By Angela Ryan Lee, MD 

 Medically reviewed by Jeffrey S. Lander, MD

According to the Centers for Disease Control and Prevention, 2.5% of Americans have valvular heart disease, and it is even more commonly seen in older adults.1

Heart valve disease can affect any of the four valves in the heart, and can range from harmless to life-threatening. While some forms of valve disease have become less common in the United States over the last century, other forms, like degenerative valve disease, have become more common as the country's population is living longer.2

This article will give an overview of valvular heart disease and highlight some important facts and statistics for diseases affecting each of the heart's valves.

bymuratdeniz / Getty Images

Heart Valve Disease Overview

The heart has four valves, and each can become diseased. When this happens, a valve can become too narrow or too leaky—or even both at once. Leakiness of a heart valve is called regurgitation, while the narrowing of a valve that restricts blood flow is called stenosis.

Over time, regurgitation or stenosis leads to changes in the heart's structure, like thickening or dilation of the heart's walls. Valvular heart disease can ultimately lead to heart failure, arrhythmias, stroke, and death.3

It's important to have heart valve disease evaluated by a cardiologist who can recommend an appropriate management plan.

The Heart's Valves

The heart's four valves separate the heart's chambers and great vessels:4

• Aortic valve sits between the left ventricle and the aorta

• Mitral valve separates the left atrium from the left ventricle

• Tricuspid valve separates the right atrium and right ventricle

• Pulmonic valve sits between the right ventricle and the pulmonic artery

How Common Is Valvular Heart Disease?

About 1 in 40 people in the U.S. has significant valvular heart disease.1 The mitral and aortic valves are more commonly affected than the other valves. The most common forms of valvular heart disease are discussed below.

Mitral Valve Disease

When it comes to valvular heart disease, the mitral valve is the most commonly affected valve. Approximately 4 million Americans have significant mitral valve regurgitation, with 250,000 cases diagnosed each year.5

One of the most common abnormalities of the mitral valve is mitral valve prolapse. This condition is harmless in many cases but can lead to significant mitral regurgitation in some people.6

Aortic Valve Disease

Aortic stenosis is one of the more common forms of heart valve disease. In the U.S., aortic stenosis affects 5% of people over the age of 65.7

With the narrowing of the aortic valve, the heart has to generate higher pressure to pump blood out of the heart. This extra stress on the heart leads to thickened heart walls and can cause symptoms like shortness of breath, chest pain, dizziness, and fainting.8

Therapies for Aortic Stenosis

In the past, severe aortic stenosis required open-heart surgery to treat. However, in recent decades, cardiologists have developed a technique called transcatheter aortic valve replacement (TAVR) that has allowed for the placement of a new valve without any surgical incisions.9 In this procedure, a new heart valve is delivered on a catheter placed in a blood vessel.

Tricuspid Valve Disease

The tricuspid valve is one of the right-sided heart valves. It separates the right atrium and right ventricle. Mild tricuspid regurgitation is common. When the valves are normal it often does not pose any problem.10 Causes of significant tricuspid valve disease include:11

• Dilation of the heart

• Inflammation of the heart's chambers and valves (endocarditis)

• Rheumatic fever

• Carcinoid syndrome (when a rare type of tumor causes symptoms)

Pulmonic Valve Disease

Problems with the pulmonic valve are usually congenital, meaning the valve is not formed properly from birth. About 7% of people born with congenital heart disease have narrowing of the pulmonic valve.10

Heart Valve Disease by Age and Sex

Degenerative valve disease is a major form of heart valve disease that increases with age. Over the years, the heart valves can become filled with calcium (calcified), leading to significant narrowing.

As people have been living to older age in the U.S., the country is seeing more cases of degenerative valve diseases.2

Some types of valvular disease are more common in people according to the sex they were assigned at birth:12

• Mitral valve prolapse is diagnosed more commonly in cisgender females

• Bicuspid aortic valve, a congenital defect of the aortic valve, is three times more common in cisgender males

Causes and Risk Factors for Valvular Heart Disease

Heart valve disease has many possible causes, including:133

• Congenital malformations

• Degeneration of valves from aging

• Heart attack

• Dilated heart

• Pulmonary hypertension

• Endocarditis

• Radiation treatment

• Implanted devices in the heart (e.g., pacemakers)

While you cannot control the valves you were born with or the aging process, there are some risk factors for valvular heart disease you can have some control over:13

• Avoid IV drug use (which can lead to endocarditis)

• Practice good dental and oral hygiene

• Take prescribed antibiotics before surgery or certain dental procedures if you have underlying valve problems to prevent endocarditis

• Get treatment for strep throat promptly to prevent rheumatic fever

• Manage health conditions like high blood pressure, cholesterol, and diabetes

What are Mortality Rates for Valvular Heart Disease?

In general, the more severe the valvular heart disease, the higher the mortality. Valve disease is graded according to symptoms, valve structure, and severity of valve stenosis or regurgitation (mild, moderate, or severe).10 The presence of other conditions, like heart failure and coronary artery disease (CAD), also affects mortality.

