Heart Valve Diseases: Valvulopathies

By Cristiano Antonino Last updated Mar 24, 2023

Valvulopathies, also called valvular diseases, are heart muscle disorders involving the four heart valves: tricuspid, pulmonary, mitral and aortic

The valves function like a swinging door; they open to allow blood to flow from the atria to the ventricles and from the ventricles to the pulmonary or systemic circulation, they close to prevent blood from flowing backwards.

Structural abnormalities and alterations in their function will give rise to diseases that will affect the normal functioning of the heart muscle.

These diseases will range from those that only require periodic check-ups, to those that require replacement or surgical repair.

These diseases will be congenital if present from birth or acquired if they appear later.

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Alterations can be of two types:

stenosis, when there is an incomplete opening
insufficiency, when there is incomplete closure.

Valvular stenosis when they cause an increase in pressure upstream of the diseased valve, which opens incompletely.

When valves narrow (stenosis), blood will have difficulty flowing from the atrium to the ventricle (e.g. mitral stenosis) or from the ventricle to the circulation (e.g. aortic stenosis);

Valve failures when the valve does not close perfectly causing regurgitation of blood in the heart chamber downstream of the valve.

When valves become exhausted or no longer close properly, blood flows backwards, such as from the ventricle to the atrium (mitral insufficiency) or from the aorta to the left ventricle (e.g. aortic insufficiency).

Valvulopathies, the most frequent valve diseases are aortic stenosis and mitral insufficiency

Diseases of the valves of the right sector of the heart, tricuspid and pulmonary, where the blood pressure is lower, are statistically rarer and have congenital causes.

Causes

Congenital valvulopathies are caused by alterations in the embryonic phase and occur in association with other abnormalities.

Acquired valvulopathies, on the other hand, can be caused by:

Age-related degeneration of the valve structures, which will cause the valve tissue to degenerate and calcify;
as a result, the valve will no longer open properly or will tend to progressively shrink, leading to valve stenosis;

Ischaemia or pathologies of the heart muscle that will cause its dilation and impaired contractile function.

An infarction, high blood pressure or heart failure will damage the heart causing progressive dilatation and distortion of the atrio-ventricular valves which will cause blood to flow backwards, valve insufficiency will then occur.

Infections, endocarditis, will see an infection of the heart valves caused by the presence of bacteria, we will be in the presence of infective endocarditis.

Rheumatic fever, will be an infection caused by beta-hemolytic streptococci, can seriously damage the valves of the heart, especially mitral and aortic; it is mainly due to degenerative diseases.

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The Symptoms

The symptoms of valvular heart disease may appear suddenly or progressively over time, symptoms which in the latter case will become apparent after a completely asymptomatic phase that may have lasted for several years.

The most frequent complaints caused by a valvular malfunction are fatigability, dyspnoea, weakness, chest pains, fainting arrhythmias, swelling in the lower limbs, and abdominal swelling.

The diagnosis of a valvular disease is nowadays very easy; with cardiac auscultation and clinical test, the cardiologist with specific instrumental techniques will be able to identify and assess the extent of the problem.

The diagnostic test par excellence in valvular diseases is the echocardiography-colour-Doppler, which will provide detailed information that will make it possible to understand whether it will be necessary to intervene surgically.

It may be necessary to perform cardiac catheterisation, which will provide information on the characteristics of the valvular disease.

Recognising severe valvular disease at an early stage, which may not show any sign of itself, is crucial in order to enable the patient to receive appropriate treatment.

Treatment

There are no drug therapies to treat heart valve disease, but they will allow certain symptoms to be controlled.

In general, the treatment of valvulopathies will be mainly surgical and will see the replacement or repair of malfunctioning valves with biological or mechanical valves.

The mechanical ones will be made of carbon and will require anticoagulant therapy throughout the patient’s life.

Biological ones are made of bovine and porcine material and have a shorter lifespan than mechanical valves.

Risk factors and prevention

Ageing and congenital heart defects do not allow prevention, but by following specific antibiotic therapies it will be possible to prevent all those streptococcal infections that, by affecting the tonsils and pharynx, could cause acute rheumatic fevers.

Prevention will be implemented by following correct lifestyles; smokers will have to stop smoking, and it will be necessary to follow a correct diet and exercise.

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The main risk factors for valvulopathies are:

Old age as with age heart valves become stiff and can calcify;
congenital valvulopathies;
infective endocarditis or rheumatic fever;
ischaemic heart disease or heart failure;
high blood pressure, hypercholesterolaemia, smoking, diabetes, obesity and overweight.

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