<< Return

The heart has four chambers. As blood is pumped through these chambers it passes through four heart valves -- tricuspid, pulmonic, mitral, and the aortic valve � which open and close to allow blood to flow in only one direction.

The valves control the direction of blood flow through the heart. The opening and closing of the heart valves produce the sound of the heartbeat.  When a heart valve is damaged, it does not work as it should. A damaged valve may narrow and limit blood flow or it may widen and allow blood flow in the wrong direction.

There are many reasons heart valves become damaged, including birth defects, infection, other diseases, or as a natural part of the aging process. Depending on the patient and their  condition, there are several surgical options for valve diseases. 

Aortic Valve Disease 

Description
The two common types of aortic valve diseases are aortic insufficiency and aortic stenosis.

Aortic insufficiency: Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Risk factors
In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen. Other risk factors for valve problems include:

• ankylosing spondylitis  
• aortic dissection  
• endocarditis
• high blood pressure
• Marfan's syndrome  
• Reiter's syndrome  
• syphilis 
• systemic lupus erythematosus  
• valve problems that are present at birth

Symptoms
Patients with aortic insufficiency may present with one or several of the following symptoms:

• chest pain under the sternum, may radiate; crushing, squeezing, pressure, tightness; pain increases with exercise, relieves with rest.
• fainting
• fatigue
• irregular, rapid, racing, pounding or fluttering pulse
• palpitations
• pulse, pounding  
• shortness of breath
• weakness

Back to Top

Aortic stenosis

Description
Aortic stenosis is the narrowing or obstruction of the heart's aortic valve, which prevents it from opening properly and blocks the flow of blood from the left ventricle to the aorta.

Risk factors
Aortic stenosis may be present from birth (congenital) or it may develop later in life (acquired).  Other risk factors include: 

• calcification of the valve 
• male gender
• rheumatic fever

Symptoms

• breathlessness with activity
• chest pain, angina-type under the sternum, may radiate; crushing, squeezing, pressure, tightness; increased with exercise, relieved with rest
• dizziness
• fainting or weakness with activity
• palpitations
• patients with aortic insufficiency may present with one or several of the following symptoms and/or may have no symptoms late in the course of the disease

Diagnostic Tools
Many tests are used to diagnose aortic valve disease.  Usually, more than one test will be done before a definitive diagnosis can be made. These tests may include:

• cardiac catheterization  
• chest x-ray  
• ECG 
• echocardiogram 
• physical examination and patient history    

Treatment Options
Heart valve surgery can be used to replace or repair damaged aortic valves:

• aortic valve repair surgery corrects aortic insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.
• aortic valve replacement surgery corrects both aortic stenosis and insufficiency. 

Surgeons may consider replacing the original valve with either:

•  mechanical valves, created from man-made materials, which require long-term blood thinning with warfarin medication. 
• biological (tissue) valves

Prevention
Steps to prevent or to reduce the risk of aortic stenosis include:

• telling your health care provider if there is a family history of congenital heart diseases
• telling your health care provider or dentist about any history of heart valve disease before treatment for any condition (any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream which can infect a weakened valve causing endocarditis)
• treating strep infections promptly to prevent rheumatic fever , which can cause aortic stenosis.

Back to Top

Mitral Valve Disease

Description
The mitral valve separates the upper and lower chambers on the left side of the heart.  The two common types of mitral valve disease are mitral insufficiency and mitral stenosis. Mitral insufficiency/mitral regurgitation (acute mitral regurgitation)  is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to leak (back-flow) into the left atrium (upper heart chamber) when the left ventricle (lower heart chamber) contracts.

Symptoms
Patients may experience an abrupt onset of symptoms, which may include:

• chest pain -- unrelated to coronary artery disease or a heart attack
• cough
• palpitations
• rapid breathing
• shortness of breath

Back to Top

Mitral stenosis/mitral valve obstruction
Mitral stenosis is a narrowing or obstruction of the opening of the mitral valve, which separates the upper and lower chambers on the left side of the heart. This prevents adequate blood flow between the left atrium (upper chamber) and ventricle (lower chamber).

