Little Heart Valves Can Cause Big Problems
Four valves in your heart keep blood flowing in the right direction. Most people give no thought to these valves until they malfunction, causing blood to back up in the heart or lungs or preventing enough blood from reaching vital organs.
Due to high pressures on the left side of the heart, the aortic and mitral valves are the most prone to developing problems; in some people, they are just faulty. When valve disease causes symptoms, it’s time to be evaluated by a cardiologist.
“Valve disease does not usually cause chest pain. Most people become short of breath with exercise or when lying flat, or they develop swelling in the feet and ankles,“ says John Barnard, MD, a cardiolo-gist and assistant professor of clinical medicine at Weill Cornell Medical College.
Aortic valve problems
Freshly oxygenated blood exits the heart through the aortic valve on its journey into the body. When the aortic valve works correctly, it prevents blood from flowing backwards into the heart. The aortic valve is a “tri-leaflet” valve, because it has three flaps, or “leaves,” that open and close. The two most common problems that occur with the aortic valve are stenosis and regurgitation.
WHAT YOU SHOULD KNOW
The symptoms of valve disease tend to mimic those of heart failure:
➤ Shortness of breath or fainting with exertion
➤ Inability to breathe when lying down
➤ Swelling in the legs and ankles
As you age, the leaves of the aortic valve can become hard and stiff, and they may fuse together, which prevents the valve from opening wide; this condition is called aortic stenosis. “It’s like a faucet with a water-saving washer that restricts flow,” explains Dr. Barnard. Aortic stenosis is serious. “It will definitely kill you if it goes untreated.”
Sometimes, the three leaves fail to close tightly, or one leaf tears, and blood flows back into the heart, an event called regurgitation.
The good news is that you usually get plenty of warning that these conditions are present.
“We can hear a heart murmur for years before any symptoms appear. Once symptoms develop, there is time to plan. However, half of symptomatic patients die within three years, so we can’t take too long,” he cautions.
There’s no medication that will fix a malfunctioning aortic valve: The valve has to be replaced with a mechanical valve or a bioprosthesis (a valve taken from a pig or cow), usually in a surgical procedure. A less-invasive procedure, called transcatheter aortic valve replacement (TAVR), is gaining favor. In this proce-dure, a catheter is inserted into an artery in the groin, or between the ribs directly into the heart. A balloon is used to crack open the valve and push it aside; then, a bioprosthetic valve is inserted inside the old one.
“As far as we can tell, this valve will last as long as a surgically implanted valve,” says Dr. Barnard.
Currently, TAVR is used only in people who are at especially high risk for surgery, but Dr. Barnard expects that to change in the near future.
Mitral valve woes
Whereas aortic valves open and close like doors, mitral valves are more complicated. “They resemble a sail that is attached to the mast of a boat,” says Dr. Barnard.
Many people have a condition called mitral valve prolapse, in which the valve tissue is too long and loose; this causes the valve to leak . In the majority of patients with mitral valve prolapse, the leakage is minimal, and no treatment is needed. Occasionally, however, the valve will leak a lot or degenerate.
Another type of problem can occur in the structures attached to the mitral valve. Several strands of rope-like structures called chordae, hold the valve, and they are attached to papillary muscles, which anchor them to the wall of the ventricle.
Sometimes, the papillary muscles weaken, or the chordae break, which interrupts proper functioning of the valve. Sometimes, the valve must be repaired or replaced.
Diagnosing valve disease
Valve disease is diagnosed by taking a medical history, noting symptoms, and listening to the heart with a stethoscope for a murmur. Different valves produce different murmurs. The suspicion of valve disease is con-firmed with a simple echocardiogram.
“Symptoms are an important warning. Listen to your body, and if something changes—for example, you usually are able to exercise, and suddenly you can’t due to difficulty breathing—let your doctor know,” says Dr. Barnard.
Whether or not an immediate “fix” is needed depends on the severity of symptoms.
“The heart grows and changes. Nothing fits perfectly. A leaking valve only becomes a problem when the leak is severe or symptoms develop,” says Dr. Barnard.
“With valve disease, we keep our eye on the heart’s function. Patients who are asymptomatic, but who have a heart murmur, need to be followed with echocardiography every few years.”
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