| Valvular heart disease | |
|---|---|
| Classification and external resources | |
| ICD-10 | I34-I37, I05-I08, Q22-Q23 |
| ICD-9 | 394-396, 424, 746 |
| MeSH | D006349 |
Valvular heart disease is any disease process involving one or more of the valves of the heart (the aortic and mitral valves on the left and the pulmonary and tricuspid valves on the right). Valve problems may be congenital (inborn) or acquired (due to another cause later in life). Treatment may be with medication but often (depending on the severity) involves valve repair or replacement (insertion of an artificial heart valve). Specific situations include those where additional demands are made on the circulation, such as in pregnancy.[1]
Contents |
| Valve involved | Stenotic disease | Insufficiency/regurgitation disease |
| Aortic valve | Aortic valve stenosis | Aortic insufficiency/regurgitation |
| Mitral valve | Mitral valve stenosis | Mitral insufficiency/regurgitation |
| Tricuspid valve | Tricuspid valve stenosis | Tricuspid insufficiency/regurgitation |
| Pulmonary valve | Pulmonary valve stenosis | Pulmonary insufficiency/regurgitation |
Pulmonary and tricuspid valve diseases are right-side heart diseases. Pulmonary valve diseases are the least common heart valve disease in adults.[2]
The most common types of pulmonary valve diseases are:
The International Statistical Classification of Diseases classifies non rheumatic pulmonary valve diseases as I37.
Both tricuspid and pulmonary valve diseases are less common than aortic or mitral valve diseases due to the lower pressure those valves experience.[2]
Complications arise when the flow of blood is obstructed from leaving the right ventricle and making its way into the pulmonary artery, or once blood is in the pulmonary artery, the blood has the ability to flow back into the right ventricle. When blood has a difficult time making its way from the right ventricle into the pulmonary artery due to the pulmonary valve area being: Too narrow, deformed in some capacity (e.g., one of the leaflets of the valve is too thick, misshaped, or doesn't separate from another leaflet), or the vessel above or below the valve being deformed in such a way as to prevent the proper flow of blood, the term "pulmonary valve stenosis" is used.
Heart valve dysplasia is an error in the development of any of the heart valves, and a common cause of congenital heart defects in humans as well as animals; tetralogy of Fallot is a congenital heart defect with four abnormalities, one of which is stenosis of the pulmonary valve. Ebstein's anomaly is an abnormality of the tricuspid valve.[1]
Valvular heart disease resulting from rheumatic fever is referred to as "rheumatic heart disease". While developed countries once had a significant burden of rheumatic fever and rheumatic heart disease, medical advances and improved social conditions have dramatically reduced their incidence. Many developing countries, as well as indigenous populations within developed countries, still carry a significant burden of rheumatic fever and rheumatic heart disease and there has been a resurgence in efforts to eradicate the diseases in these populations. Inflammation of the heart valves due to any cause is called endocarditis; this is usually due to bacterial infection but may also be due to cancer (marantic endocarditis), certain autoimmune conditions (Libman-Sacks endocarditis) and hypereosinophilic syndrome (Loeffler endocarditis). Certain medications have been associated with valvular heart disease, most prominently ergotamine derivatives pergolide and cabergoline.[3]
The evaluation of individuals with valvular heart disease who are or wish to become pregnant is a difficult issue. Issues that have to be addressed are the risks during pregnancy to the mother and the developing fetus. In individuals who require an artificial heart valve, consideration must be made for deterioration of the valve over time (for bioprosthetic valves) versus the risks of anticoagulation during pregnancy.
The following table includes the main types of valvular stenosis and regurgitation. Major types of valvular heart disease not included in the table include mitral valve prolapse, rheumatic heart disease and endocarditis.
| Valvular disease | Mitral stenosis | Aortic stenosis | Aortic regurgitation | Mitral regurgitation | Tricuspid regurgitation |
|---|---|---|---|---|---|
| Prevalence | Most common valvular heart disease in pregnancy[4] | Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85[5] | 2% of the population, equally in males and females.[6] | ||
| Main causes and risk factors | Almost always caused by rheumatic heart disease[7] |
Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process.[8] |
Acute
Chronic
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Acute
Chronic |
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| Hemo dynamics / Patho- physiology |
Progressive obstruction of the mitral ostium causes increased pressure in the left atrium and the pulmonary circulation.[8] Congestion may cause thromboembolism, and atrial hypertension may cause atrial fibrillation.[8] | Obstruction through the aortic ostium causes increased pressure in the left ventricle and impaired flow through the aorta | Insufficiency of the aortic valve causes backflow of blood into the left ventricle during diastole. | Insufficiency of the mitral valve causes backflow of blood into the left atrium during systole. | Insufficiency of the tricuspid valve causes backflow of blood into the right atrium during systole. |
| Symptoms |
Symptoms increase with exercise and pregnancy[7] |
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| Medical signs |
Signs increase with exercise and pregnancy[7] |
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In acute cases, the murmur and tachycardia may be only distinctive signs.[8] |
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| Diagnosis |
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| Treatment |
No therapy is required for asymptomatic patients. Diuretics for any pulmonary congestion or edema.[7] If stenosis is severe, surgery is recommended.[7] Any atrial fibrillation is treated accordingly.[7]
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No treatment in asymptomatic patients.[7]
Medical therapy and percutaneous balloon valvuloplasty have relatively poor effect.[7] |
Also, endocarditis prophylaxis is indicated before dental, gastrointestinal or genitourinary procedures.[7] |
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| Follow-up |
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