanced valve disease produces symptoms of heart failure:

• Shortness of breath during exercise; cough
• Sometimes dizziness and fainting
• Edema in the legs or feet
• Valve disease is frequently accompanied by cardiac arrhythmias (e.g. severe palpitations).

What are possible causes?

In rare cases, heart valve disease develops before birth, i.e. is congenital. More frequently, however, heart valve disease is seen to develop later in life, for instance as a result of: 

• Atherosclerosis, particularly in older people
• Inflammation of the heart valves
• Heart attack

Diagnosis of heart valve disease

• Auscultation using a stethoscope: often, heart valve disease is detected as a result of distinctive heart sounds
• Cardiac ultrasound scan (echocardiogram) to assess the type and extent of heart valve disease present
• Cardiac catheterization can provide detailed information on the type of problem affecting valve function, thus assisting with treatment planning.
• ECG for the assessment of cardiac arrhythmias

Treatment for heart valve disease

• Medication
• Catheter-based procedures
• Surgical procedures

Medication

Less severe cases of heart valve disease can be treated with medication. This approach is particularly suited to managing heart failure  and cardiac arrhythmias.

Catheter-based procedures

Certain severe cases of heart valve disease can be treated using catheter-based procedures to repair the heart valves. This type of procedure involves a physician inserting a special catheter via an artery in the groin, and then advancing it all the way to the heart. The procedure then allows the physician to either widen a narrowed aortic valve (aortic valve stenosis), or to replace it with an expandable prosthetic valve. In patients with mitral regurgitation, whose mitral valves no longer close properly, the physician can use a special metal clip to hold together the mitral valve leaflets, thus significantly reducing mitral regurgitation.

Surgical procedures

Many patients with heart valve disease require surgery. An experienced surgeon can sometimes repair a diseased valve using reconstruction techniques. In many cases, however, the valve will need to be replaced with either a mechanical or a tissue valve.

One advantage of metal or synthetic prosthetic valves is their almost unlimited durability. The main disadvantage of prosthetic valves is that patients have to take anticoagulant medication for the rest of their lives in order to prevent the formation of dangerous blood clots around the valves.

Although this is not necessary in patients fitted with porcine or bovine tissue valves, these valves only have a life span of approximately 10 years.
  

Nowadays, different models are available for both types of heart valve, ensuring that prosthetic valves can be selected to suit the individual patient's internal anatomy. This means, for instance, that there are heart valves specifically for patients with a very narrow aorta, as well as heart valves for very young patients. Careful selection of the appropriate heart valve is paramount and must be made based on the individual patient's requirements.

Where can I find out more about heart valve disease?

General information

Deutsche Herzstiftung (German Heart Foundation)
www.herzstiftung.de