Valvular Heart Disease

Valvular heart disease is the name given to any dysfunction or abnormality of one or more of the heart's four valves, including 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 flow though and then tightly shut until the next cycle begins. 

About five million Americans are  diagnosed with valvular heart disease each year.  According to the American Heart Association's 2003 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 aortic valve (63 percent) and mitral valve (14 percent).  Deaths due to pulmonic and tricuspid valve disorders are more rare (0.06 percent and 0.01 percent, respectively).

Valvular heart disease in women may pose a greater risk of complications in pregnancy-to herself and to the fetus.  This is largely due to the otherwise normal increase in cardiac output during pregnancy.  Some heart valve conditions, like Mitral valve prolapse, 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 pregancy.

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

• Valvular stenosis. A condition in which there is a narrowing, stiffening, thickening, fusion or blockage of one or more valves of the heart. As a result, the defective valve can interfere with the smooth passage of blood that should be flowing through it. Depending on which valve is affected, the diagnosis may be aortic stenosis, mitral stenosis, pulmonic stenosis or tricuspid stenosis.
  

• Valvular regurgitation. A condition in which blood leaks back in the wrong direction because one or more of the heart’s valves is closing improperly. The nature and severity of the leakage, in turn, may keep the heart from circulating an adequate amount of blood through the defective valve. Depending on which valve is affected, the diagnosis may be aortic regurgitation, mitral regurgitation, pulmonary regurgitation or tricuspid regurgitation.

• 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. 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.

Treatment for valvular heart disease depends on the type and severity of the diagnosis. Many patients can be treated successfully with medications such as the following:

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

If medications are not successful, then 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.

Instead of a heart valve repair, 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.