What is Heart Valve Disease?

Your heart has four valves, each covered with a set of flaps called leaflets: mitral, aortic, tricuspid, and pulmonary. You develop heart valve disease when one or more of your valves doesn’t work well and forces your heart to work harder to pump blood.

Heart valve disease can stem from birth defects, age-related changes, infections, or other causes. Basically, heart valves can have three types of problems:

• Regurgitation happens when the valve doesn’t close tightly and blood leaks back into the heart rather than flowing into arteries and out to the rest of the body.
• Stenosis occurs when the valve flaps stiffen, keeping the valve from opening all the way and partially blocking blood flow out of the heart.
• Atresia is when the valve doesn’t form correctly and lacks a hole for blood to flow through.

At Mount Sinai Heart, we can diagnose and treat this range of disorders.

Mitral Valve Disease

Mitral valve disease affects the valve located between the heart’s two left chambers. Blood flows from the upper left chamber (called the left atrium) to the lower left (left ventricle). Mitral valve disease refers to any abnormality of this valve and is an extremely common condition. Often, it causes no problems. However, for some people, the disease can be life-threatening. There are several types of mitral valve disease including mitral regurgitation, mitral stenosis, and mitral valve prolapse.

Aortic Valve Disease

As the population ages, Mount Sinai Heart physicians are seeing more cases of aortic valve disease in older people. "Aortic valves are kind of like car valves," Paul Stelzer, MD, Professor of Cardiovascular Surgery says. "Eventually, they just wear out." Aortic valve diseases fall within three categories:

Aortic Stenosis

Aortic stenosis is one of the most common and most serious types of valve disease. It occurs when the aortic valve opening narrows making it harder for blood to push through to the aorta. The ventricle, or bottom two chambers of the heart, becomes overworked, its walls thicken, and the risk of heart attack or heart failure increases. The heart valves are also susceptible to infection when you have aortic stenosis. Signs and symptoms include fatigue, difficulty breathing, chest pain, and fainting.  

Aortic Regurgitation

Aortic regurgitation is also known as aortic incompetence or aortic insufficiency. This disease occurs when blood flows backwards through the aortic valve. People with heart-damaging infections (such as rheumatic fever and high blood pressure) and certain birth defects (for instance, a bicuspid aortic valve) are at higher risk for aortic regurgitation. If regurgitation becomes severe, heart failure may result.

Bicuspid Aortic Valves

Bicuspid aortic valves, which are present at birth, are another abnormality of the aortic valve. Patients affected with this condition have only two aortic valves rather than the usual three. Over time, a bicuspid valve may become narrow due to plaque build-up (stenosis) or incompetent (regurgitant). About a third of people with bicuspid aortic valves will require treatment.

Tricuspid Valve Disease

Tricuspid valve disease occurs between the right atrium (on the top) and the right ventricle (on the bottom). Tricuspid regurgitation, also known as tricuspid incompetence or tricuspid insufficiency, happens when a leaky tricuspid valve causes blood to move backwards into the right atrium. This puts undue pressure on the atrium walls and the nearby veins, causing them to enlarge. An enlarged atrium can cause abnormal heart rhythms, and if left untreated, tricuspid regurgitation may lead to heart failure. We usually see tricuspid regurgitation in conjunction with problems on the opposite side of the heart, such as mitral valve disease or left ventricular dysfunction.

Pulmonary Valve Disease

There are two types of pulmonary valve disease, pulmonary regurgitation and pulmonary stenosis, both of which affect the part of the heart between the right ventricle and the pulmonary artery.

Pulmonary Regurgitation

Pulmonary regurgitation occurs when the pulmonary valve leaks forcing the right side of the heart to work harder. This can lead to heart failure. This condition is usually caused by pulmonary hypertension, heart infections such as endocarditis and rheumatic fever, or a congenital defect. Typically we choose the best treatment based on the cause of the regurgitation.

Pulmonary Stenosis

Pulmonary stenosis happens when there’s an obstruction of the flow of blood to the heart. It usually develops before birth (called congenital), though occasionally occurs as a result of another illness. Mild cases don’t usually get worse, but moderate and serious cases typically require surgery. Treatment is usually very successful. Children born with the congenital disorders Tetralogy of Fallot and Noonan's syndrome are at increased risk of pulmonary stenosis.