<aside>
Valvular Heart Disease (VHD) refers to abnormalities of one or more of the heart valves (aortic, mitral, tricuspid, and pulmonary), affecting their ability to open (stenosis) or close (regurgitation) properly.
</aside>
It may be congenital or acquired, and can involve isolated or multiple valves, leading to pressure or volume overload, cardiac remodeling, and eventually heart failure.
https://www.youtube.com/watch?v=X4BEFWb1MTg
https://www.youtube.com/watch?v=LP_YTrcrsZA
| Type of Dysfunction | Description | Hemodynamic Effect |
|---|---|---|
| Stenosis | Impaired valve opening → obstruction | Pressure overload upstream |
| Regurgitation | Incomplete valve closure → backflow | Volume overload of affected chamber |
| Mixed | Both stenosis and regurgitation | Combination of pressure and volume load |
Heart valves can become diseased, reducing the amount of blood flow going through your heart or out of your heart and causing your heart to be overworked or work improperly. Heart valve disease can cause heart failure, arrhythmias, blood clots, strokes, pulmonary hypertension, dizziness, shortness of breath, fainting and cardiac arrest.
Rahman F MD. Understanding Heart valve Disease | Louisville KY | UOFL Health. UofL Health | Louisville Hospital and Health Care System Serving Kentucky and Indiana. https://uoflhealth.org/articles/understanding-heart-valve-disease/. Published March 14, 2025.
| Valve | Common Causes – Stenosis | Common Causes – Regurgitation |
|---|---|---|
| Aortic | Bicuspid aortic valve, calcific, rheumatic | Aortic root dilation, bicuspid valve, endocarditis |
| Mitral | Rheumatic, MAC (mitral annular calcification) | MVP (mitral valve prolapse), flail leaflet, ischemia |
| Tricuspid | Functional (pulmonary HTN, RV dilation), carcinoid | Infective endocarditis, trauma, iatrogenic |
| Pulmonic | Congenital (e.g., Tetralogy), carcinoid | Pulmonary hypertension, repair of TOF |
| Symptom | Commonly Associated Valve Lesion |
|---|---|
| Dyspnea on exertion | Most stenotic and regurgitant lesions |
| Angina | Aortic stenosis |
| Syncope | Severe aortic stenosis |
| Palpitations | Mitral valve prolapse, AF (in mitral disease) |
| Edema, ascites | Right-sided lesions (tricuspid/pulmonic) |
| Fatigue | Low output in severe valvular disease |
| Modality | Imaging features |
|---|---|
| TTE | First-line test |
| • Evaluates valve morphology, motion, flow velocities | |
| • Assesses stenosis severity (peak/mean gradient, valve area) | |
| • Quantifies regurgitation (vena contracta, EROA, regurgitant volume) | |
| TEE | • Prosthetic valve evaluation |
| • Infective endocarditis | |
| • Mitral anatomy prior to repair | |
| CMR | • Valve morphology: Visualizes leaflet motion and structure |
| • Flow quantification: Phase contrast MRI: regurgitant volume/fraction | |
| • Chamber remodeling: Accurate biventricular size and function | |
| • Tissue characterization: Fibrosis (LGE) in chronic regurgitation | |
| Cardiac CT | • Pre-TAVR planning: aortic root, annulus sizing, calcification |
| • Valve anatomy and coronary evaluation | |
| Cardiac Catheterization | • Confirms hemodynamics in uncertain cases |
| • Pressure gradients and valve area measurement |