Valvular Heart Disease

Your heart has four chambers: two upper chambers (atria) and two lower chambers (ventricles). You also have four heart valves, one for each chamber of the heart. The valves act as a one-way gate, making sure blood flows in the correct direction.

Valvular heart disease occurs when one or more of your heart valves become damaged or diseased. Leaky or narrowed heart valves disrupt the blood flow through your heart, which puts extra strain on your heart.

Valvular heart disease can affect any of the four heart valves. There are 2 major types of valvular heart disease are:

• Regurgitation (leakage) — The valve does not close tightly enough, which causes blood to leak backwards into your heart instead of going in one direction only. This means your heart works harder to keep enough blood circulating around your body.

• Stenosis (narrowing) — The opening of the valve becomes narrowed and does not open properly, which limits the blood flow through the valve.

The types of valves are:

• Tricuspid valve — between the right atrium and right ventricle
• Pulmonary valve — between the right ventricle and pulmonary artery
• Mitral valve — between the left atrium and left ventricle
• Aortic valve — between the left ventricle and the aorta

These valves work together as the heart muscle contracts and relaxes, opening and closing to let blood flow through the ventricles and out to the body at alternate times.

Most people have one type of valvular heart disease which affects one valve. However, some people may develop problems in more than one valve.

In some cases, there can be both regurgitation and stenosis in a single valve.

Aortic stenosis (narrowing of the aortic valve) is the most common acquired valvular heart disease in developed countries. It is typically due to ageing and is often unpreventable. It is estimated that 10% of adults aged 80 years and older have aortic stenosis.

Mitral regurgitation (leakage of blood backward through the mitral valve) is another common acquired valvular heart disease. It may be due to enlarged heart chambers from weakened and injured heart muscle, mitral valve prolapse, and more uncommonly rheumatic heart disease, infections, and Marfan’s syndrome.

If left untreated valvular heart disease can cause a variety of complications, including:

• Heart failure
• Stroke
• Blood clots
• Irregular heart rhythm (arrhythmia)
• Infective endocarditis
• Death

There are many causes of valvular heart disease, congenital or acquired, including:

• Being born with an abnormal valve (congenital heart disease)
• Degeneration of valve due to ageing
• Previous infections (endocarditis)
• Valve damage and scarring from rheumatic fever (rheumatic heart disease)
• Heart attacks, atherosclerosis (clogged arteries), cardiomyopathy (heart muscle disease), high blood pressure
• Radiation therapy
• Drugs (migraine medication, diet pills)

A doctor would often detect heart murmurs through auscultation with a stethoscope as the first sign of valvular heart disease — a sound that occurs when blood flows through the heart valve that does not open or close effectively.

You may experience mild to moderate symptoms. However, these symptoms often come on gradually and become progressively worse, which eventually leads to heart failure.

Common symptoms include:

• Chest pain
• Palpitations
• Fatigue
• Dizziness or feeling pain
• Shortness of breath
• Ankle swelling
• Rapid weight gain

It is important to note that the symptoms you experience may not necessarily reflect the seriousness of your condition, which is why it is very important to run tests to measure the extent of the damage and to closely monitor the issue.

During your consultation, your cardiologist will take a detailed history and conduct a physical examination. As mentioned earlier, your cardiologist will listen for a heart murmur as this can be a sign of valvular heart disease.

Your cardiologist may also perform the following cardiac tests:

• Electrocardiogram (ECG)
• Echocardiography (transthoracic or transoesophageal)
• Coronary angiography
• Cardiac MRI

The treatment of valvular heart disease depends on the severity of your condition. This usually depends on:

• Which valves are affected
• The number of affected valves
• The extent of damage to the heart valves
• The heart muscle’s ability to function
• Your symptoms and general health

If you are experiencing symptoms, treatment options include:

1.   Medications

Medications are usually meant for symptom relief. Some of the common medications prescribed fall under the following classes:

• Diuretics to reduce water retention in the lungs, legs or other parts of the body.
• Beta-blockers to reduce the strain on the heart.
• ACE inhibitors/ ARBs to treat heart failure.

2.   Percutaneous (minimally-invasive) procedures

Percutaneous balloon valvuloplasty is sometimes used to widen narrowed (or stenotic) valves. It involves inserting a small tube with a balloon at the end into an artery through your groin. The tube is then threaded through and brought to your narrowed heart valve. The balloon is then inflated until the valve opening is sufficiently widened. This procedure is sometimes employed for severely narrowed mitral or aortic valves.

Percutaneous valve repair is used to appose valve leaflets which do not close properly and cause significant regurgitation. It involves inserting a small tube with a clip at the end into a vein through your groin. The tube is then threaded through and brought to your diseased heart valve. The clip is then deployed which brings together the valve leaflets. This procedure is sometimes employed for the mitral valve or the tricuspid valve

Transcatheter valve replacement is an advanced minimally invasive procedure to implant a fully functioning valve over the diseased valve. It involves inserting a small tube with an unexpanded valve at the end into an artery through your groin. The tube is then threaded through and brought to your diseased heart valve. The balloon is then inflated until the new valve is expanded and implanted within the old valve. This procedure is usually performed for aortic stenosis.

3.   Surgery to repair or replace the damaged valve

• Heart valve repair
  Heart valve repair involves patching holes or tears, reshaping the valve or separating the valve leaflets so that they can open and close properly

• Heart valve replacement
  When the heart valves are severely damaged, they can be replaced with a mechanical or biological prosthetic heart valve.Mechanical valves are usually made from biocompatible metals. Biological valves are usually made from animal or human tissue.

You reduce your risk of valvular heart disease by living a heart-healthy lifestyle:

• Stop smoking
• Maintain an active lifestyle as much as your symptoms allow
• Eat a low-fat, well-balanced diet
• Maintain a healthy weight and lose weight if you are overweight
• Manage your blood pressure (reduce stress, reduce salt intake, adhere to medication)
• If you are diabetic, have good control over your diabetes

Valvular heart disease is a condition where one or more of your heart valves become damaged, which can put extra strain on your heart. Many people with valvular heart disease are able to lead full lives. These symptoms can be managed through lifestyle changes, medication, procedural intervention or surgery. The first step to managing this condition is getting a proper diagnosis so that your cardiologist can work with you in discerning treatment best suited to you.