Your heart has four valves that keep blood flowing in one direction as it moves through your heart's chambers. Valve disease means a valve either doesn't open fully (stenosis) or doesn't close tightly enough (regurgitation, also called insufficiency) — problems that range from mild and simply monitored to severe and requiring repair or replacement. This page covers the most common valve conditions: aortic stenosis, aortic regurgitation, mitral regurgitation, mitral stenosis, and tricuspid regurgitation. It's also worth knowing that a heart murmur — an extra sound your doctor hears with a stethoscope — is often how valve disease is first suspected, though not every murmur means valve disease (see Cardiac Murmurs).
How Heart Valves Work (In Plain Terms)
Each of your heart's four valves — aortic, mitral, tricuspid, and pulmonary — opens to let blood flow forward with each heartbeat and closes to stop it from flowing backward. Stenosis means a valve has become narrowed or stiff and doesn't open fully, making the heart work harder to push blood through it. Regurgitation (or insufficiency) means a valve doesn't close tightly, letting some blood leak backward instead of moving forward efficiently. Either problem, over time, can strain the heart and lead to symptoms.
Aortic Stenosis (AS)
The aortic valve — between the heart's main pumping chamber and the aorta — narrows, most commonly due to age-related calcium buildup over decades (similar in concept to arterial calcification), or less commonly from a valve that was congenitally abnormal (like a bicuspid valve, having two leaflets instead of three) or from prior rheumatic fever. As it narrows, the heart has to generate much higher pressure to push blood out, which can eventually cause chest pain, shortness of breath, or fainting with exertion — symptoms that mark an important turning point in how urgently the valve needs attention.
Aortic Regurgitation (AI)
The aortic valve doesn't close completely, letting blood leak backward into the left ventricle after each beat. Causes include the valve's own degeneration, a bicuspid valve, high blood pressure and aortic enlargement, infection of the valve (endocarditis), or connective tissue conditions. Mild AI is often well tolerated for years; more significant AI can enlarge and eventually weaken the left ventricle if untreated.
Mitral Regurgitation (MR)
The mitral valve — between the heart's left upper and lower chambers — doesn't close tightly, letting blood leak backward into the left atrium. Causes range from the valve tissue itself degenerating (the most common cause, called "primary" or "degenerative" MR) to a stretched, weakened heart pulling the valve out of its normal shape (called "secondary" or "functional" MR — a consequence of heart failure itself, not just a separate primary valve problem), to infection or rheumatic disease. Significant MR can cause shortness of breath, fatigue, and, over time, atrial fibrillation or heart enlargement.
Mitral Stenosis (MS)
The mitral valve narrows and doesn't open fully, most classically from rheumatic fever earlier in life (now less common in the US but still seen, especially in people who grew up in regions where rheumatic fever remains more common), or less commonly from age-related calcification. Narrowing raises pressure in the left atrium and lungs, causing shortness of breath, and raises the risk of atrial fibrillation and blood clots.
Tricuspid Regurgitation (TR)
The tricuspid valve — between the heart's right upper and lower chambers — doesn't close tightly. Often it's "secondary," meaning it develops because the right side of the heart has enlarged from another problem (like pulmonary hypertension, left-sided heart failure, or longstanding atrial fibrillation) rather than a primary defect in the valve itself. Significant TR can cause swelling, abdominal fullness, and fatigue as blood backs up into the body's veins.
How These Are Diagnosed
An echocardiogram is the primary test for essentially all valve disease — it shows which valve is affected, how severe the problem is, and its effect on heart size and function. Cardiac MRI, transesophageal echo, and heart catheterization add detail in specific situations, particularly before a procedure. (See Cardiac Testing & Imaging.)
Main Treatment Approaches
Mild to moderate valve disease is usually just monitored with periodic echocardiograms — most valve disease doesn't need immediate intervention. Medications can help manage symptoms and related conditions (blood pressure, heart failure, atrial fibrillation) but don't fix the valve itself. When valve disease becomes severe and symptomatic, or affects heart function significantly, procedural or surgical valve repair or replacement is considered — options range from traditional open-heart surgery to catheter-based approaches like TAVR for aortic stenosis or transcatheter mitral/tricuspid repair, depending on the specific valve, your anatomy, and your surgical risk. Your heart failure or general cardiologist works closely with a structural heart or cardiac surgery team to determine timing and the best approach for you. (See Procedures I Don't Perform, But May Refer You To.)
If You Need a Replacement: Mechanical vs. Biological Valve
When a valve needs replacing rather than repairing, one of the central decisions is the type of replacement valve — a conversation worth having in detail with your surgical or structural heart team, since the right choice depends heavily on your age, other health conditions, and personal preferences around long-term blood thinning.
| Mechanical Valve | Biological (Tissue) Valve | |
|---|---|---|
| Durability | Typically lasts a lifetime | Generally 10–20 years before it may wear out and need replacement |
| Blood thinners | Required for life (usually warfarin) | Not usually required long-term |
| Best generally suited for | Younger patients, where avoiding a second surgery for valve wear matters most | Older patients, or anyone who can't safely take lifelong blood thinners |
| Bleeding risk | Higher, due to lifelong anticoagulation | Lower, without long-term blood thinners |
| Reintervention risk | Low (valve itself rarely wears out) | Higher over time as the tissue valve degenerates |
| TAVR-compatible if it wears out | Not typically an option | Often can be treated later with a catheter-based "valve-in-valve" procedure |
This is a general guide, not a personal recommendation — your own age, kidney function, pregnancy plans, occupation, and comfort with lifelong blood thinning all factor into which is right for you.
Living With It
Many people live for years with mild or moderate valve disease requiring nothing more than periodic monitoring. The key is not skipping follow-up echocardiograms, even when you feel well, since valve disease can progress gradually without obvious symptoms until it reaches a more advanced stage — regular monitoring is what allows treatment to be well-timed rather than reactive.
When to Call Your Doctor vs. Go to the ER
- New or increasing shortness of breath, fatigue, or swelling
- Reduced exercise tolerance you've noticed over weeks to months
- Chest pain, fainting, or severe shortness of breath — especially with known aortic stenosis, where fainting with exertion is a particularly important warning sign
Common Questions
Do I need surgery right away?
Usually not — most valve disease is monitored for a period of time before intervention is needed, and your team will explain the specific triggers (symptoms, severity measurements, effect on heart function) that would change that.
What's the difference between stenosis and regurgitation?
Stenosis means the valve doesn't open fully (narrowed); regurgitation means it doesn't close fully (leaking) — different mechanical problems that are evaluated and monitored somewhat differently.
Will I need open-heart surgery?
Not necessarily — for several valve conditions, particularly aortic stenosis, catheter-based options like TAVR are now available for many patients as an alternative to traditional surgery, depending on your specific situation.
How often will I need an echo once I'm being monitored?
It depends on the specific valve, the severity, and how quickly it's been progressing — mild disease might be checked every few years, while moderate-to-severe disease is often followed annually or more often; your cardiologist sets the specific interval for your case.
My doctor heard a murmur — does that mean I have valve disease?
Not necessarily — many murmurs are "innocent" and don't reflect any structural problem at all; an echocardiogram is what actually determines whether a murmur reflects true valve disease (see Cardiac Murmurs).
What's the recovery like after TAVR compared to open valve surgery?
Generally much shorter — many TAVR patients go home within a few days, compared to a longer hospital stay and recovery after open-heart surgery, which is part of why it's increasingly offered to a broader range of patients, not just those considered too high-risk for surgery.