In industrialized countries, the incidence of rheumatic valve disease has decreased dramatically, but the overall incidence of valve disease does not appear to have varied, mainly due to the increasing prevalence of degenerative valve disease and, to a much lesser extent, to the detection of new types of valve disease. In fact, these new valvular diseases constitute clinical rarities and include those caused by the chronic ingestion of certain drugs, such as ergotamine or methysergide, and those associated with certain types of systemic disease, such as antiphospholipid syndrome.
It seems, however, that valve involvement is uncommon in this syndrome.
Valvular Heart Disease
The recent Euro Heart Survey 5 on valve diseases collected data on patients with valvular heart disease, infective endocarditis or previous valve intervention from 25 European countries. In this registry, aortic stenosis and degenerative mitral insufficiency were the most common valve diseases, while the prevalence of rheumatic valve disease and other valve diseases was considerably lower Table The differentiating features of valve disease in women have not been very widely studied.
The influence of gender on the prevalence and characteristics of rheumatic valve disease has been recognized for years, but there is very little data concerning the prevalence in other types of valve disease. The data specifically related to the prognosis of valve disease according to sex is also very limited.. Rheumatic mitral stenosis predominantly affects women.
This classical observation, reported many years ago, has remained unchanged in all the countries in which rheumatic fever continues to be a public health problem. It is also widely known and accepted that when the rheumatic involvement takes the form of mitral insufficiency or aortic valve disease, the incidence in men and women is more or less the same.
The reasons for this female predominance in rheumatic mitral valve disease have not been studied.. A greater proportion of women than men has also been reported for mitral valve prolapse. However, other studies in different types of populations reported a similar incidence in the 2 sexes 1. Calcification of the mitral annulus is especially frequent in older women, and it has been associated with cardiovascular risk.
Among the patients with congenital aortic valve disease and, particularly, bicuspid aortic valve, men clearly predominate. Likewise, the prevalence of isolated aortic insufficiency is significantly lower among women than among men. While there is a clear male predominance in rheumatic aortic stenosis and congenital aortic stenosis, there is no evidence of the influence of gender in degenerative aortic stenosis. Population-based studies suggest a higher incidence among males. The Cardiovascular Health Study, in which echocardiography was employed to investigate the prevalence of aortic sclerosis and stenosis in a sample of patients over 65 years of age, demonstrated that male patients had a 2-fold higher risk of aortic valve involvement than female patients.
Table 2 shows the distribution by sex and age of the valve diseases most prevalent in the Euro Heart Study. Recent studies have shown that men present a higher degree of valve calcification than women. Analyzing the calcium content of a total of stenotic aortic valves obtained during valve replacement, Ortlepp et al 16 demonstrated that for similar degrees of valve stenosis, that is, for established based on mean gradients, women present less valvular calcification. In their study, they found no relationship between the degree of calcification and cardiovascular risk factors.
However, they did observe that gender and genetic polymorphisms were associated with the extent of valve calcification. On the other hand, Roberts and Jong investigated the relationship between the weights of stenotic aortic valves obtained from patients undergoing valve replacement and transvalvular gradients. In their study, they observed that, for each valve weight, women presented higher pressure gradients than men. In this respect, Carroll et al 18 observed that, for similar aortic valve areas, women presented significantly higher gradients, smaller end-systolic chamber size and a high proportion of supranormal ejection fractions..
The mortality rate associated with cardiac surgery is higher in women. This fact has been clearly demonstrated in coronary surgincal coronary revascularization. In a series of consecutive patients undergoing coronary surgery in Sweden, female sex was an independent factor of surgical mortality and of perioperative complications, although the outcome and the long-term benefits of surgery were similar.
The ultimate causes for the higher mortality rate in women are unclear since, both in coronary artery bypass surgery and valve surgery, the higher risk associated with the female sex appears to be independent of age and the presence or absence of comorbidity.. In patients with aortic insufficiency, a valve disease in which the decision to undergo surgery is based on the presence of symptoms or ventricular dysfunction, established on the basis of the ejection fraction and a given degree of ventricular dilation, in these patients the results of surgery have been found to be poorer in women.
It is a well-known fact that the most important cardiovascular changes occurring during pregnancy are an increase in blood volume, a decrease in peripheral resistance and an increase in heart rate. On the other hand, during pregnancy there are a series of changes in hemostasis that contribute to a state of hypercoagulability and a higher risk of embolism.
Congestive Heart Failure as a Consequence of Valvular Heart Disease
The valve diseases that are associated with the greatest risk of hemodynamic decompensation are those involving stenosis, particularly mitral stenosis, the disease that most frequently produces clinical problems and severe aortic stenosis. Another risk situation is pregnancy in patients with Marfan syndrome associated with dilated ascending aorta since there is a high risk of dissection during pregnancy.
For these reasons, preventive correction of moderate or severe mitral stenosis should be carried out in asymptomatic patients or those who wish to have children, especially those who are candidates for percutaneous valvuloplasty. The decision as to the type of prosthesis to implant in a young woman who wants to have children is difficult. These risks should be taken into account, together with the risks of an eventual future reoperation should a biological prosthesis be implanted. Although, obviously, the decision must be made in agreement with the patient, most groups at the present time may are inclined to recommend a bioprosthesis since, in a young patient, the risk of an eventual reoperation may be lower than the real risk of embryopathy and prosthetic valve thrombosis that, during pregnancy, is associated with mechanical prostheses.
In the case of aortic stenosis, some authors consider aortic surgery using the Ross procedure to be clearly indicated.. Patients with valve disease who are already pregnant when they first visit the cardiologist should undergo strict cardiological monitoring, especially in the case of moderate or severe stenotic lesions.
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The use of beta-blockers to slow the heart rate is especially indicated in patients with mitral stenosis, as is a low-sodium diet and diuretics if congestive symptoms develop. When there is severe hemodynamic deterioration that does not respond to rest or medication, percutaneous valvuloplasty can be attempted. The medical literature provides sufficient evidence in support of the application of this approach in pregnant women with mitral stenosis. Finally, pregnant patients with mechanical prostheses, especially in the mitral position, pose an especially difficult problem.
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Signs and symptoms of heart valve disease may include:. If you have a heart murmur, your doctor may recommend you visit a cardiologist. If you develop any symptoms that may suggest heart valve disease, see your doctor. A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart.
The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings. Heart valve problems may include a narrowed valve stenosis , a leaking valve regurgitation or a valve with leaflets that are bulging back prolapse , as shown in the bottom two images. A normal heart and valves is shown in the top image.
Heart valve disease - Symptoms and causes - Mayo Clinic
These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps leaflets or cusps that open and close once during each heartbeat.
Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body. Heart valve disease may be present at birth congenital. It can also occur in adults due to many causes and conditions, such as infections and other heart conditions.
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Heart valve disease care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview In heart valve disease, one or more of the valves in your heart doesn't work properly.
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