Heart disease related to valvular insufficiency, what consequences for the patient?

By Cristiano Antonino On May 26, 2023

Let’s talk about valvular insufficiency: heart valves are anatomical structures of the heart, whose main function is to regulate the passage of blood within the heart muscle, guaranteeing the unidirectionality of the blood flow thanks to a hermetic closing mechanism that prevents the regurgitation of blood within the heart cavities

Clinical picture of the patient with valvular insufficiency

When a patient presents with structural abnormalities or dysfunctions of the heart valves, he or she may experience very serious pathologies that risk compromising the functioning of the entire cardiac organ, called valvulopathies.

Valvulopathies can be of different types and affect one or more heart valves at the same time: specifically, the main disorders can involve either a stenosis of the valve orifice or a valve insufficiency; they can be either congenital or acquired.

Treatment of the condition varies significantly depending on the nature of the disorder and the extent of the reported symptoms.

In some cases, targeted drug therapy can be used, while in more severe cases, surgery is required.

Anatomy of the heart

Before analysing the disorders that can affect the heart valves, it may be useful to briefly review some of the main anatomical features of the heart.

The heart muscle is divided into two halves, a right and a left part, each of which consists of two distinct chambers through which blood flows, namely the atria and the ventricles.

The right and left hearts are separated by a laminar membrane called the septa: between the right and left atrium is the interatrial septum, while the right and left ventricles are separated by the interventricular septum.

Although the blood circulation within the cardiac compartments is separate, the right and left hearts contract in a coordinated manner: first the atria contract, then the ventricles contract.

Atrium and ventricle of the same half are placed one above the other, respectively, and are put in communication with each other through the atrioventricular valves: blood passes from the right atrium to the right ventricle through the tricuspid valve, while the atrium and left ventricle communicate through the mitral valve.

In addition, the ventricular cavities are equipped with two other heart valves, referred to as the semilunar valves: on the right side of the heart there is the pulmonary semilunar valve, which regulates the passage of blood from the right ventricle to the pulmonary artery, thanks to which carbon dioxide-rich blood reaches the lungs and is enriched with oxygen again; on the left side, on the other hand, there is the aortic semilunar valve, located between the left ventricle and the aorta, the main artery of the human body, which is responsible for transporting oxygenated blood into the body.

The movements made by the heart to pump blood are called systole (contraction phase) and diastole (relaxation phase).

Valvular insufficiency: what are valvulopathies?

When heart valves have structural abnormalities or dysfunctions that impair their function, we speak of valvulopathies.

Valvulopathies can be of different types and can affect any of the heart valves, however, disorders of the left side of the heart (mitral valve and aortic semilunar valve) tend to have a higher incidence, while disorders of the right side (tricuspid valve and pulmonary semilunar valve) are generally of congenital origin or a consequence of other pathological disorders.

Specifically, diseases of the heart valves may include: malformations of the valve structures; stenosis, i.e. a narrowing of the valve orifice leading to inadequate blood supply to the heart muscle; valve insufficiency, i.e. defects in the hermetic closure mechanism that compromise continence.

These conditions may occur singularly or be coexistent with each other, however, in general, valvulopathies are characterised by a progressively degenerative course, which may eventually compromise the functioning of the entire cardiac organ.

Valvular insufficiency

Valvular insufficiency is one of the main disorders associated with heart valves; depending on the valve affected, different types of insufficiency can be distinguished:

Aortic insufficiency
Mitral insufficiency
Tricuspid insufficiency
Pulmonary insufficiency

Heart valves are made up of thin membranes that open and close in a coordinated manner with each heartbeat, allowing blood to move in a single direction; the mechanism of valve opening and closing depends on the pressure gradient, i.e. the difference in pressure between the various cardiac compartments during systole and diastole.

In patients with valve insufficiency, this mechanism is abnormal, resulting in a total or partial lack of adhesion between the valve membranes.

When valves do not close properly, blood tends to flow back into the heart cavity before it, causing a decrease in ejection volume and cardiac output.

In such cases, if the heart fails to adequately pump blood to organs and tissues, these may suffer from hypoxic conditions and nutrient deficiencies.

Furthermore, due to blood regurgitation, the walls of the heart cavities tend to dilate and thicken (hypertrophy), leading to myocardial muscle rigidity and difficulty in contracting, which can result in severe heart failure.

