Valvulopathy describes any disease or abnormality affecting one or more of the heart’s four valves. These structures are made of thin, strong flaps of tissue, called leaflets or cusps, that operate as precise one-way doors within the heart’s chambers. Their fundamental role is to regulate the direction of blood flow, opening and closing in synchrony with each heartbeat to ensure blood moves forward without leaking backward. When a valve becomes diseased, this flow is disrupted, forcing the heart muscle to work harder to maintain circulation.
How Heart Valves Fail: Stenosis and Regurgitation
Valvular disease manifests mechanically through two primary modes of failure: stenosis and regurgitation. Stenosis is a condition where the valve opening becomes stiffened or narrowed. This change restricts the amount of blood that can pass through, similar to a clogged pipe limiting flow.
When a valve is stenotic, the heart chamber behind it must generate greater pressure to push blood through the opening. This increased workload causes the heart muscle to thicken or enlarge, eventually compromising its ability to pump effectively. Aortic stenosis, the narrowing of the valve leading out to the body’s main artery, is a common example of this obstruction.
The second mechanism of failure is regurgitation, also known as insufficiency. This occurs when the valve leaflets do not close tightly, causing blood to leak backward into the preceding heart chamber.
Regurgitation means a portion of the blood pumped forward immediately returns, reducing the heart’s efficiency. The heart must pump the same blood multiple times, leading to volume overload in the affected chamber. This chronic overfilling and overstretching ultimately leads to dilation and weakens the heart over time.
Primary Causes of Valve Damage
The most common cause of valve damage is age-related degenerative disease. Constant mechanical stress over decades causes wear and tear. This often involves calcium deposits, making the leaflets rigid and thick, leading to progressive stenosis.
Infectious processes, primarily infective endocarditis, are another significant category. This bacterial infection of the heart’s inner lining can rapidly destroy valve tissue. Bacteria adhere to the valve surface, forming vegetation that damages the leaflets and causes acute regurgitation or complete valve failure.
Rheumatic fever is a historical, but still relevant, cause resulting from an untreated Streptococcus infection. The immune response mistakenly attacks the heart valve tissue, leading to inflammation and scarring. This damage, known as rheumatic heart disease, often causes chronic stiffness and fusion of the valve leaflets that may not become symptomatic until adulthood.
Some individuals are born with structural abnormalities, categorized as congenital defects. The most frequent is the bicuspid aortic valve, which has only two leaflets instead of the typical three. This difference creates turbulent blood flow, making the valve susceptible to early calcification and stenosis.
Identifying Symptoms and Diagnostic Methods
The symptoms of valvulopathy result from the heart struggling to maintain adequate blood flow and pressure. Reduced cardiac output commonly leads to chronic fatigue and general weakness, as tissues do not receive sufficient oxygenated blood.
Symptoms often include:
- Shortness of breath, especially during physical activity or when lying flat, resulting from fluid backing up into the lungs.
- Fluid retention, manifesting as noticeable swelling (edema) in the feet, ankles, or abdomen.
- Heart palpitations, which are sensations of a rapid, fluttering, or irregular heartbeat.
- Lightheadedness or fainting episodes caused by reduced blood flow to the brain in severe cases.
The diagnostic process begins with a physical examination, where a physician uses a stethoscope to listen for a heart murmur. A diseased valve creates turbulence in the blood flow, producing this abnormal sound. The timing and location of the murmur often indicate which valve is affected and the type of failure.
The definitive diagnostic tool is the echocardiogram, which uses ultrasound waves to create detailed, moving images of the heart. This non-invasive test allows physicians to visualize the valve structure and quantify the severity of both stenosis and regurgitation. Additional tests, such as an electrocardiogram (EKG) or a chest X-ray, may be used to further evaluate the condition and its effects.
Managing and Treating Valvulopathy
Initial management involves medical therapy aimed at alleviating symptoms and reducing strain on the heart muscle. Diuretics are prescribed to reduce fluid volume, decreasing swelling in the lungs and extremities. Blood pressure medications, such as vasodilators, lower the resistance the heart pumps against, easing its workload.
These medications manage the consequences of a failing valve but do not correct the mechanical problem. When the disease progresses and symptoms become severe, surgical correction is necessary. The two main options are repairing the existing valve or replacing it entirely.
Repair procedures, such as valvuloplasty or annuloplasty, are preferred when feasible because they preserve the patient’s own valve tissue. A surgeon may reshape the leaflets or reinforce the supporting ring to tighten a leaky valve. Repair procedures often result in better long-term heart function and may avoid the need for lifelong anticoagulant medication.
If the valve is too damaged, replacement surgery involves implanting a prosthetic valve. Replacement valves are either mechanical (durable synthetic materials) or tissue-based (derived from animal or human tissue). Mechanical valves require lifelong blood-thinning medication to prevent clot formation, while tissue valves are less durable and typically wear out after 10 to 15 years.