Heart Valve Leakage & Narrowing
The heart has four valves that help keep blood moving in the correct direction. When a heart valve does not close properly, blood may leak backwards. When a valve becomes narrowed, it may restrict the amount of blood that can pass through.
These conditions are known as valve regurgitation and valve stenosis. They can affect different heart valves and range from mild abnormalities that require monitoring to more significant valve disease that may require treatment.
What Is a Leaking Heart Valve?
A leaking heart valve occurs when the valve does not close completely. This allows some blood to flow backwards instead of continuing in its intended direction.
The medical term for this is valve regurgitation or valvular regurgitation.
Leakage can occur in any of the heart’s four valves:
- Mitral valve
- Aortic valve
- Tricuspid valve
- Pulmonary valve
The effect on the heart depends on which valve is affected and how much blood is flowing backwards.
A small amount of regurgitation may not cause symptoms or require treatment. More significant leakage can increase the workload on the heart and, over time, may affect the size and function of its chambers.
What Does Heart Valve Narrowing Mean?
Heart valve narrowing is known as valve stenosis.
A narrowed valve cannot open fully, making it more difficult for blood to pass through. The heart may therefore need to generate greater pressure to pump blood across the affected valve.
One example is aortic stenosis, which occurs when the aortic valve becomes narrowed and restricts blood flow from the left ventricle into the aorta.
Stenosis can also affect the mitral, tricuspid and pulmonary valves.
What Is the Difference Between Valve Leakage and Valve Narrowing?
The main difference is how the affected valve interferes with blood flow.
With valve leakage (regurgitation), the valve does not close properly, allowing blood to flow backwards.
With valve narrowing (stenosis), the valve does not open fully, restricting forward blood flow.
Some people may have both stenosis and regurgitation affecting the same valve. Others may have abnormalities involving more than one heart valve.
An echocardiogram can help determine the type of valve abnormality and assess its severity.
What Causes a Heart Valve to Leak or Become Narrow?
Heart valve abnormalities can develop for different reasons.
Possible causes include:
- Age-related changes to the valves
- Calcium deposits affecting a valve
- Congenital valve abnormalities
- Previous rheumatic fever
- Infection of a heart valve, known as infective endocarditis
- Changes to the heart following a heart attack
- Cardiomyopathy
- Enlargement or changes in the structure of the heart
The cause can also differ according to which valve is affected.
What Are the Symptoms of Heart Valve Leakage or Narrowing?
Mild valve abnormalities may cause no noticeable symptoms.
When valve disease becomes more significant, symptoms may include:
- Shortness of breath
- Reduced exercise tolerance
- Fatigue
- Chest pain or discomfort
- Palpitations
- Dizziness or light-headedness
- Fainting
- Swelling of the feet, ankles or legs
The presence or absence of symptoms does not by itself determine the severity of valve disease. Some people may have significant valve abnormalities before noticing changes in how they feel.
Can You Have a Leaking or Narrowed Heart Valve Without Knowing It?
Yes. Heart valve disease may sometimes be detected before symptoms develop.
For example, a doctor may hear a heart murmur during a physical examination. Further assessment with an echocardiogram may then identify valve leakage or narrowing.
In other cases, a valve abnormality may be found incidentally during cardiac imaging performed for another reason.
Whether treatment or follow-up is required depends on the type and severity of the abnormality and its effect on the heart.
How Is Heart Valve Leakage or Narrowing Diagnosed?
Assessment generally includes a review of symptoms and medical history, together with a physical examination.
Further investigations may include:
Echocardiography
An echocardiogram uses ultrasound to examine the structure and function of the heart.
For heart valve disease, it can provide information about:
- How well a valve opens and closes
- Whether blood is leaking backwards
- How narrow a valve has become
- Blood flow across the valve
- The size of the heart chambers
- The heart’s pumping function
Echocardiography is therefore an important investigation for assessing and monitoring valve leakage and stenosis.
Trans-Oesophageal Echocardiography
A trans-oesophageal echocardiogram (TOE) may be considered when more detailed images of the heart valves are required.
During this procedure, an ultrasound probe is passed into the oesophagus, which lies close to the heart. This allows certain cardiac structures and valves to be examined in greater detail.
Electrocardiogram
A 12-lead ECG records the electrical activity of the heart. While it does not directly show valve leakage or narrowing, it may identify changes in heart rhythm or other findings relevant to the overall cardiac assessment.
Additional investigations may be considered depending on the valve involved, symptoms and clinical findings.