Risk factors
Risk factors for mitral valve stenosis include rheumatic fever. Since rheumatic fever rates are declining in the United States, the incidence of mitral stenosis is also decreasing. Only rarely do other disorders cause mitral stenosis

Symptoms
Patients may present with no symptoms, or the following symptoms may appear or worsen with exercise or increase in heart rate:

• chest discomfort
• cough
• difficulty breathing
• fatigue
• frequent respiratory infections
• palpitations
• swelling of feet or ankles

Diagnostic Tools
Many tests are used to diagnose mitral valve disease. Usually, more than one test is done before a definitive diagnosis can be made. These tests may include:

• cardiac catheterization  
• chest x-ray  
• ECG 
• echocardiogram 
• physical examination and patient history  

Treatment Options
Heart valve surgery can be used to replace or repair damaged mitral valves:

• Mitral valve repair surgery corrects mitral valve insufficiency;  the damaged valve is strengthened and shortened to help the valve close more tightly
• Mitral valve replacement surgery corrects both mitral stenosis and insufficiency 

Surgeons may consider replacing the original valve with either:

• Mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
• Biological (tissue) valves

Prevention
Mitral stenosis itself often cannot be prevented, but its complications may be prevented. Preventive measures to limit complications may include:

• informing your health care provider of any history of heart valve disease before medical treatment
• taking anticoagulation medication as prescribed
• telling your health care provider if you have a family history of congenital heart diseases or valve disease
• treating strep infections promptly to prevent rheumatic fever  

Back to Top

Tricuspid Valve Disease

Description
The tricuspid valve separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber.  
The two common types of tricuspid valve diseases are tricuspid insufficiency/tricuspid regurgitation  and tricuspid stenosis.

Tricuspid insufficiency/tricuspid regurgitation is a disorder involving backward flow of blood across the tricuspid valve, which separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber).

This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.

Risk factors
The most common cause of tricuspid regurgitation is not damage to the valve itself, but enlargement of the right ventricle, which may be a complication of any disorder that causes failure of the right ventricle.

Rheumatic fever , diet medications such as "Phen-fen" (phentermine and fenfluramine) or dexfenfluramine, and a congenital heart disease (Ebstein anomaly) are also risk factors for tricuspid regurgitation. Rarely, tricuspid regurgitation is caused by an unusual tumor called carcinoid which secretes a hormone which damages the valve. Other infrequent causes of tricuspid regurgitation include endocarditis, rheumatoid arthritis, radiation therapy, Marfan syndrome, and injury.

Symptoms
In the absence of high blood pressure in the lungs (pulmonary hypertension), tricuspid regurgitation is usually asymptomatic. If pulmonary hypertension and moderate-to-severe tricuspid regurgitation coexist, symptoms may include:

• active neck vein pulsations
• decreased urine output
• fatigue, tiredness
• generalized swelling
• swelling of the abdomen
• swelling of the feet and ankles
• weakness

 Prevention
Steps to prevent or to reduce the risk of tricuspid regurgitation include:

• telling your health care provider or dentist if you have a family history of  heart valve disease or any family history of congenital heart diseases before treatment 
• obtaining prompt treatment for conditions that may cause valve disease
• treating strep infections promptly to prevent rheumatic fever

Back to Top

Tricuspid stenosis

Diagnostic Tools
Many tests are used to diagnose tricuspid valve disease. Usually, more than one test is done before a definitive diagnosis can be made. Some of the tests may include:

• cardiac catheterization  
• chest x-ray  
• ECG 
• echocardiogram 
• physical examination and patient history  

Treatment Options
Heart valve surgery can be used to replace or repair damaged tricuspid valves:

• Tricuspid valve repair surgery corrects tricuspid insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.

Tricuspid valve replacement surgery corrects both tricuspid stenosis and insufficiency 

Surgeons may consider replacing the original valve with either:

• Mechanical valves created from manmade materials.
• Biological (tissue) valves

Back to Top
<< Return

Print This Page     Email to a Friend