Pressure changes behind and in front of the valves allow them to open their flap–like “Doors” (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood.

There are 4 types of valves in the heart

• Tricuspid valve.
• Pulmonary valve.
• Mitral valve.
• Aortic valve.

Oxygen–depleted blood returning from the body flows into the heart’s right atrium (upper–right chamber). From there, it is forced through the tricuspid valve into the right ventricle (lower–right chamber). The right ventricle pumps the blood through the pulmonary valve and into the lungs, where the blood can pick up oxygen. As the right ventricle is preparing to push blood through the pulmonary valve, the tricuspid valve closes to prevent blood from flowing back into the right atrium.

Oxygen–rich blood returning from the lungs flows into the left atrium (upper–left chamber). This blood is forced through the mitral valve into the left ventricle (lower–left chamber) with the mitral valve sealing off to prevent backflow. At the same time that the right ventricle is pumping oxygen–depleted blood into the lungs, the left ventricle is pushing oxygen–rich blood through the aortic valve and on to all of the body’s organs.

Two types of problems can disrupt blood flow though the valves
Regurgitation
It is also called as insufficiency or incompetence which occurs when a valve doesn’t close properly and blood leaks backward instead of continuing in the proper one–directional flow. If too much blood flows backward, only a small amount can travel forward to the body’s organs. The heart tries to make up for this by working harder, but eventually the heart will become enlarged (dilated) and less able to pump blood through the body.

Stenosis
It occurs when the leaflets do not open wide enough, reducing the amount of blood that can flow through the valve. Stenosis results from the leaflets thickening, stiffening, or fusing together. Because of the narrowed valve, the heart must work harder to maintain circulation.

Causes of valve disease

• Myxomatous degeneration, which is a weakening of the valve tissue caused by metabolic changes in the body. This occurs most often in the elderly and commonly affects the mitral valve.
• Calcific degeneration, which causes a buildup of calcium on the aortic or mitral valves, causing the valves to thicken.
• Congenital (inherited) defects, such as an irregularly shaped aortic valve or a narrowed mitral valve.
• Infective endocarditis, which is an infection in the lining of the heart’s walls and valves (the endocardium).
• Coronary artery disease.
• Heart attack.

Symptoms
Symptoms will vary from patient to patient and depend on the type and severity of valve disease. Some patients have no symptoms at all. In other cases, valve disease may take its toll over many years. Eventually, congestive heart failure may occur. In addition, valve disease also may lead to heart muscle disease, arrhythmia (irregular heartbeat), and blood clots.

Diagnosis
Initial diagnosis is made by listening to the heart with a stethoscope. Valve disease tends to be associated with distinct clicking sounds or murmurs. A more definitive diagnosis requires the use of imaging techniques.

• A chest X-ray can show if the heart is enlarged, which may occur if the valve isn’t functioning properly.
• Doppler ultrasound can be used to determine whether blood is flowing properly through the valves by recording the “Swishing” noise (turbulence) of the blood flow.
• Echocardiography can produce a picture of the thickness of the heart’s walls, the valves’ shape and action, and the size of valve openings. Doppler echocardiography can be used to diagnose and determine the severity of either stenosis (narrowing) or backflow of blood.
• Electrocardiography (EKG or ECG) can be used to determine if the ventricles or the atria are enlarged. ECG can also determine if arrhythmia (irregular heartbeat) is present.
• Coronary angiography, as part of cardiac catheterization, allows physicians to see the heart as it is pumping to identify a narrowed valve or any backflow of blood. This test also helps physicians decide if surgery is needed, and, if so, what type. Likewise, any associated coronary artery disease may be identified.
• Chest magnetic resonance imaging (MRI) can provide an accurate 3–dimensional picture of the heart and valves without having to inject a dye.

Treatment
Persons whose valve disorders cause no symptoms or only minimal symptoms may not require treatment. Others do well with medication that reduces the discomfort of symptoms, but drugs cannot cure valve disease. If the condition worsens or becomes difficult to control, or intolerance to drug therapy develops, an interventional procedure or surgery may be necessary.

Lifestyle Changes
Not much can be done to prevent valve disease, but it is still important to maintain a heart–healthy lifestyle and control as many risk factors as possible. One step you can take is to ensure you do not contract rheumatic fever, which comes from a bacterial infection. Throat infections should be diagnosed early, and the full course of antibiotics should be completed to prevent the infection from coming back.
If you have valve disease, you should always tell your dentist, because you may need to take antibiotic drugs before a dental procedure. Whenever you are giving a physician your medical history, remember to include information about valve disease. Like in dental procedures, you may need to take antibiotics before surgical or other procedures to prevent the development of infective endocarditis.

Medication
Drugs are prescribed to minimize the discomfort of symptoms, reduce the workload on the heart, and regulate the heart’s rhythm. The following classes of drugs are most commonly prescribed:

• Digitalis, which reduces the workload on the heart and relieves some of the symptoms of valve disease.
• Diuretics, which can lower and reduce the salt and fluid levels in the body to reduce swelling and reduce the workload on the heart.
• Anticoagulant medications, which prevent blood clots, especially in patients who have had heart valve surgery and have a prosthetic valve made of synthetic material.
• Beta blockers control heart rate and lower blood pressure.
• Calcium channel blockers, which favorably affect the contractions of muscle tissue in the heart. By lowering blood pressure and reducing the workload on the heart, calcium channel blockers offer potential for delaying the need for heart valve surgery.

Interventional Procedures
Balloon Valvuloplasty is a procedure that may be used to open narrowed tricuspid and pulmonary valves, a narrowed mitral valve, and, rarely, the aortic valve. The procedure is a variation of the balloon angioplasty used on arteries, like angioplasty, it is performed in the cardiac catheterization laboratory. A balloon–tipped catheter is inserted into the valve. When the balloon is inflated, it pushes back any deposits along the edge of the valve, enlarging the central area of the valve. The catheter and deflated balloon are then removed from the valve.

Surgery
Surgery is the most invasive option for the treatment of valve disease. During surgery, valves may either be repaired or replaced. Repair may involve opening a narrowed valve by removing calcium deposits or reinforcing a valve that doesn’t close properly. Repair also may be used to treat congenital defects and defects of the mitral valve. Replacement is used to treat any diseased valve disease that cannot be repaired.

• Commissurotomy is a repair procedure that is used for stenosed or narrowed valves, where the leaflets have thickened and adhered to one another. The surgeon opens the valve by cutting or shaving the commissures, the points where the leaflets meet.
• Valvuloplasty is a repair procedure that reinforces the leaflets to provide more support and permit the valve to close tightly. This support comes from a ring–like device that surgeons attach around the outside of the valve opening.
• Valve replacement involves surgical removal of a defective valve and stitching in its place a prosthetic valve. Prosthetic valves can either be mechanical (made from synthetic materials such as plastic, carbon, or metal alloys) or biologic (made from human or animal tissue).