Valvular Stenosis

Anatomy of the Heart

The heart has four chambers. The two upper chambers are called the left and right atriums, and the two lower chambers are called the left and right ventricles. There is a valve at the exit of each chamber that ensures one-way continuous flow of blood through the heart.

The four valves are the tricuspid valve, pulmonary valve, mitral valve and aortic valve. These valves open and close to prevent blood from flowing backwards.

• Oxygen-poor blood coming into your heart from your body flows into the right atrium. The tricuspid valve is the valve between the right atrium and the right ventricle. It opens so blood can be pumped to the right ventricle.
• The pulmonary valve controls blood flow between the right ventricle and the lungs. It opens to let the heart pump blood out of the ventricles into the pulmonary artery toward the lungs so it can pick up oxygen. The oxygen-rich blood flows back from the lungs into the left atrium.
• The mitral valve lies between the left atrium and the left ventricle. It opens so the oxygen-rich blood from the left atrium can be pumped into the left ventricle.
• The aortic valve controls blood flow from the left ventricle into the aorta (the main artery in your body). When this valve opens, the oxygen-rich blood is pumped to the aorta and then out to fuel the rest of your body.

Stenosis

Stenosis is when the valve opening becomes narrow and restricts blood flow.

• Tricuspid valve stenosis: If your tricuspid valve narrows, blood is not able to fully move from the right atrium to the right ventricle. This can cause the atrium to enlarge, affecting pressure and blood flow in the surrounding chambers and veins. It can also cause the right ventricle to become smaller, so less blood circulates to your lungs to pick up oxygen.
• Pulmonary valve stenosis: If your pulmonary valve narrows, the flow of oxygen-poor blood from the right ventricle through the pulmonary arteries to the lungs is restricted. This affects your blood’s ability to pick up oxygen and deliver oxygen-rich blood to the rest of your body. With pulmonary valve stenosis, the right ventricle has to work harder to pump blood through the narrowed pulmonary valve and the pressure in the heart is often increased.
• Mitral valve stenosis: When the mitral valve narrows, blood flow from the left atrium to the left ventricle is reduced. This can cause fatigue and shortness of breath because the volume of blood carrying oxygen from the lungs is reduced. Pressure from the blood that has stayed in the left atrium can cause the atrium to enlarge and fluid to build up in the lungs.
• Aortic valve stenosis: When the aortic valve narrows, blood flow from your heart to your aorta (the main artery to your body) and onwards to the rest of your body is restricted. As a result, the left ventricle has to contract harder to try to push blood across the aortic valve. This can often lead to thickening of the left ventricle (left vernacular hypertrophy) which eventually makes the heart less efficient.

Causes

Valvular heart disease can develop before or at birth (congenital causes) or normal valves may become damaged during one’s lifetime (acquired causes). The cause of valvular heart disease is not always known.

Symptoms

Many people do not notice any symptoms until their blood flow has been significantly reduced by valvular heart disease. Symptoms can include:

• Chest discomfort, pressure or tightness (angina)
• Palpitations (irregular or rapid heartbeats caused by problems with the heart’s electrical system) can sometimes be a symptom of valvular heart disease. Your heart may be working harder.
• Shortness of breath – especially when you are active. Valvular heart disease reduces the amount of oxygen available to fuel your body and that causes breathlessness.
• Fatigue or weakness. You may find it harder to do routine activities such as walking or housework.
• Light-headedness, dizziness or near fainting (most common with aortic stenosis).
• Swelling can occur when valve problems cause blood to back up in other parts of the body, leading to fluid buildup and swollen abdomen, feet and ankles.

If you don’t have many symptoms or if they are mild and not affecting you too much, your doctor may choose to monitor your condition carefully and wait until it is necessary to treat your symptoms. It is important to understand that the symptoms of valvular heart disease may not necessarily reflect the seriousness of the problem. Regular check-ups are recommended.

Treatment

Treatment will depend on the severity of your disease! If it’s minor, you may not need treatment at all. You and your doctor will discuss your options based on your condition.

Options include:

• Medication: It cannot cure stenosis, but it may relieve the symptoms.
• Surgeries or other procedures: Such as valve repair or replacement.
• Lifestyle changes: Such as being smoke-free, active, a healthy weight, eating a balanced diet.