What is heart valve disease?
The four heart valves help regulate blood flow through the heart and prevent blood from flowing the wrong way. Each valve has a set of flaps that open and close fully when working properly. However, some people are born with abnormal heart valves, and others develop valvular disease from aging, infections, coronary heart disease, or other diseases such as Marfan syndrome.
There are two types of heart valve disease — valvular stenosis, which occurs when the valves are stiff and don’t open completely, and valvular regurgitation, when the valves do not close properly and tend to leak.
How does heart valve disease and treatment differ in women and men?
There are gender differences in the physiologic changes that accompany valvular heart disease.1 These differences must be considered when caring for women with valvular disease. For example, because women typically have a smaller body stature than men, body size should be considered for all patients when valve sizing is performed.1
More than 60 percent of heart valve replacement procedures are performed in women.1 There also are gender differences in the frequency of different types of valvular disease. There is a 3-to-1 female predominance of mitral valve stenosis, whereas there is a 3-to-1 male preponderance of aortic valve disease.1 Mitral valve prolapse is more often diagnosed in younger women, and the incidence decreases dramatically with age. In men, the occurrence of mitral valve prolapse is relatively constant across all age groups.2
The stress of pregnancy poses a particular challenge in patients with valvular disease. Because of hemodynamic changes, previously asymptomatic and undiagnosed valvular problems may be unmasked during pregnancy. If a woman is aware of her valvular heart disease, her best option is to address the condition before pregnancy. However, valvular conditions that surface during pregnancy may be managed medically if the problem is not too severe. Severe valvular problems may require valve replacement, and successful valve replacement during pregnancy has been documented.2,3 In some cases, valvuloplasty (placing a balloon in the valve to open a narrowed valve) may be an option. The choice of a valve, should a replacement be neccessary during pregnancy, poses additional risks. Blood thinners such as warfarin required for certain types of valves pose the threat of birth defects for an unborn child.2 In such high-risk cases, the close collaboration between heart surgeon and obstetrician is vital.
Washington University heart surgeons who treat heart valve disease
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Resources
References
- Redberg RF, Schiller NB. Gender and valvular surgery (editorial). Journal of Thoracic and Cardiovascular Surgery. 2004;127(1): 1-3.
- Carpenter AJ, Camacho M. Valvular heart disease in women: The surgical perspective (editorial). Journal of Thoracic and Cardiovascular Surgery. 2004;127(1): 4-6.
- Gopal K, Hudson IM, Ludmir J, Braffman MN, Ewing S, Bavaria JE, Wong KL, Bridges CR. Homograft aortic root replacement during pregnancy. Annals of Thoracic Surgery. 2002;74(1):243-245.