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. 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. A regurgitant (incompetent, insufficient, or leaky) valve does not close completely, letting blood move backward through the valve.
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:
- stenotic - stiff valve leaflets that can not open or close properly
- leaky - not able close tightly
Normal aortic valve
Bicuspid aortic valve
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.
Infective endocarditis and rheumatic fever are the two common infections that cause valve disease.
Rheumatic fever causes a common type of valve disease, rheumatic heart disease
Rheumatic heart disease
Stretching or tearing of chordae tendineae or papillary muscles
- 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 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
- 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. Learn More.
Other causes of valve disease include:
Changes in your valve structure can occur due to both acquired and congenital causes
Stretching or Tearing of Chordae Tendineae or Papillary Muscles
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
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.
Mitral Valve Prolapse (MVP)
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.
Normal mitral valve
Mitral valve prolapse
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. 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
Dilation of the Valve Annulus
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:
Dilatation of the valve annulus causes the valve to leak
- a heart attack (heart muscle injury)
- cardiomyopathy (weakened heart muscle)
- heart failure
- advanced stages of high blood pressure
- inherited disorders (such as Marfan syndrome)
The staff at Cleveland Clinic, the #1 heart hospital in the nation as ranked by U.S. News & World Report, has prepared a free detailed overview on Aortic Aneurysm and treatment options.