Date: May 1st, 2011
Each year, as many as 5 million Americans are diagnosed with valve disease. There are a number of different types of valve disease and all of them involve defects or damage to one or more of the heart’s four valves. While some types are not serious, others can lead to major complications, including death. Fortunately, most valve disease can be successfully treated with surgery in patients of all ages and races.
The Valve Disease Gap
Cardiovascular diseases—which include heart diseases and stroke—are the leading cause of death in the United States. More than 800,000 people die from cardiovascular diseases each year. But the picture is even more dismal for African Americans who have a much higher rate of mortality—in 2007, African American men were 30% more likely to die from heart disease than non-Hispanic white men.
African Americans are also disproportionately impacted by valve disease, in part because of gaps in diagnosis and treatment, but also because they have higher rates of other cardiovascular diseases that also increase their risk of valve disease. Coronary artery disease and high blood pressure, for instance, can lead to some types of valve disease.
Valve Disease Basics
Every day our hearts beat up to 100,000 times and pump around 2,000 gallons of blood. The valves keep blood moving in one direction and with the right amount of force—preventing the blood from leaking backwards as it’s pumped through the heart. In most cases, when a valve is damaged it disrupts blood flow by not opening or closing properly. When a valve doesn’t fully close and allows blood to leak backwards, it’s referred to as regurgitation. It is also commonly called insufficiency, or a leaky valve. Stenosis is when a valve doesn’t fully open so not enough blood flows through—also commonly called a sticky, narrowed, or stiff valve. The most common types of valve disease involve the aortic and mitral valves.
Mitral valve prolapse is a common type of regurgitation where the leaflets of the valve “flap” backwards and allow blood to leak. An estimated 2 – 3% of the population have the disease, although in most cases treatment isn’t needed.
Valve problems can be there at birth (congenital) or acquired from damage later in life—infection, hardening of the valves, and other cardiovascular diseases can cause damage. Age is a common risk factor for many of the acquired types of valve disease such as aortic stenosis where calcium builds up over the years and causes the valve to stiffen. Race can also impact risk, for example, African Americans are more likely to need surgery of the mitral valve at a younger age than Caucasians. Scientists aren’t entirely sure why this is true but believe it’s a combination of higher risk and lack of access to good primary care.
What to Expect from Treatment
When valve damage reduces blood flow the heart has to work harder and the body gets less oxygen—leading to a number of symptoms such as shortness of breath, dizziness, fatigue, pain, and lightheadedness. However, some people with valve disease don’t have any symptoms, even when their disease is severe. In these cases, a heart murmur (heard only by a trained professional) is the most important clue, making it especially important to see a doctor if valve disease is suspected.
Valve disease can lead to even more serious diseases and conditions like heart attacks, irregular heart beats, heart failure, and even stroke. With aortic stenosis, a common type of valve disease in older Americans, the average life expectancy once symptoms start is less than three years.
While some cases of valve disease only need to be monitored, others need treatment to provide relief from symptoms, slow the disease, and prevent serious complications. There are currently NO drugs that keep valve disease from getting worse or that undo damage already done. However, there are some drugs that provide temporary relief from symptoms.
Fortunately surgery is usually an effective treatment for valve disease. It has a very high success rate, and in most cases, improves quality of life and adds many more healthy years to a patient’s life. For most patients, the risk of complications and death from surgery is very low—in fact the survival rate is around 97% and higher. While the risk of complications does rise slightly with age, age alone is not a reason to avoid surgery. Unless a person has other serious diseases or conditions that could complicate the surgery, they are most likely a good candidate—at any age.
Valve surgery typically involves either repair or replacement. Repair is the preferred option when possible because it avoids introducing a foreign object (the new valve) into the body. When repair isn’t possible, the valve is replaced by either a mechanical (man-made) or bioprosthetic (tissue from animals or humans) valves. Both have risks and benefits. For instance, mechanical valves don’t wear out but do require patients to take blood-thinning drugs to prevent clots. Tissue valves have less risk of clots but don’t last as long. The best choice for the patient depends on their medical history and personal preferences.
Even though valve disease can usually be successfully treated, facing a diagnosis can be scary and leave you with many questions. There area number of great resources out there can help you understand more about the disease and what to expect. A few are noted below:
- Adam’s Heart Valve Surgery Blog
Read about patient experiences, commonly asked questions, and heart valve surgery basics on this helpful blog from a former valve disease patient
- Alliance Valve Disease Website
Listen to podcast interview with patients and health care professionals, take a quiz to test your knowledge about valve disease, and read e-brochures on valve disease basics