Types of Valvular Heart Disease

There are four valves within your heart. They are the mitral, tricuspid, aortic and pulmonic valves. The valves make sure blood flows in only one direction through the heart. Click here to learn more.

What is heart valve disease?

Valvular heart disease occurs when your heart's valves do not work correctly. Valvular heart disease can be caused by valvular stenosis or valvular insufficiency.

In the valvular heart disease condition valvular stenosis, the tissues forming the valve leaflets become stiffer, narrowing the valve opening and reducing the amount of blood that can flow through it. If the narrowing is mild, the overall functioning of the heart may not be reduced. However, the valve can become so narrow (stenotic) that heart function is reduced, and the rest of the body may not receive adequate blood flow.

Another valvular heart disease condition, called valvular insufficiency (or regurgitation, incompetence, "leaky valve"), occurs when the leaflets do not close completely, letting blood leak backward across the valve. This backward flow is referred to as “regurgitant flow.”

	A narrowed or “stenotic” valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body.
stenotic valve
	A regurgitant (incompetent, insufficient, or leaky) valve does not close completely, letting blood move backward through the valve.
regurgitant

Some patients may have both valvular stenosis and valvular insufficiency in one or more valves. Valve disease causes the heart muscle to work harder to circulate the right amount of blood through the body.

What causes heart valve disease?

There are many types of valve disease .Valve disease can be congenital (present at birth) or may be acquired later in life. Sometimes the cause of valve disease may be unknown.

Congenital valve disease is an abnormality that develops before birth. It may be related to improper valve size, malformed leaflets, or an irregularity in the way the leaflets are attached. This most often affects the aortic or pulmonic valve.

Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be:

• Normal aortic valve	Bicuspid aortic valve

  stenotic - stiff valve leaflets that can not open or close properly
• leaky - not able close tightly

This occurs more frequently in some family members. About 1/4 of patients may have some enlargement of the aorta above the valve. Bicuspid aortic valve disease affects about 2 percent of the population.

Acquired valve disease includes problems that develop with valves that were once normal. These may involve changes in the structure of your valve or infection.

Infection

Infective endocarditis and rheumatic fever are the two common infections that cause valve disease.

Rheumatic heart disease

Rheumatic fever causes a common type of valve disease, rheumatic heart disease.

It causes:

• the heart valve leaflets to become inflamed
• may cause the leaflets to stick together and become scarred, rigid, thickened and shortened
• may cause one or more of the valves (most commonly the mitral valve) to become stenotic (narrowed) or leaky

Rheumatic fever is usually caused by an untreated streptococcal infection, such as strep throat. The use of penicillin to treat strep throat can prevent this disease. Rheumatic fever occurs most often in children aged five to fifteen, but symptoms of valve disease may not be seen for years. The valve itself is not infected in rheumatic fever. Antibodies developed by the body to fight the infection react with the heart valves, causing inflammation and eventual scarring.

Endocarditis

Endocarditis is a major infection and can be life-threatening. It occurs when germs (especially bacteria) enter your blood stream and attach to the surface of your heart valves. With endocarditis:

• germs attack the heart valve, causing growths on the valve, holes in the valve or scarring of the valve tissue
• may cause the valve to leak or become stenotic (narrowed)

The germs can enter your blood stream during:

• dental procedures
• surgery
• intravenous (IV) drug use
• severe infections

If you have valve disease (unless you have mild forms of mitral valve prolapse) or have had valve surgery, you are at increased risk for getting this life-threatening infection. Click here to learn more.

Stretching or tearing of chordae tendineae or papillary muscles

Other causes of valve disease include: coronary artery disease, heart attacks, cardiomyopathy (heart muscle disease) , syphilis, hypertension, aortic aneurysms, connective tissue diseases, and less commonly, tumors, some types of drugs and radiation.

Changes in your valve structure can occur due to both acquired and congenital causes. These include:

Stretching or tearing of chordae tendineae or papillary muscles most commonly occurs to the mitral valve. This can be a result of:

• heart attack
• heart valve infection
• trauma

If the chordae become torn or papillary muscles become stretched, the leaflets may flop backward when the ventricles contract (flail leaflet), causing a leaky valve.

Normal mitral valve Mitral valve prolapse Mitral valve prolapse (MVP) is a type of myxomatous valve disease. MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. Is mitral valve prolapse serious? MVP occurs in about 1 to 2 percent of the population and equally in men and women. Most often it is not a cause for concern. Only 1 in 10 patients with MVP eventually require surgery. If the prolapse becomes severe or is associated with torn chordae or flail (floppy, lacking support) leaflets, the leak may be greater, and surgery may be needed. All patients with MVP should ask their doctor if they require measures to prevent endocarditis. Click here to learn more about MVP.

Fibro-calcific degeneration most commonly affects the aortic valve. It most often occurs in adults over the age of 65. This condition can be compared to atheroma in coronary artery disease. The valve leaflets become fibrotic (thickened) and calcified (hardened), producing a narrowed valve opening. Risk factors for this type of valve disease include:

• increased age
• low body weight
• high blood pressure

Dilatation of the valve annulus causes the valve to leak

Dilatation of the valve annulus is a widening or stretching of the annulus. This causes the leaflets to lack support and not close tightly.

Dilatation may occur when the heart muscle is damaged due to:

• a heart attack (heart muscle injury)
• cardiomyopathy (weakened heart muscle)
• heart failure
• advanced stages of high blood pressure
• syphilis
• inherited disorders (such as Marfan syndrome)

Click here to learn more about valve disease