About Valve and Structural Heart Disease

What is Valve and Structural Heart Disease?

Valve and structural heart disease can refer to any of a number of conditions that affect the non-coronary components of the heart (meaning that they do not affect the blood vessels). To understand valve and structural heart disease, it’s important to understand how the heart works.

The heart is made up of four chambers – two atria (upper chambers) and two ventricles (lower chambers). Blood passes through a valve as it leaves each chamber of the heart, and the valves prevent the backward flow of blood. They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The four heart valves are:

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

As the heart muscle contracts and relaxes, the valves open and close, letting blood flow into the ventricles and out of the body at alternate times.

Types of heart valve disease are regurgitation/insufficiency, which is leakage of the valve, and stenosis, which is narrowing of the valve. Heart valves can develop both regurgitation and stenosis at the same time, and more than one heart valve can be affected at the same time.

Some of the more common heart valve diseases include:

  • Bicuspid aortic valve
  • Mitral valve prolapse
  • Aortic valve stenosis
  • Mitral valve stenosis
  • Tricuspid valve stenosis
  • Pulmonary valve stenosis
  • Mitral valve regurgitation
  • Aortic valve regurgitation
  • Pulmonary or pulmonic valve regurgitation
  • Tricuspid valve regurgitation

Structural heart disease often refers to a hole or defects in the wall or chamber of the heart that are congenital (birth defects) but may also include abnormalities that develop with wear and tear on the heart or through other disease processes. Some of the more common structural heart diseases include:

  • Atrial septal defect (ASD)
  • Patent foramen ovale (PFO)
  • Ventricular septal defect (VSD)

What Causes Valve and Structural Heart Disease?

Valve and structural heart disease can develop before birth (congenital), be acquired during your lifetime, or result from an infection. Causes include:

  • Changes or damage in the heart valve structure or weakening of the valve tissue due to aging, coronary artery disease, heart attack, high blood pressure, untreated infection or injury
  • Calcification accumulating on the valves
  • Congenital birth defects
  • Radiation received as treatment for childhood cancer
  • Related illnesses and conditions including infective endocarditis, syphilis and rheumatic fever
  • Myxomatous degeneration, an inherited connective tissue disorder that weakens the heart valve tissue

Valve disease has become an increasing problem in recent years. It is more common among older people because as we age, our heart valves can become lined with calcium deposits that cause the valve flaps to thicken and become stiffer.

You’re also at higher risk for valve or structural heart disease if you have risk factors for coronary heart disease, including high cholesterol, high blood pressure, smoking, insulin resistance, diabetes, being overweight or obese, lack of physical activity, and a family history of early heart disease.

Can Valve and Structural Heart Disease Be Prevented?

Heart-healthy eating, physical activity, other heart-healthy lifestyle changes, and medicines aimed at preventing a heart attack, high blood pressure, or heart failure may help prevent some but not all valve and structural heart diseases.

To prevent disease caused by rheumatic fever, see your doctor if you have signs of a strep infection, including a painful sore throat, fever and white spots on your tonsils. If you have a strep infection, be sure to take all medicines prescribed to treat it. Prompt treatment of strep infections can prevent rheumatic fever, which damages the heart valves.

What Are the Symptoms?

Mild to moderate disease may not cause any symptoms, or symptoms may gradually become worse over time. But even when heart problems are severe, there are often no recognizable symptoms until heart damage has progressed significantly.

The most common symptoms of heart valve and structural disease are:

  • Chest pain or pressure, especially when active or in the cold
  • Palpitations caused by irregular heartbeats
  • Migraine headaches
  • Fatigue
  • Dizziness
  • Coughing
  • Kidney dysfunction
  • Congestion around the heart and lungs
  • Low or high blood pressure, depending on which disease is present
  • Shortness of breath, especially after activity or when lying flat
  • Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)
  • Foot, ankle, leg or belly swelling
  • Stroke or transient ischemic attack

Some of these symptoms may look like other medical problems, so always see your doctor for a diagnosis. Complications of valve or structural heart disease can include abnormal heartbeats (arrhythmias), pulmonary hypertension, congestion (fluid buildup) in the lungs, enlarged heart, heart failure, blood clots, stroke, heart attack and death.

All too often, patients fail to notice small changes that may be clues of disease progression. By the time it’s recognized, the patient may have heart muscle damage or congestive heart failure or may even experience sudden death. It is important to pay attention to changes and recognize when they may be connected to your heart condition.

How Is Valve and Structural Heart Disease Diagnosed?

