Your heart has four valves that keep blood flowing in the right direction. When one or more of these valves doesn't work properly, it can put extra strain on your heart and lead to serious symptoms. This guide explains the most common valve conditions, how they're diagnosed, and the treatment options available today.
The heart has four chambers — two upper (atria) and two lower (ventricles). Between each chamber, and at the exits of the ventricles, sit valves that open and close with each heartbeat to ensure blood moves forward through the heart and out to the body.
The four valves are the aortic valve (between the left ventricle and the aorta), the mitral valve (between the left atrium and left ventricle), the tricuspid valve (between the right atrium and right ventricle), and the pulmonic valve (between the right ventricle and the pulmonary artery).
Valve disease occurs in two main forms: stenosis, where the valve becomes stiff or narrowed and doesn't open fully, restricting blood flow; and regurgitation (also called insufficiency or a "leaky valve"), where the valve doesn't close completely and blood flows backward.
Aortic stenosis is the most common valve disease requiring intervention in adults. The aortic valve — which sits between the left ventricle and the aorta — becomes calcified and stiff over time, making it harder for the heart to pump blood out to the body. It is most often caused by age-related calcium buildup on the valve leaflets, though some patients are born with a bicuspid (two-leaflet) aortic valve that is prone to earlier degeneration.
Symptoms typically develop gradually and may include shortness of breath with exertion, chest pain or pressure, dizziness or fainting (especially with activity), and fatigue. Once symptoms appear, severe aortic stenosis can progress rapidly without treatment.
Severe aortic stenosis with symptoms is a serious condition. Once symptoms like fainting, chest pain, or heart failure develop, the average survival without valve replacement is significantly reduced. Early evaluation by a cardiologist is essential.
Treatment options for aortic stenosis include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). The choice depends on age, overall health, anatomy, and a shared decision between the patient and the heart team. Medical therapy alone cannot reverse stenosis but may help manage symptoms temporarily.
In aortic regurgitation, the aortic valve doesn't close tightly, allowing blood to leak backward into the left ventricle after each heartbeat. Over time, the heart enlarges to accommodate the extra volume, eventually leading to heart failure if untreated.
AR can be caused by a bicuspid valve, connective tissue disorders (such as Marfan syndrome), endocarditis (infection of the valve), or age-related degeneration. Unlike stenosis, AR may remain asymptomatic for years while the heart compensates — but once the heart begins to weaken, intervention is needed.
Historically, surgical valve replacement was the only option. Today, transcatheter options are emerging for patients at high risk for surgery. The JenaValve Trilogy system is the first transcatheter valve specifically designed for aortic regurgitation, studied in the landmark ALIGN-AR trial.
Mitral regurgitation is the most common form of valve disease worldwide. The mitral valve sits between the left atrium and left ventricle. When it doesn't close properly, blood leaks backward into the atrium with each heartbeat.
MR is classified as primary (degenerative) — caused by a structural problem with the valve itself, such as a floppy leaflet (mitral valve prolapse) or a torn chord — or secondary (functional) — where the valve is structurally normal but doesn't close well because the left ventricle has enlarged, typically from heart failure or a prior heart attack.
Treatment depends on the type and severity. Options include surgical mitral valve repair or replacement, transcatheter edge-to-edge repair (TEER) using devices like MitraClip, and emerging transcatheter mitral valve replacement (TMVR) technologies.
Mitral stenosis — narrowing of the mitral valve — is less common in developed countries today. It is most often caused by rheumatic heart disease, a complication of untreated strep throat. In some cases, balloon valvuloplasty (opening the valve with a catheter-based balloon) or surgical intervention may be needed.
The tricuspid valve, on the right side of the heart, has historically received less attention — sometimes called "the forgotten valve." However, tricuspid regurgitation (TR) is increasingly recognized as an important contributor to symptoms and outcomes in patients with heart disease.
Severe TR causes fluid retention, leg swelling, abdominal bloating, fatigue, and exercise intolerance. It often develops secondary to left-sided heart disease or pulmonary hypertension but can also be caused by pacemaker or defibrillator leads crossing the valve.
Treatment options are expanding rapidly. In addition to surgical repair or replacement, newer catheter-based approaches include TEER for the tricuspid valve (TriClip) and emerging transcatheter tricuspid valve replacement (TTVR) systems.
The primary tool for diagnosing valve disease is echocardiography — an ultrasound of the heart that shows how the valves are moving, how much blood is leaking or being obstructed, and how well the heart is pumping. Additional imaging may include transesophageal echo (TEE), cardiac CT, or cardiac MRI depending on the valve involved and whether a procedure is being considered.
Your cardiologist will assess the severity of valve disease (mild, moderate, or severe), the impact on heart function, and the presence of symptoms to determine the best management approach.
Complex valve decisions are made by a multidisciplinary "heart team" that includes interventional cardiologists, cardiac surgeons, imaging specialists, and anesthesiologists. This ensures that every patient receives a personalized recommendation based on their unique anatomy, health status, and goals.