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What Is Heart Valve Disease?

Heart valve disease occurs when one or more of the heart’s four valves — the aortic, mitral, tricuspid, and pulmonary valves — does not function properly. Valves may fail in two fundamental ways: stenosis (narrowing that restricts forward blood flow) or regurgitation (leakage that allows blood to flow backward). Both conditions force the heart to work harder, leading over time to heart failure, arrhythmia, and other serious complications. Heart valve disease affects an estimated 5 million Americans and becomes increasingly common with age.

Types of Heart Valve Disease

Aortic Stenosis — The aortic valve narrows due to calcium buildup on the leaflets, restricting blood flow from the heart to the body. It is the most common valvular heart disease in adults over 65. Symptoms — chest pain, shortness of breath, and syncope with exertion — mark severe disease requiring intervention. Transcatheter aortic valve replacement (TAVR) has transformed treatment for high-risk surgical patients.

Mitral Regurgitation — The mitral valve fails to close fully, allowing blood to leak backward into the left atrium with each heartbeat. Causes include mitral valve prolapse, rheumatic heart disease, and ischemic heart disease (from coronary artery disease). Severe mitral regurgitation causes volume overload leading to left atrial enlargement, atrial fibrillation, and heart failure.

Mitral Stenosis — Thickening and scarring of the mitral valve leaflets (most often from rheumatic fever) narrows the valve opening, obstructing blood flow from the left atrium to the left ventricle. This leads to pulmonary congestion, atrial fibrillation, and elevated pulmonary artery pressures.

Aortic Regurgitation — The aortic valve leaks, allowing blood to flow backward into the left ventricle. Causes include bicuspid aortic valve, aortic root dilation (as in Marfan syndrome), rheumatic disease, and infective endocarditis.

Tricuspid Regurgitation — Leakage of the tricuspid valve is common and often secondary to left-sided heart disease or pulmonary hypertension. Severe isolated tricuspid regurgitation can cause right heart failure.

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Diagnosis and Monitoring

Echocardiography (ultrasound of the heart) is the primary diagnostic and surveillance tool for heart valve disease. It provides detailed information about valve anatomy, function, severity of stenosis or regurgitation, heart chamber size, and ejection fraction. Serial echocardiograms are used to monitor disease progression and determine optimal timing for intervention before irreversible cardiac remodeling occurs. Transesophageal echocardiography (TEE) provides superior imaging of the mitral valve and is used pre-operatively and for endocarditis evaluation. Cardiac MRI and cardiac catheterization are used in selected patients for comprehensive hemodynamic assessment.

Treatment Approach

Management of valve disease is tailored to valve type, severity, symptoms, and heart function. Mild to moderate valve disease is typically managed with surveillance echocardiography and medical therapy to control symptoms and comorbidities such as atrial fibrillation and heart failure. Severe symptomatic valve disease generally requires intervention. Surgical valve repair or replacement remains the standard for many conditions, particularly mitral valve repair for degenerative mitral regurgitation. Transcatheter approaches — TAVR for aortic stenosis and MitraClip for mitral regurgitation — have expanded options for high-risk surgical patients. Anticoagulation with warfarin is required for patients with mechanical valve prostheses.

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Why Choose Cross County Cardiology?

• Board-Certified, FACC Cardiologists — Fellowship of the American College of Cardiology credentialed physicians
• Affiliated with Mount Sinai & Hackensack Meridian Health — Academic medical center connectivity for structural heart referrals
• 5 NJ Locations — Secaucus, Edgewater, Teaneck, Hoboken, and North Bergen
• Same-Week Appointments Available — Fast access without long waits
• In-Office Echocardiography — Comprehensive transthoracic echocardiography with Doppler assessment available on-site

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Frequently Asked Questions

What are the symptoms of heart valve disease?

Common symptoms include shortness of breath — especially with exertion or when lying flat — fatigue, chest pain or pressure, heart palpitations, lightheadedness, and ankle or leg swelling. In severe aortic stenosis, exertional syncope (fainting with activity) is a particularly important warning sign. Some patients with significant valve disease remain asymptomatic for years, which is why echocardiographic surveillance is critical.

How often should I have an echocardiogram for valve disease?

Frequency depends on valve type and severity. Mild valve disease typically requires echocardiography every 3–5 years. Moderate disease is reassessed annually or biannually. Severe valve disease requires more frequent surveillance — often every 6–12 months — to determine optimal timing for intervention before left ventricular dysfunction develops. Your cardiologist will determine the appropriate monitoring schedule.

What is the difference between valve repair and valve replacement?

Valve repair preserves the patient’s own valve tissue and avoids the need for lifelong anticoagulation. It is preferred when anatomically feasible, particularly for degenerative mitral regurgitation where repair is durable and outcomes are superior to replacement. Valve replacement — either with a mechanical or bioprosthetic valve — is required when the valve cannot be adequately repaired. Mechanical valves are more durable but require lifelong warfarin anticoagulation; bioprosthetic valves do not require anticoagulation but have a finite lifespan (typically 10–20 years).

What is TAVR?

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a new valve is delivered through a catheter — typically via the femoral artery in the groin — without open-heart surgery. TAVR was originally approved for patients who were too high-risk for surgery but is now approved for intermediate and low-risk patients as well. Recovery is significantly faster than surgical AVR, with most patients discharged within 2–3 days.

Can heart valve disease lead to atrial fibrillation?

Yes. Mitral valve disease — particularly mitral stenosis and mitral regurgitation — causes left atrial enlargement, which is a major substrate for atrial fibrillation (AFib). Aortic stenosis and other valve lesions can also predispose to AFib through pressure and volume overload. Conversely, AFib worsens valve disease by increasing heart rate and reducing cardiac output. Managing both conditions simultaneously is an important goal of valve disease care.