When a heart murmur is detected during auscultation , it is often associated with a problem in a heart valve. These disorders are known as valvular heart disease , conditions that affect one or more heart valves, preventing them from opening or closing properly. This can compromise the heart's function.
What are heart valves and what is their function?
The heart has four valves:
Mitral valve: between the left atrium and the left ventricle.
Aortic valve: between the left ventricle and the aorta.
Tricuspid valve: between the right atrium and the right ventricle.
Pulmonary valve: between the right ventricle and the pulmonary artery.
These valves function as gates that ensure blood flows in the correct direction, opening and closing in time with the heartbeat.
Under normal conditions, heart valves have three leaflets (except for the mitral valve, which has two). However, congenital variations can exist, such as the bicuspid aortic valve , which has only two leaflets from birth.
What happens when there is valvular disease?
When a valve does not work properly, it can cause:
Valvular insufficiency: the leaflets do not close properly, allowing blood to flow backward (regurgitation).
Valvular stenosis: the leaflets become stiff or thick, making it difficult for blood to pass through the valve.
These alterations can appear alone or in combination, and compromise heart function.
What are the causes?
The causes can be congenital or acquired , the most common being valvular degeneration associated with aging. Over time, the leaflets can thicken and calcify, especially in the aortic and mitral valves.
Other common causes include:
Mitral valve prolapse: the leaflets are too long and flexible, causing inadequate closure.
Infections such as infective endocarditis or rheumatic fever.
Enlargement of heart chambers (atria or ventricles), which alters valve function.
What symptoms may appear?
Most valvular heart disease progresses slowly and may not cause symptoms for years. However, when symptoms do occur, they often include:
Dyspnea (shortness of breath) when exerting oneself.
Edema (swelling in feet or legs).
Palpitations or a feeling of irregular heartbeat.
Fainting or syncope.
Chest pain.
Sometimes an infection or rapid arrhythmia can trigger the first apparent decompensation.
How is it diagnosed?
To correctly evaluate a valvulopathy, studies such as:
Electrocardiogram (ECG).
Echocardiogram: essential for assessing which valves are affected and to what severity. It also evaluates the size and function of the heart chambers and detects the possible presence of pulmonary hypertension.
Cardiac catheterization : in some cases, especially before surgery.
What treatment options are available?
Treatment depends on the evolution and severity of the valvular disease:
1. Pharmacological treatment
Indicated in early stages or when symptoms are still mild.
2. Surgical treatment
When cardiac function is compromised or symptoms are significant, surgery is considered. Options include:
valve repair
Whenever possible, valve repair is preferred to preserve heart function and avoid prosthetic valve complications. This may involve removing the damaged segment and reinforcing the valve with an artificial ring (annuloplasty).
Valve replacement
If repair is not possible, the valve is replaced with a prosthesis:
Biological prostheses: made from animal tissue (pig or cow). They do not require anticoagulants, but their durability is limited.
Mechanical prostheses: made of titanium and carbon. They are very durable, but require lifelong anticoagulation.
Less invasive alternatives
In patients at high surgical risk, there are percutaneous treatments (through a catheter, usually through the groin):
TAVI (transcatheter aortic valve replacement): for aortic stenosis.
MitraClip: for mitral regurgitation.
These techniques have revolutionized treatment for patients who are fragile or have contraindications to traditional surgery.
Important care
If you have valvular heart disease, it is essential to:
Maintain good oral hygiene , as oral germs can infect diseased valves, causing infective endocarditis.
Follow up appropriately with a valvular heart disease specialist.
Do not delay evaluation if new symptoms appear.
By Dr. Alejandra Carbonell, head of the Valvular Heart Disease Unit