Heart Valve: Function, Diseases & Treatment
A heart valve is a structure in the heart that controls blood flow in the correct direction. Heart valve diseases can significantly impair cardiac function.
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A heart valve is a structure in the heart that controls blood flow in the correct direction. Heart valve diseases can significantly impair cardiac function.
What Is a Heart Valve?
The human heart contains four heart valves that act as one-way gates, ensuring that blood flows in the correct direction through the heart chambers and into the major blood vessels. They open and close with each heartbeat, preventing the backflow of blood. The four heart valves are:
- Mitral valve (bicuspid valve): between the left atrium and left ventricle
- Tricuspid valve: between the right atrium and right ventricle
- Aortic valve: between the left ventricle and the aorta (main artery)
- Pulmonary valve: between the right ventricle and the pulmonary artery
Structure and Function
Heart valves consist of thin, flexible tissue structures called valve leaflets (or cusps). The atrioventricular valves (mitral and tricuspid) have leaflets anchored to the ventricular wall via chordae tendineae (tendon-like strings) and papillary muscles. The semilunar valves (aortic and pulmonary) consist of three crescent-shaped cusps that open and close solely due to changes in blood pressure, without muscular attachment.
Heart Valve Diseases
Heart valves can malfunction in two fundamental ways:
- Stenosis: The valve is narrowed and does not open fully, obstructing blood flow.
- Regurgitation (insufficiency): The valve does not close fully, allowing blood to flow backward.
Both conditions can occur simultaneously and, over time, place increased strain on the heart, potentially leading to heart failure.
Causes
Heart valve defects may be congenital (present at birth) or acquired throughout life. Common causes include:
- Congenital heart defects (e.g., bicuspid aortic valve)
- Age-related calcification (degenerative valve disease)
- Rheumatic fever following untreated streptococcal infection
- Bacterial inflammation of the heart lining (endocarditis)
- Heart attack (with damage to papillary muscles)
- Connective tissue disorders (e.g., Marfan syndrome)
Symptoms
Many heart valve defects initially cause no symptoms. As the condition progresses, the following symptoms may develop:
- Shortness of breath, especially during physical activity
- Palpitations or irregular heartbeat (arrhythmia)
- Chest pain or a feeling of pressure in the chest
- Dizziness and fainting episodes
- Fluid retention in the legs and abdomen (edema)
- Abnormal heart sounds (heart murmurs detected during examination)
Diagnosis
Diagnosing heart valve disease involves several examinations:
- Auscultation: Listening to the heart with a stethoscope to detect murmurs
- Echocardiography (cardiac ultrasound): the primary imaging method for evaluating heart valves
- ECG (electrocardiogram): measuring the electrical activity of the heart
- Chest X-ray: assessing heart size and lung condition
- Cardiac catheterization: used when needed to assess the severity of the condition
- Cardiac MRI: detailed imaging in unclear cases
Treatment
Treatment depends on the type, severity, and symptoms of the valve disease:
Medication
Medications can relieve symptoms and slow progression, but cannot correct the structural defect. Commonly used medications include diuretics, ACE inhibitors, beta-blockers, and anticoagulants in cases of atrial fibrillation.
Surgical Treatment
In severe cases, a surgical procedure is often necessary:
- Valve repair: The patient's own valve is repaired and preserved.
- Valve replacement: The diseased valve is replaced with a mechanical or biological prosthetic heart valve.
- TAVI (Transcatheter Aortic Valve Implantation): a minimally invasive procedure to replace the aortic valve without open-heart surgery, particularly suitable for elderly or high-risk patients.
References
- Vahanian A et al. - 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022; 43(7): 561-632.
- Otto CM et al. - 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology, 2021; 77(4): e25-e197.
- Bonow RO et al. - Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th edition, Elsevier, 2022.
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