Heart Disease Prevention - What Is Heart Valve Leakage?

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What Is Heart Valve Leakage?

Healthy people can have one or more slightly leaky valves, frequently, with no symptoms. But if the heart valve is severe, it might significantly interfere with normal blood flow through the heart. This can cause symptoms of congestive heart failure that include shortness of breath, leg swelling or liquid retention elsewhere in the body. Sometimes, people with leaky heart valve can also have symptoms like lightheadedness, rapid heartbeat, heart fluttering or palpitations, and fatigue.

Regurgitation is the name for leaking heart valves. It occurs when either blood flows back through the valve as the leaflets are closing or blood leaks through the leaflets when they should be completely closed. Valve regurgitation can occur suddenly or it may develop gradually over decades.

The heart has 4 valves, namely tricuspid valve, pulmonic valve, mitral valve, and aortic valve. Any of the 4 valves can become leaky. Mitral regurgitation is the most common type of valve problem. Aortic valve regurgitation can be due to a congenital heart defect, complications of an infection or other rarer causes. Pulmonary or spumoni regurgitation is very uncommon and is usually a result of other problems like pulmonary hypertension. Tricuspid regurgitation is more commonly caused by an enlarged lower chamber on the right side of the heart, but it may also develop because of other valve problems on the left side of the heart that end up straining the entire system.

Currently, no medicine can cure heart valve disease. Nevertheless, lifestyle changes and medicines can often treat symptoms successfully and delay problems for years. But eventually, surgery to repair or replace a faulty heart valve might be necessary.

Doctors can diagnose a leaky heart valve by listening to the heart with a stethoscope for abnormal sounds such as a heart murmur and looking at the description of symptoms along with physical examination and results of a heart ultrasound (echocardiogram) can determine how serious a leaky heart valve is.

Even if the heart valve disease is not causing any symptoms, the doctor may still recommend repairing or replacing heart valve. This is because repairing or replacing a valve can prevent lasting damage to the heart and sudden death. The decision to repair or replace heart valves depends on many factors, including the severity of the patient’s valve disease and his or her age and general health.

Repairing heart valve is preferred whenever possible. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of infective endocarditis after the surgery, and they do not require to take blood-thinning medicines for the rest of their lives. Heart valve repair surgery is, however, harder to do. Also, not all valves can be repaired. Mitral valves can often be repaired but aortic and pulmonary valves often have to be replaced.

Up to 15 percent of patients with replaced valve (artificial valve) might have a leak due to a breakdown of the sutures holding the artificial heart valve to their own tissue. Studies showed that mild valve leakages usually do not have deleterious effects on the heart. Conventional treatment option would be to offer a repeat open-heart operation to repair the gap or hole between the artificial heart valve and the patient's tissue, though this would cause significant risks and a lengthy post-surgery recovery period.

Since 2010, an alternative option has been made available: a minimally invasive or percutaneous sealing or plugging of the leak. Overall, the risk of serious complications from the procedure is less than 5 percent. A possible complication is that the plug only partially seals the gap, causing residual leakage. In this case, further procedures may be needed to fix the problem.

In rare cases, the plug can obstruct the normal function of the artificial heart valve and may have to be removed, either by a minimally invasive approach or open-heart surgery. The risk of this particular complication is probably between 1 and 2 percent. There are also usual risks that come with any cardiac procedure, including bleeding, stroke and heart attack.