Does a Mildly Leaking Heart Valve Need Treatment?
Not always.
Mild valve regurgitation may not require a procedure, particularly when it is not causing symptoms or affecting heart function.
A cardiologist may instead recommend periodic clinical reviews and repeat echocardiograms to monitor the valve and determine whether there have been any changes.
The frequency of monitoring varies according to the valve involved, the severity of leakage and the patient’s overall cardiac condition.
Does a Narrowed Heart Valve Always Get Worse?
The progression of valve stenosis varies between individuals and depends partly on its underlying cause.
Some valve abnormalities may remain relatively stable for a period of time, while others can become more significant.
Regular assessment may therefore be recommended for people with known valve stenosis, even when symptoms are absent.
Changes in symptoms, valve measurements and heart function can help determine whether management needs to be reconsidered.
How Are Leaking or Narrowed Heart Valves Treated?
Treatment depends on the valve affected, whether the problem involves leakage or narrowing, its severity, symptoms and its effect on heart function.
Monitoring
For mild or moderate valve disease without significant symptoms or changes in heart function, ongoing monitoring may be appropriate.
Medication
Medication cannot correct the structural problem of a leaking or narrowed valve itself.
However, medication may be used to manage certain symptoms or associated cardiovascular conditions, such as high blood pressure, fluid retention or abnormal heart rhythms.
Heart Valve Repair
Some abnormal valves may be suitable for repair. The procedure used depends on the valve and the nature of the structural abnormality.
Heart Valve Replacement
When repair is not suitable, replacement of the affected valve may be considered. Replacement valves may be mechanical or biological.
Catheter-Based Valve Procedures
Certain valve conditions may also be treated using catheter-based procedures in selected patients.
For example, transcatheter aortic valve implantation or replacement (TAVI/TAVR) may be considered for some patients with severe aortic stenosis.
The appropriate approach is determined following cardiovascular assessment and discussion of the individual’s clinical circumstances.
When Should I See a Cardiologist About a Heart Valve Problem?
A cardiology assessment may be considered if:
- A heart murmur has been detected
- An echocardiogram has shown valve leakage or narrowing
- You develop unexplained shortness of breath
- Your ability to exercise has decreased
- You experience chest discomfort
- You have recurrent palpitations
- You experience dizziness or fainting
- You have unexplained swelling of the legs or ankles
- You have previously been diagnosed with valve disease and require follow-up
Sudden severe chest pain, significant difficulty breathing or loss of consciousness requires urgent medical assessment rather than waiting for a routine cardiology appointment.
Heart Valve Assessment at Apex Heart Clinic
Apex Heart Clinic at Gleneagles Hospital, Singapore provides cardiology assessment and diagnostic testing for cardiovascular conditions, including heart valve disorders.
Dr Daniel Yeo is a Senior Consultant Cardiologist and Medical Director of Apex Heart Clinic. His clinical focus includes echocardiography and the assessment and management of cardiovascular conditions.
Cardiac investigations available at Apex Heart Clinic include echocardiography, 12-lead electrocardiography and other cardiovascular tests where clinically appropriate.
Where a heart valve procedure or surgery is required, care may involve coordination with the relevant cardiac subspecialists and cardiac surgeons.
Have You Been Told You Have a Leaking or Narrowed Heart Valve?
Finding valve leakage or narrowing on an echocardiogram does not necessarily mean that a procedure is required. The significance of the finding depends on the valve involved, its severity, your symptoms and how the condition is affecting the heart.
Frequently Asked Questions
Is a leaking heart valve the same as regurgitation?
Yes. Heart valve regurgitation refers to blood leaking backwards through a valve that does not close completely.
Is valve stenosis the same as a narrowed heart valve?
Yes. Stenosis is the medical term used when a heart valve has become narrowed and cannot open fully.
Can I have both a leaking and narrowed heart valve?
Yes. A valve can have both stenosis and regurgitation. It is also possible for more than one heart valve to be affected.
How do doctors determine whether valve leakage is mild or severe?
Echocardiography can be used to assess blood flow across the valve, the degree of regurgitation and the effect of the valve abnormality on the heart’s chambers and function. These findings are considered together with symptoms and other clinical information.
Can medication repair a leaking heart valve?
Medication does not repair the structural abnormality of the valve itself. It may, however, be used to manage symptoms or associated cardiovascular conditions in some patients.
Will I need surgery if I have a narrowed heart valve?
Not everyone with valve stenosis requires surgery. Management depends on the affected valve, severity of narrowing, symptoms, heart function and other clinical factors.
