About Heart Valves and Heart Valve Disease
What is a heart valve?
The heart has four heart valves: the tricuspid, mitral, pulmonic and aortic valves. Healthy heart valves provide a one-way gate that allows blood to flow only in the desired direction. Each valve opens and closes with every heartbeat. Valves are comprised of thin, strong tissue attached to the heart muscle by a flexible hinge, called an annulus.
The tricuspid valve is located between the right atrium and right ventricle and is composed of three leaflets. In addition to the leaflets, this valve is comprised of relatively undefined valve "ring" (or annulus) that connects the leaflets to the heart, and muscular "chords" that connect the valve leaflets to the heart muscle.
The mitral valve is located between the left atrium and left ventricle and is composed of two leaflets. In addition to the leaflets, this valve is comprised of a valve "ring" (or annulus) that connects the leaflets to the heart, muscular "chords" that connect the valve leaflets to the heart muscle.
The pulmonary valve is the smallest of the four cardiac valves. It is located between the right ventricle and the pulmonary artery (that brings blood from the heart to the lungs to exchange oxygen and carbon monoxide). The pulmonary valve has cusps leaflets and a valvular ring that is attached to the base of the heart.
The aortic valve is located at the junction of the left ventricle and the origin of the ascending aorta. The valve has three cusps, a ring of tissue surrounding the cusps (called the annulus) and structures called the Sinuses of Valsalva, which are pouches between the valve cusps and the wall of the aorta.
What is heart valve disease?
Heart valve disease occurs when the valve cannot open all the way because of disease or injury, so blood has a hard time flowing to the next heart chamber. Or the value does not close completely, and blood leaks backwards. As a result, the heart has to work harder to pump blood or blood may back up in the lungs or lower body.
The cause of valve disease can be a childhood attack of rheumatic fever, a bacterial infection or an injury to the heart. Some people are born with a valve that does not work properly, or the valves may wear out with the aging process. A variety of other problems, including coronary artery disease (blockages in the coronary arteries of the heart), can sometimes cause valve problems.
What is the difference between stenosis and insufficiency?
A stenotic valve has problems fully opening. The valve may be firm or stiff due to scarring or calcium deposits, making it hard for the heart muscle to propel blood through the valve. Blood has to flow through a smaller opening, so less blood gets through the valve into the next chamber. An insufficient valve does not close tightly. The structures that support it may be stretched, loose or torn. Blood leaks backwards ("regurgitation") rather than flowing forward.
How is a valve problem diagnosed?
A history and physical provide important clues. One key indicator of a heart valve problem is the sound ("murmur") made by blood passing through a damaged valve. Diagnostic tests include an echocardiogram (to measure the blood flow across a valve, to visualize the valve structure and its movement, and to assess heart chamber sizes that can change as valve disease progresses),chest x-ray film, electrocardiogram and/or a cardiac catheterization can detect the presence of valve problems and underlying abnormalities as a result of the valve problem (i.e. an enlarged heart or heart rhythm abnormality). Your Inova cardiologist may recommend, based on the diagnostic evaluation, that you have a valve surgically replaced or repaired. Many times, the final decision whether to "replace" or "repair" a valve is not made until surgery, when the Inova Heart Center's cardiac surgeon can look at the valve directly.