Dr. Richard Mansfield

Dr. Richard Mansfield

Note: I am happy to answer general questions regarding the content of this website, but I cannot give clinical advice. Such requests will not be answered.

Heart valve disease

What and where are the heart valves?

The heart has four main chambers. There are two atria at the top and two ventricles at the bottom. The right side of the heart has an atrium and ventricle separated by the tricuspid valve. The right ventricle pumps blood to the lungs through the pulmonary valve. On the left side, the left atrium feeds blood to the left ventricle through the mitral valve. The left ventricle pumps blood into the aorta and rest of the body through the aortic valve.

What can go wrong with the heart valves?

Valves may either be narrowed (stenosis) or may leak (regurgitation). The two most common valves to be affected are the aortic and mitral. The commonest cause of valvular heart disease a few years ago was rheumatic fever but in current practice it is more likely to be due to gradual wear and tear of a valve.

Does heart valve disease cause symptoms and make people unwell?

Patients with heart valve disease may have no symptoms whatsoever if it is mild but as it progresses further it may present with breathlessness, reduced effort tolerance or palpitation. Angina may also occur. Fainting does occur in more severe valve disease particularly when affecting the aortic valve.

Commonly valve disease is picked up incidentally as part of a routine medical when a murmur is heard when a doctor is listening to the chest with a stethoscope. A heart murmur merely represents turbulence across the valve and may be quite normal but it is important to be sure whether the valve is narrowed or leaking.

What tests are carried out for valve disease?

Tests for heart valve disease include an ECG, chest x-ray and commonly an echocardiogram. The echocardiogram allows an assessment of the heart size and the dimensions of the individual chambers as well as giving clear pictures and data regarding the structure and function of the cardiac valves. It may be necessary to undergo cardiac catheterisation to get additional information and this is commonly carried out in patients whose valve disease is severe enough to warrant onward referral for heart valve surgery.

Does everyone with heart valve disease need to have an operation?


For many patients all that is required is annual follow up with an echocardiogram or outpatient review. If there are symptoms of breathlessness, syncope or angina then an operation may be needed. If valve disease is severe then an operation may be recommended even if there are no symptoms.

Heart valve replacement surgery is a common cardiac surgical procedure. Heart valves are generally of two types. This may be either tissue valves or mechanical valves. Tissue valves are made from pig and beef tissues and mechanical valves are made from carbon and metal. Tissue valves do not last as long as mechanical valves but mechanical valves do require long-term treatment with Warfarin, which thins the blood to prevent the valve clotting. Detailed discussion takes place between the surgeon and the patient as to which valve would be most suitable.

Some patients are having the aortic valve replaced using a less invasive approach, known as TAVI (trans catheter aortic valve implantation). This procedure is carried out through the groin artery and does not require the chest to be opened as with a more traditional valve operation. It is a developing technology and not suitable for all patients.

If I have valve disease or have had a valve operation do I need to take antibiotics before visiting the dentist?

The recommendations on taking antibiotics before dental procedures have changed. It is still recommended if you have a valve replacement or have had a valve infection (endocarditis). You should seek advice on this from your doctor.