Early diagnosis is crucial for effectively treating and managing serious heart conditions. To define the type of disease and extent of the damage, doctors may use any of the following tests:

  • Magnetic resonance imaging (MRI): This noninvasive test uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures.
  • Echocardiogram (also called echo): This noninvasive test evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that make a moving picture of the heart's chambers and valves.
  • Transesophageal echocardiogram (TEE): This test involves passing a small ultrasound transducer down into the esophagus and uses sound waves to create an image of the valves and chambers of the heart.
  • Cardiac catheterization: With this procedure, a long, thin tube (catheter) is put through a large artery in the leg or arm leading to the heart to provide images of the heart and blood vessels.
  • Computed tomography (CT) scan: CT is a noninvasive diagnostic tool that utilizes radiation to provide detailed images of the heart and its surrounding structures.

How is Valve and Structural Heart Disease Treated?

Specific treatment for valve and structural heart disease will be determined by our heart team based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Location of the valve
  • Your symptoms
  • Your tolerance of specific medicines, procedures or therapies
  • Expectations for the course of the disease

In some cases, your doctor may just want to closely watch your heart condition for a period or prescribe you medication for the symptoms. Some people live long and full lives with mild heart problems and never require intervention. But once a condition begins to affect the heart’s ability to pump blood, it is likely to require surgery or transcatheter interventions.


Medications are not a cure for valve or structural heart disease, but they can often relieve symptoms. They include:

  • Beta-blockers, digoxin and calcium channel blockers to reduce symptoms by controlling the heart rate and helping to prevent abnormal heart rhythms.
  • Medications to control blood pressure, such as diuretics (which remove excess water from the body by increasing urine output) or vasodilators (which relax the blood vessels, decreasing the force against which the heart must pump) to ease the work of the heart.

Surgical and Minimally Invasive Treatments

Because medications cannot always protect the heart from damage, further treatment may be needed.

Your health care team can help you understand and evaluate options for other treatments, including surgery.

  • Surgical valve repair: During surgical valve repair, the surgeon does not replace the native valve but rather preservers and repairs it. This treatment may be offered for valve regurgitation, and its feasibility will depend on the conditions of the native valve.
  • Surgical valve replacement: When heart valves are severely malformed or destroyed, they may need to be replaced with an entirely new valve. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves, which can consist of metal, plastic or another artificial material.
  • Transcatheter mitral valve repair: This is a nonsurgical procedure that enables the treatment of mitral valve regurgitation (insufficiency) with a catheter that delivers a clip (MitraClip) in the mitral valve.
  • Transcatheter mitral valve replacement: This is a nonsurgical procedure that can replace dysfunctional mitral valves or dysfunctional mitral valves that have been previously treated with surgical repair. University Hospitals Harrington Heart & Vascular Institute is the only program in Northeast Ohio to offer to patients with native severe mitral valve regurgitation the possibility of transcatheter mitral valve replacement with the Intrepid® valve.

Transcatheter technology represents a less invasive means for treating heart disease and uses a catheter inserted through the body’s cardiovascular system, thus eliminating the need to open the chest.

  • Transcatheter aortic valve replacement (TAVR) (sometimes called transcatheter aortic valve implantation – TAVI): TAVR is a nonsurgical procedure performed at UH with local anesthesia and mild sedation in which a special catheter (hollow tube) is threaded into a blood vessel in the groin and guided into the heart. This procedure is much less invasive than open heart surgery and enables the implantation of a new valve without the need to open the chest.
  • Balloon aortic valvuloplasty: This is a nonsurgical procedure during which a severely stenotic aortic valve is dilated with a balloon. It is usually reserved for very sick patients who cannot undergo TAVR or as a “bridge” treatment before a mandatory surgical intervention in another organ.
  • Balloon mitral valvuloplasty: This is a nonsurgical procedure that dilates severely stenotic mitral valves with a balloon. It is the gold standard procedure for patients with severe mitral stenosis who fulfill certain criteria. A patient's eligibility for this procedure is determined by the heart team.
  • Left arterial appendage closure: The left atrial appendage (LAA) is a small pouch in the muscle wall of the left atrium. When a patient has atrial fibrillation, this pouch can collect blood that can form clots, creating an increased risk of stroke. To minimize this risk, interventional cardiologists can seal the LAA through catheterization, preventing blood from gathering there and avoiding the long-term use of anticoagulants for these patients.
  • Transcatheter repair of congenital defects: Through catheterization, a “plug” can be fed through a thin tube and inserted in the heart to block any leaks or close holes for patients with atrial septal defects, patent foramen ovale and ventricular septal defects.

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