Causes of onset

As already mentioned, valvular insufficiency can be congenital or acquired, i.e. developed over time due to traumatic events, associated pathological disorders or with advancing age.

Although the causes of onset can vary greatly depending on the valve affected, it is possible to identify some of the main factors that lead to valve insufficiency.

First of all, insufficiency can be caused by congenital causes, such as

Malformations, such as a prolapse of the valve, changes in the number of cusps or valvular schisis.
Congenital diseases, such as Marfan syndrome, Ebstein disease or Ehlers-Danlos syndrome.

Valvular insufficiency can also be a consequence of other disorders such as

Associated cardiopathies, in particular dilated cardiomyopathies and severe cardiac arrhythmias.
Presence of other valvulopathies.
Coronary artery disease.
Cardiovascular disease or hypertension.

Lung diseases such as pulmonary stenosis or emphysema, particularly right-sided valvular insufficiency of the heart.

In some cases, valvular insufficiency may have an infectious origin, as in the case of endocarditis or rheumatic fever due to bacterial infections; or it may arise due to inflammatory processes such as:

Systemic lupus erythematosus
Rheumatoid arthritis
Ankylosing spondylitis

Finally, and valve insufficiency may be due to

Myxomatous degeneration
Carcinoid syndrome
Thoracic trauma
Ageing

When no triggering cause can be identified, we speak of idiopathic forms of insufficiency.

What are the main symptoms?

Generally speaking, valvular insufficiency is characterised by a rather slow evolutionary process: in the initial stages, it presents itself in an almost asymptomatic manner, with minimal blood regurgitation; it may take up to several years for the patient to manifest the first symptoms.

As already mentioned, the valvular insufficiency can degenerate over time, leading to increasing difficulties for the myocardial muscle, which can be subjected to considerable stress and can become increasingly dysfunctional.

If the insufficiency arises as a result of violent chest trauma, myocardial infarction or injury due to infection, the onset of symptoms may be sudden.

The main signs of valve insufficiency include

A characteristic heart murmur, due to the turbulence with which blood flows back into the heart cavities;
Dyspnoea or difficulty breathing, particularly following physical exertion;
Sense of fatigue and weakness;
Asthenia or fainting;
Cardiac arrhythmias and palpations;
Angina pectoris, i.e. chest pain;
Abdominal swelling due to blood congestion;
Edema in the lower limbs;
Stroke, due to blood clots formed in the heart cavities that can enter the bloodstream and reach a cerebral artery;
Liver congestion, especially in the case of right-sided valvulopathy.

Diagnosis

Recognising heart valve disease at an early stage is very important in order to intervene promptly and avoid a significant worsening of symptoms: although valvular insufficiency is generally well tolerated by the patient, it can lead to irreversible decompensation if not treated promptly and adequately.

In order to diagnose a valvulopathy, it is necessary to undergo a thorough cardiological examination: during the check-up, the doctor will carry out an objective examination of the patient’s general condition, also assessing the abdomen and limbs to check for fluid accumulation, and will listen to the heart and lungs to detect any murmurs or abnormalities; he will also assess the symptoms reported and investigate the patient’s personal and family history to rule out any present or previous pathologies that may affect the heart.

At the end of the examination, the cardiologist may prescribe some specific tests such as:

Electrocardiogram (ECG)
Echocardiography
Colour Doppler echography
Cardiac catheterisation
Stress test
Chest X-ray (chest X-ray)
Magnetic resonance imaging (cardiac MRI)
Laboratory tests;

Treatment

The treatment of valve insufficiency naturally varies depending on the type of disorder and the valve affected, the extent of the symptoms or the age of the patient.

In general, mild insufficiency does not require treatment, although in some cases it may be appropriate to set up a drug therapy based on:

ACE inhibitors
Anticoagulants
Antiarrhythmics
Diuretics
Digoxin

In more serious cases, surgery is required.

Modern cardiac surgery makes it possible to operate using micro-invasive techniques to repair or reconstruct the malfunctioning valve, working directly on the flaps or ring of the affected valve.

In some cases, it is necessary to remove the diseased valve by surgery to replace it with an artificial or biological type.

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