Our heart is made up of four chambers namely the right and left atrium and the right and left ventricle. These chambers are connected in series. The impure blood from the body first reaches the right atrium. From the right atrium, the blood flows into the right ventricle. The right ventricle pumps blood in to the pulmonary artery, which takes the blood in to the lungs for oxygenation. The oxygenated blood then returns to the left atrium, from there it goes into the left ventricle. From the left ventricle the blood is pumped into the aorta.

Our heart also has four valves. The Tricuspid valve between the right atrium and right ventricle. The pulmonary valve between the right ventricle and the main pulmonary artery. The mitral valve between the left atrium and left ventricle. The aortic valve between the left atrium and left ventricle and Aorta. These delicate structures ensure efficient forward flow of blood through the heart chambers.

Disease can effect the valves in two ways.

01. Narrowing of the valves or stenosis, so that blood cannot flow through freely.
02. Regurgitation which is a failure of the one way valve so that blood flows back through the valve in the wrong direction.

CAUSES OF DISEASES OF THE VALVES

01. Congenital Heart Disease - present from birth
02. Rheumatic Heart Disease - Long-term sequale of rheumatic fever, which is a delayed inflammatory reaction to streptococcal throat infection.
03. Specific damage from a heart attack.
04. Weakening of the supporting structure of the heart
05. Weakening of the heart muscle
06. Infections
The valves most commonly affected by disease are the mitral and aortic valves

CLINICAL PRESENTATIONS

Common symptoms of valvular heart disease may include the following:

- Weakness on exertion
- Rapid Heartbeat
- Chest Discomfort
- Fainting Spells
- No symptoms at all in-some patients
Most cases of valvular heart disease can be detected with a stethoscope. The abnormal blood flow often produces a sound called a heart murmur. An echocardiogram is a very useful means for evaluation of valvular heart disease. This is a non-invasive means of visualizing the heart muscle and valves using sound waves. The valves can usually be visualized quite well and the degree of leakage or stenosis can be estimated with a high degree of accuracy.

TREATMENT OF VALVULAR HEART DISEASES

There are many patients with valvular heart disease who do very well without any medical intervention, at the same time there are quite a few patients who would be significantly benefited by some type of medications or surgery. Medications do not work to correct the defect on the valve, but only minimize its consequences or treat its complication.

Surgical options depend on the exact type of problem, patient and severity of process. In cases of Mitral Valve Disease (either stenosis, regurgitation or combined) in the hands of skilled surgeons repair of the valve is a very good option. Aortic valves are rarely suitable for repair. In patients whom repair is not feasible they need to undergo valve replacement.

BALLOON DILATATION

In patients who have isolated stenosis, these patients could undergo a balloon dilatation of the valve rather than surgical repair. In this procedure a deflated balloon is advanced through the blood vessels and positioned across the valve. The balloon is then inflated, creating a somewhat uncontrolled but effective split of the valves along the fused margin (commissure). Depending on the valve that is being dilated it will be called as Tricuspid, Pulmonary, Mitral or Aortal Balloon Valvotomy.

ARTIFICAL VALVES

There are two main type of artificial valves. "Mechanical" and "Bioprosthetic" valve. Mechanical valves are made of metal or a similar material. They could have either a tilting disc or a ball and cage. They have the advantage of lasting the longest time. The main disadvantage is the need to take potent blood thinners which decrease the tendency to form clots on the surface.

Bioprosthetic valves are treated aortic valves from cadavers, treated pig aortic valves and valves fashioned from the pericardium of cows. Patients which Bioprosthetic valves do not require blood thinners, but generally do not last as long as Mechanical valves. It is generally used in patients who may not be good candidate to take blood thinners. This group includes young women who wish to become pregnant as the blood thinners can frequently cause birth defects, people who are likely to have complication with blood thinners and older individuals.