Heart Valve Disease

Valvular heart disease (VHD) occurs when one or more of the heart’s four valves (aortic, mitral, tricuspid, pulmonary) become damaged or dysfunctional, leading to narrowing (stenosis), leakage (regurgitation), or improper closure (prolapse).

VHD can be congenital (present at birth) or acquired due to aging, infections, or cardiovascular diseases. If left untreated, it can lead to heart failure, arrhythmias, stroke, or sudden cardiac death.

• Aortic Stenosis (AS) – The aortic valve becomes narrowed, restricting blood flow from the left ventricle to the aorta.
• Aortic Regurgitation (AR, Aortic Insufficiency) – The valve fails to close properly, causing blood to flow backward into the left ventricle.

Causes:
•       Aging & Calcification (most common cause in the elderly)
•       Congenital bicuspid aortic valve (instead of the normal tricuspid valve)
•       Rheumatic heart disease (causes scarring and narrowing)
•       Endocarditis (infection leading to valve destruction)

Symptoms:
•       Shortness of breath (especially on exertion)
•       Chest pain (angina)
•       Dizziness, syncope (fainting), or palpitations
•       Heart failure symptoms (leg swelling, fatigue, orthopnea)

Complications:
•       Heart failure due to increased cardiac workload
•       Arrhythmias (e.g., atrial fibrillation, ventricular tachycardia)
•       Sudden cardiac death (in untreated severe AS)

• Mitral Stenosis (MS) – The mitral valve becomes narrowed, obstructing blood flow from the left atrium to the left ventricle.
• Mitral Regurgitation (MR, Mitral Insufficiency) – The mitral valve fails to close completely, allowing blood to leak backward into the left atrium.
• Mitral Valve Prolapse (MVP) – The valve bulges (prolapses) into the left atrium, which can cause mitral regurgitation.

Causes:
•       Rheumatic fever (most common cause of mitral stenosis)
•       Mitral valve prolapse (MVP) – Genetic connective tissue disorder
•       Degenerative changes (aging-related valve weakening)
•       Endocarditis (infection leading to valve damage)
•       Marfan syndrome, Ehlers-Danlos syndrome (connective tissue disorders)

Symptoms:
•       Fatigue, shortness of breath
•       Coughing, hemoptysis (coughing up blood) – seen in mitral stenosis
•       Palpitations (especially in mitral prolapse)
•       Swelling in legs and abdomen

Complications:
•       Pulmonary hypertension (due to left atrial pressure buildup)
•       Atrial fibrillation (common in mitral stenosis)
•       Stroke (due to blood clots forming in the left atrium in MS & MR)

• Tricuspid Stenosis (TS) – The tricuspid valve becomes narrowed, impeding blood flow from the right atrium to the right ventricle.
• Tricuspid Regurgitation (TR, Tricuspid Insufficiency) – The valve fails to close properly, causing blood to flow backward into the right atrium.

Causes:
•       Rheumatic heart disease (common in developing countries)
•       Endocarditis (especially in IV drug users – affects the right side of the heart)
•       Pulmonary hypertension (causing right heart strain)
•       Congenital defects

Symptoms:
•       Swelling in legs and abdomen (right-sided heart failure symptoms)
•       Fatigue, cold extremities
•       Jugular vein distention (prominent neck veins)

Complications:
•       Severe right heart failure (fluid overload, hepatomegaly, ascites)

• Pulmonary Stenosis (PS) – The pulmonary valve becomes narrowed, restricting blood flow from the right ventricle to the pulmonary arteries.
• Pulmonary Regurgitation (PR) – The valve fails to close properly, allowing blood to leak backward into the right ventricle.

Causes:
•       Congenital heart disease (e.g., Tetralogy of Fallot)
•       Carcinoid syndrome (causes plaque formation on right-sided valves)
•       Pulmonary hypertension

Symptoms:
•       Shortness of breath, cyanosis (bluish skin)
•       Fatigue, dizziness

Complications:
•       Right ventricular hypertrophy (thickened right ventricle)

• Echocardiography (TTE & TEE) – The gold standard for assessing valve function.
• Cardiac MRI & CT Scan – Provides detailed imaging of heart structures.
• ECG (Electrocardiogram) – Detects arrhythmias or chamber enlargement.
• Cardiac Catheterization – Measures pressures inside the heart and severity of valve disease.
• Chest X-ray – May show heart enlargement, pulmonary congestion.

1. Medical Management (For Mild to Moderate Cases)

Medications

• Diuretics (e.g., furosemide, spironolactone) – Reduce fluid overload.
• Beta-blockers (e.g., metoprolol, carvedilol) – Lower heart rate & reduce workload.
• ACE inhibitors / ARBs (e.g., ramipril, losartan) – Manage hypertension & heart failure.
• Anticoagulants (e.g., warfarin, DOACs) – Used in atrial fibrillation or mechanical valve replacement to prevent stroke.

2. Interventional & Surgical Procedures (For Severe Cases)

Minimally Invasive Procedures

• Balloon Valvuloplasty – Used for stenotic (narrowed) valves, especially mitral stenosis.

Transcatheter Aortic Valve Replacement (TAVR/TAVI)

• Minimally invasive valve replacement for severe aortic stenosis.
• Preferred for older or high-risk surgical patients.

MitraClip (Transcatheter Mitral Valve Repair)

• Used for mitral regurgitation in patients who cannot undergo open surgery.

Surgical Valve Replacement or Repair

• Mechanical Valves (Lasts longer but requires lifelong anticoagulation with warfarin).
• Bioprosthetic Valves (Tissue Valves) (Lower risk of clotting but may need replacement after 10–15 years).
• Valve Repair (Annuloplasty, leaflet repair) – Preferred for mitral and tricuspid regurgitation.

• Heart Failure – Increased strain on the heart.
• Stroke & Embolism – Especially in atrial fibrillation from mitral disease.
• Sudden Cardiac Death (SCD) – Common in severe aortic stenosis.
• Pulmonary Hypertension – Due to left-sided valve disease.
  
  

• Next-Generation Transcatheter Valves – Research into longer-lasting, self-healing valve technology.
• Stem Cell Therapy – Exploring regenerative options for damaged valves.
• Machine Learning & AI in Echocardiography – Improving early detection of valve disease.