National Heart Institute

Valvular Heart Disease

Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.

The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease.

Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).

A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.

The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.

When to Call an Ambulance
When to Call Your Doctor

When to Call an Ambulance
Call an ambulance if you experience severe chest pain.

When to Call Your Doctor
Call your physician if you develop persistent shortness of breath, palpitations or dizziness.

Valve disease symptoms can occur suddenly, depending upon how quickly the disease develops. If it advances slowly, then your heart may adjust and you may not notice the onset of any symptoms easily. Additionally, the severity of the symptoms does not necessarily correlate to the severity of the valve disease. That is, you could have no symptoms at all, but have severe valve disease. Conversely, severe symptoms could arise from even a small valve leak.

Many of the symptoms are similar to those associated with congestive heart failure, such as shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles, hands or abdomen (edema). Other symptoms include:

  • Palpitations, chest pain (may be mild).
  • Fatigue.
  • Dizziness or fainting (with aortic stenosis).
  • Fever (with bacterial endocarditis).
  • Rapid weight gain.

There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life.

  • Rheumatic fever may cause valvular heart disease.
  • Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.
  • High blood pressure and atherosclerosis may damage the aortic valve.
  • A heart attack may damage the muscles that control the heart valves.
  • Heart valve tissue may degenerate with age.
  • Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves.
  • Methysergide, a medication used to treat migraine headaches, and some diet drugs may promote valvular heart disease.
  • Radiation therapy (used to treat cancer) may be associated with valvular heart disease.

Get prompt treatment for a sore throat that lasts longer than 48 hours, especially if accompanied by a fever. Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.

A heart-healthy lifestyle is also advised to reduce the risks of high blood pressure, atherosclerosis and heart attack.

  • Don’t smoke.
  • Consume no more than two alcoholic beverages a day.
  • Eat a healthy, balanced diet low in salt and fat, exercise regularly and lose weight if you are overweight.
  • Adhere to a prescribed treatment program for other forms of heart disease.
  • If you are diabetic, maintain careful control of your blood sugar.

During your examination, the doctor listens for distinctive heart sounds, known as heart murmurs, which indicate valvular heart disease. As part of your diagnosis, you may undergo one or more of the following tests:

  • An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy) and heart-muscle damage from coronary artery disease.
  • Stress testing, also known as treadmill tests, to measure blood pressure, heart rate, ECG changes and breathing rates during exercise. During this test, the heart’s electrical activity is monitored through small metal sensors applied to your skin while you exercise on a treadmill.
  • Chest X-rays.
  • Echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape and movement. Echocardiography also can be used to calculate the ejection fraction, or volume of blood pumped out to the body when the heart contracts.
  • Cardiac catheterization, which is the threading of a catheter into the heart chambers to measure pressure irregularities across the valves (to detect stenosis) or to observe backflow of an injected dye on an X-ray (to detect incompetence).

The following provides an overview of the treatment options for valvular heart disease:

  • Don’t smoke; follow prevention tips for a heart-healthy lifestyle. Avoid excessive alcohol consumption, excessive salt intake and diet pills—all of which may raise blood pressure.
  • Your doctor may adopt a “watch and wait” policy for mild or asymptomatic cases.
  • A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis.
  • Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
  • Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs (see this disorder for more information).
  • More potent anticoagulants, such as warfarin, may be prescribed for those who have atrial fibrillation (a common complication of mitral valve disease) or who continue to experience TIAs despite initial treatment. Long-term administration of anticoagulants may be necessary following valve replacement surgery, because prosthetic valves are associated with a higher risk of blood clots.
  • Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.
  • Valve Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on the patient’s age, condition, and the specific valve affected.

A number of minimally-invasive cardiac surgeries are performed at the Heart and Vascular Institute. These include:

  • Minimally-Invasive Atrial Septal Defect Closure
  • Minimally-Invasive Mitral Valve Repair and Replacement
  • Minimally-Invasive Aortic Valve Replacement

Cardiac Surgery (Valve Surgery) at Johns Hopkins
What is it? You may have had an illness or injury or been born with a problem that does not let a heart valve work the way it should. You may need to have heart surgery to repair or replace the heart valve.

Why is it necessary? You have four valves in your heart. Valve surgery is needed when one of the valves in your heart is not working, which means the blood is not flowing through your heart in the right way. Sometimes the valve can be repaired. Other times the valve must be replaced, either with a valve from a pig or one that is manmade.

How is it done? The surgeon opens the chest by cutting through the breastbone. The surgeon then connects the heart-lung machine. The machine “acts” as the heart and lungs so that the doctor can work on the heart. Once the surgery is done, the heart starts beating and the machine is stopped. The breastbone is wired together to let the bone heal, which takes about four to six weeks.

For more information on this procedure, including patient information, please see the full description of Cardiac Surgery (Valve Surgery) at Johns Hopkins.

Cardiovascular Diagnostic and Interventional Laboratory at Johns Hopkins
The Johns Hopkins Hospital Cardiovascular Diagnostic Laboratory (CVDL) is a state-of-the-art imaging facility performing over 24,000 diagnostic and interventional procedures annually. The CVDL operates 11 procedure rooms.

There are three general areas within the CVDL: Cardiology, Radiology and Electrophysiology. The Cardiology section is involved in treating patients with disorders of the heart and vascular tree including coronary artery disease, congestive heart failure, valve disease, congenital heart defects, cardiomyopathy and peripheral vascular disease.

Valvular Heart Disease services included in the CVDL:

  • Diagnosis of valvular stenosis and regurgitation.
  • Percutaneous mitral valvuloplasty for mitral stenosis.
  • Percutaneous pulmonary valvuloplasty for pulmonic stenosis.
  • Percutaneous aortic valvuloplasty for aortic stenosis.

The Johns Hopkins Coronary Care Unit
The Coronary Care Unit is a 25-bed unit consisting of 13 critical care beds and 12 intermediate care beds. The CCU cares for patients admitted from the emergency department and floors of the Johns Hopkins Hospital as well as many patients referred from outside institutions. Patient diagnoses include the care and management of acute myocardial infarction and complications including cardiogenic shock, post-infarction angina and congestive heart failure. The CCU staff also cares for many other critically ill patients including those with severe cardiomyopathies, valvular heart disease and life-threatening arrhythmias. We have a large support team including experienced nurses, case managers, house staff, cardiology fellows and an attending who oversees the care and management of all the patients.

Extensive services include cardiac catheterization, right heart catheterization, continuous monitoring, physical therapy, nutritional education, risk factor modification education and exercise rehabilitation.