According to data from the CDC, deaths from valvular heart disease are attributed to the aortic and mitral valves as follows:1

• 61% of deaths are due to aortic valve disease

• 15% of deaths are due to mitral valve disease

Based on research, here is what we know about survival rates for the different types of valvular heart disease when they're left untreated:

• Severe Aortic Stenosis with symptoms: 50% survival rate at one year14

• Severe Aortic Regurgitation: 2.2% mortality rate per year15

• Severe Mitral Stenosis: 72% survival at one year16

• Severe Mitral Regurgitation: 61% survival at five years (though this estimate might be artificially low because the people who did not undergo surgery for their valve were generally sicker)17

• Severe Tricuspid Regurgitation: ~64% survival at one year18 19

Keep in mind that with treatment—which can include a combination of medication, surgery, and transcatheter therapies—these survival rates can be much higher.

Understanding Survival Rates

Survival rate is the proportion of people who are still living after a specified period of time. Mortality rate, on the other hand, is the proportion of people not surviving after the specified time.

The survival rates listed above come from research studies, which sometimes under- or overestimate survival rates based on the people who were included in the study.

For example, survival rates for untreated valvular heart disease can be significantly underestimated when looking at valve disease in the modern era when treatments like valve replacement are common.

Screening and Early Detection

Your healthcare provider is checking for valvular heart disease when they listen to your heart with a stethoscope. This is called cardiac auscultation and it helps them identify a heart murmur.

What is a Heart Murmur?

A heart murmur is a noise that blood makes when flowing through the heart. It is not always a sign of a problem with the heart's valves. For example, pregnant people can have harmless murmurs due to the increased blood flow through normal valves. However, a murmur can sometimes be the first indication of a potential heart valve problem.

If a concerning heart murmur is heard, or if you have symptoms of a heart valve problem (like shortness of breath, exercise intolerance, lightheadedness, or fainting), your provider can diagnose the problem with an echocardiogram. An echocardiogram is an ultrasound test of the heart that provides information about the heart's structure, valves, and blood flow.20

If a significant heart valve problem is identified, you will be referred to a cardiologist, a heart specialist who is knowledgeable about caring for patients with heart valve disease.

Some forms of heart valve disease only need to be monitored with echocardiograms every year or so. More severe forms of valve problems require intervention such as valve repair or replacement with surgery or transcatheter therapies.10 Early detection and treatment are important parts of treating valvular heart disease.

Summary

Heart valve disease is a problem with any one or more of the heart's four valves that can cause regurgitation or stenosis, and lead to complications like heart failure, stroke, and death. The most commonly affected valves are the mitral and aortic valves. While there are many causes of valvular heart disease, aging contributes to degenerative valve disease, which is becoming more common in the United States.

Heart valve disease is diagnosed using echocardiography, and managed by cardiologists. Many forms of heart valve disease are treatable with open heart surgery, and now with even less invasive transcatheter techniques.

Sources

Centers for Disease Control and Prevention. Valvular Heart Disease.

Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: Disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002-1012. doi:10.1016/j.jacc.2013.05.015

National Library of Medicine, MedlinePlus. Valvular Heart Diseases.

American Heart Association. Roles of Your Four Heart Valves.

American College of Cardiology. Succeed in Managing Heart Valve Disease Initiative.

American Heart Association. Problem: Mitral Valve Prolapse.

Ancona R, Pinto SC. Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): Is the prevalence of AS/AI similar in different parts of the world?. e-journal of Cardiology Practice. 2020;18(10).

American Heart Association. Aortic Stenosis Overview.

Bourantas CV, Serruys PW. Evolution of transcatheter aortic valve replacement. Circ Res. 2014;114(6):1037-1051. doi:10.1161/CIRCRESAHA.114.302292

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227. doi:10.1161/CIR.0000000000000923

American Heart Association. Problem: Tricuspid Valve Regurgitation.

DesJardin JT, Chikwe J, Hahn RT, Hung JW, Delling FN. Sex differences and similarities in valvular heart disease. Circ Res. 2022;130(4):455-473. doi:10.1161/CIRCRESAHA.121.319914

National Heart, Lung, and Blood Institute. Heart Valve Diseases: Causes and Risk Factors.

Bevan GH, Zidar DA, Josephson RA, Al-Kindi SG. Mortality due to aortic stenosis in the United States, 2008-2017. JAMA. 2019;321(22):2236-2238. doi:10.1001/jama.2019.6292

Mentias A, Feng K, Alashi A, et al. Long-term outcomes in patients with aortic regurgitation and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2016;68(20):2144-2153. doi:10.1016/j.jacc.2016.08.045

Kato N, Padang R, Scott CG, Guerrero M, Pislaru SV, Pellikka PA. The natural history of severe calcific mitral stenosis. J Am Coll Cardiol. 2020;75(24):3048-3057. doi:10.1016/j.jacc.2020.04.049

Rafique AM, Zarrini P, Singh N, et al. Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era. Open Heart. 2016;3(2):e000378. doi:10.1136/openhrt-2015-000378

Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging. 2014;7(12):1185-1194. doi:10.1016/j.jcmg.2014.07.018

Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43(3):405-409. doi:10.1016/j.jacc.2003.09.036

American Heart Association. Echocardiogram (echo).

By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.