Heart valve disease is a condition in which one or more of your heart’s four valves don’t work properly, disrupting the normal flow of blood through your heart. An estimated 10.6 million people in the United States have some form of valvular heart disease, and many don’t know it because symptoms can take years or even decades to appear.
How Heart Valves Work
Your heart has four valves, each acting as a one-way gate between chambers or between a chamber and a major blood vessel. The tricuspid valve sits between the right atrium and right ventricle. The pulmonary valve separates the right ventricle from the pulmonary artery, which carries blood to your lungs. The mitral valve connects the left atrium to the left ventricle. And the aortic valve guards the exit from the left ventricle into the aorta, the body’s largest artery.
Each valve has small flaps called leaflets that open and close with every heartbeat. They open to let blood move forward, then snap shut to prevent it from flowing backward. When you consider that your heart beats roughly 100,000 times a day, it’s not surprising that these structures can wear out or become damaged over a lifetime.
Two Main Types: Stenosis and Regurgitation
Valve disease generally falls into two categories based on what goes wrong with those leaflets.
Stenosis means a valve has become narrowed or stiffened, making it harder for blood to push through. When the aortic valve narrows, the heart has to pump harder to force blood out to the body. When the mitral valve narrows, blood has trouble filling the left ventricle, the heart’s main pumping chamber. In both cases, the heart is working against an obstacle it wasn’t designed for.
Regurgitation (also called insufficiency) is the opposite problem. The leaflets don’t close tightly, so blood leaks backward through the valve after each beat. Instead of all the blood moving forward, some of it sloshes back into the chamber it just left. This creates a volume overload: the heart has to handle extra blood with every cycle, which over time causes the heart to enlarge.
Both types force the heart to compensate, and both can eventually weaken it. Some people have a combination of stenosis and regurgitation in the same valve.
What Causes Valve Damage
The most common cause in older adults is age-related calcification. Over decades, calcium deposits build up on the valve leaflets, gradually stiffening them. This is especially common with the aortic valve and typically doesn’t produce symptoms until age 70 or 80. As calcium accumulates, the valve opening progressively narrows, forcing the heart to work under increasing pressure.
Rheumatic fever, a complication of untreated strep throat, remains a significant cause worldwide. The infection triggers scar tissue formation on the valve leaflets, which narrows the opening and creates a rough surface where calcium deposits can later collect. Though rheumatic fever has become less common in developed countries, it still affects millions of people globally.
Other causes include congenital valve defects (being born with a valve that has the wrong number of leaflets or an abnormal shape), infections of the heart lining that damage valve tissue, and conditions that stretch or weaken the heart muscle enough to pull valve leaflets out of alignment.
Symptoms to Recognize
Heart valve disease is often silent for years. Many people live with mild valve problems and feel perfectly fine. When the disease progresses far enough to strain the heart, symptoms typically include:
- Shortness of breath during activity, at rest, or when lying flat
- Fatigue that seems out of proportion to your activity level
- Chest pain or tightness
- Swelling in the ankles and feet
- Dizziness or fainting
- Irregular heartbeat, which you might feel as fluttering or pounding in your chest
These symptoms overlap with many other conditions, which is one reason valve disease often goes undiagnosed. A heart murmur, an unusual sound your doctor hears through a stethoscope, is frequently the first clue.
How It’s Diagnosed
An echocardiogram, essentially an ultrasound of the heart, is the primary tool for evaluating valve disease. It lets doctors see the valves opening and closing in real time, measure how much blood is flowing through, and calculate whether the valve opening has narrowed.
For aortic stenosis specifically, doctors look at how fast blood moves through the valve and how much pressure builds up across it. A severely narrowed aortic valve typically has an opening of 1.0 square centimeters or less, compared to the normal 3 to 4 square centimeters. CT scans that measure calcium buildup on the valve can provide additional confirmation when echocardiogram results are borderline. In some cases, exercise testing helps reveal symptoms or abnormal blood pressure responses that aren’t apparent at rest.
What Happens Without Treatment
Mild valve disease often stays stable for years and may never need more than periodic monitoring. But when significant valve disease goes untreated, the heart gradually loses its ability to compensate. The potential consequences include heart failure, abnormal heart rhythms, blood clots, high blood pressure in the lung arteries, stroke, and in severe cases, cardiac arrest.
The progression varies widely depending on which valve is affected, what type of damage is present, and how quickly it worsens. Some people remain stable for a decade or more. Others, particularly those with severe aortic stenosis, can decline rapidly once symptoms appear.
Repair, Replacement, and Catheter-Based Options
Treatment depends on the severity of the disease, which valve is involved, and your overall health. Mild cases often require only regular monitoring with echocardiograms to track progression. When intervention becomes necessary, the main options are valve repair and valve replacement.
Valve repair preserves your own valve by reshaping, trimming, or reinforcing the leaflets. It’s generally preferred when feasible because it avoids the need for a replacement device. Recovery from a repair procedure, such as mitral valve repair, typically takes four to eight weeks. If the surgery involves a full sternotomy (opening the breastbone), the bone itself needs six to eight weeks to heal. Minimally invasive approaches through smaller incisions heal faster.
Valve replacement swaps the damaged valve for a new one, either mechanical (made from durable materials) or biological (made from animal tissue). The choice between the two involves tradeoffs around durability, the need for blood-thinning medication, and the patient’s age and lifestyle.
For patients who face high risks with open-heart surgery, or increasingly for lower-risk patients as well, transcatheter procedures offer a less invasive alternative. Transcatheter aortic valve replacement (TAVR) has become the most common intervention for severe aortic stenosis in the United States, regardless of surgical risk. A new valve is threaded through a blood vessel, usually in the leg, and positioned inside the old valve without opening the chest.
Five-year data comparing TAVR to traditional surgery in low-risk patients show nearly identical outcomes. The rate of death or disabling stroke at five years was 15.5% for TAVR patients and 16.4% for surgical patients, a difference that was not statistically significant. Valve reintervention rates were also similar: 3.3% for TAVR and 2.5% for surgery. Both approaches resulted in low rates of complications like valve blood clots, and TAVR patients actually had slightly better blood flow through their new valves at the five-year mark.
Many people who undergo valve repair or replacement report getting back the energy and strength they had been missing, often not realizing how much the disease had gradually limited them until the valve was fixed.