What are valve diseases?

Valvulopathies are a group of diseases that affect the function of heart valves, causing stenosis (narrowing of the opening) and/or insufficiency (incomplete closure).

Heart valves are 'valves' that allow blood to flow one way:

• Mitral valve: between the left atrium and the left ventricle.
• Tricuspid valve: between right atrium and right ventricle.
• Aortic valve: between the left ventricle and the aorta (main artery leading from the heart).
• Pulmonary valve: between the right ventricle and the pulmonary artery (which carries blood to the lungs).

Types of valve dysfunction

Valvular stenosis

Stenosis is the abnormal narrowing of the opening of a valve, which makes it difficult for blood to flow through it. The consequences vary depending on which valve is affected:

• In atrioventricular valves (mitral and tricuspid), stenosis causes blood to accumulate upstream of the valve (in the lungs in the case of the mitral valve and in the body in the case of the tricuspid valve) and insufficient filling of the ventricles. This reduces the heart's ability to pump blood efficiently.

Valve insufficiency (regurgitation)

Insufficiency (or regurgitation) means incomplete closure or failure of a valve to close properly. This allows blood to flow back in the wrong direction:

• In atrioventricular (mitral and tricuspid) valve insufficiency, some of the blood volume that should be pumped by the ventricles will flow back to the atria. The heart's pumping function becomes much less efficient, overtaxing the heart.
• Aortic or pulmonic valve insufficiency causes much of the blood pumped by the ventricles with each beat to flow back into the ventricle. So not enough blood will reach the body (in aortic insufficiency) or the lungs (in pulmonary insufficiency).

Both stenosis and insufficiency cause some chambers of the heart to become enlarged over time, progressively affecting the function of other valves and leading to heart failure and pulmonary hypertension (increased pressure in the arteries that carry blood to the lungs).

It should be noted that from the onset of symptoms related to valvular dysfunction(s), the function of the heart progressively alters at a relatively rapid pace. It is very important that the patient undergoes valve surgery before the onset of significant heart dysfunction, which may be irreversible.

Diagnostics

The essential investigations for the diagnosis of valvulopathies are:

• Echocardiography
• Coronary angiography (mandatory in all patients over 40 or with cardiovascular risk factors)

Treatment

If severe valvular damage or symptoms develop, surgical treatment with valve prosthesis/valve replacement is required.