- Valvular heart disease (VHD) refers to any abnormality or dysfunction of one or more of the heart’s four valves: the mitral, aortic, tricuspid, and pulmonic valves. These valves function as one-way gates, ensuring that blood flows efficiently and in the correct direction through the heart’s chambers and into the circulation. When valves fail to open or close properly, the heart’s workload increases, blood flow becomes inefficient, and a range of cardiovascular complications can develop. VHD is a significant global health problem, affecting millions of people, with its causes and prevalence varying between high-income and low-income regions.
- Valvular disease typically presents in two main forms: stenosis and regurgitation (insufficiency). In stenosis, a valve becomes narrowed, restricting blood flow through its opening; the heart must generate higher pressure to push blood forward, leading to hypertrophy of the affected chamber. In regurgitation, the valve fails to close completely, allowing blood to leak backward and causing volume overload in the preceding chamber. Valves can also be affected by prolapse, as seen in mitral valve prolapse, where the valve leaflets bulge backward into the atrium during systole, sometimes leading to regurgitation. Over time, these changes can compromise cardiac output, strain the myocardium, and contribute to the development of heart failure, arrhythmias, and thromboembolic events.
- The causes of valvular heart disease are diverse and may be congenital or acquired. Congenital valve malformations, such as bicuspid aortic valve, often remain silent until adulthood but predispose individuals to early degeneration and complications. Acquired causes include rheumatic heart disease, still common in developing countries, which results from an autoimmune response to group A streptococcal infection and leads to progressive valve scarring and deformity. In industrialized nations, degenerative (calcific) valve disease predominates, particularly calcific aortic stenosis in the elderly, caused by progressive wear, tear, and calcium deposition. Other causes include infective endocarditis, trauma, connective tissue disorders (such as Marfan or Ehlers-Danlos syndrome), and radiation therapy to the chest.
- Clinical manifestations depend on the specific valve involved, the severity of dysfunction, and the rate of progression. Aortic stenosis often presents with chest pain (angina), syncope, and exertional dyspnea—the classic triad of symptoms. Mitral stenosis may cause breathlessness, palpitations, and fatigue, often linked to left atrial enlargement and atrial fibrillation. Mitral regurgitation produces exertional dyspnea, fatigue, and eventually left-sided heart failure. Tricuspid valve disease can result in peripheral edema, ascites, and hepatomegaly, while pulmonic valve disease is less common and usually congenital. In early stages, VHD may be asymptomatic, with detection occurring only through characteristic murmurs heard on auscultation.
- Diagnosis of valvular heart disease combines clinical evaluation with imaging. Echocardiography is the cornerstone diagnostic tool, providing detailed information on valve anatomy, motion, regurgitant flow, and pressure gradients. Doppler studies allow quantification of stenosis severity and regurgitation volume. Chest X-ray, electrocardiography (ECG), and cardiac MRI may offer complementary data on heart size, rhythm disturbances, or myocardial involvement. In certain cases, cardiac catheterization is performed for hemodynamic assessment and surgical planning.
- Management of VHD depends on the valve involved, severity, symptoms, and underlying cause. In mild or asymptomatic disease, treatment focuses on monitoring progression and controlling contributing factors such as hypertension, arrhythmias, or infections. Medical therapy, including diuretics, vasodilators, and anticoagulants, may relieve symptoms or prevent complications but does not reverse valve pathology. For severe disease, surgical or interventional procedures are often required. Options include valve repair (particularly effective for the mitral valve) or valve replacement using mechanical or bioprosthetic valves. Transcatheter techniques, such as transcatheter aortic valve implantation (TAVI/TAVR), have revolutionized treatment for high-risk or elderly patients with aortic stenosis. Long-term follow-up is essential, as patients with prosthetic valves may require lifelong anticoagulation and monitoring for complications like thrombosis, infection, or valve degeneration.
- The prognosis of valvular heart disease varies widely. Some forms progress slowly and remain stable for years, while others deteriorate rapidly, leading to heart failure, arrhythmias, and premature death if untreated. Early detection, timely intervention, and ongoing advances in minimally invasive valve therapies have greatly improved outcomes. Nevertheless, rheumatic heart disease continues to be a leading cause of VHD and premature death in many low- and middle-income countries, underscoring the importance of preventive strategies, including streptococcal infection control, improved healthcare access, and public health awareness.
