6th May 2025

Overview and definitions

Valvular abnormalities are becoming more prevalent in western society due to an ageing population. As such, a significant proportion of patients seen on a general cardiology take, and thus on cardiology wards, will need assessment and workup for valvular intervention. 

In this chapter we will look at the most common valvular abnormalities, their underlying pathologies and standard treatment strategies.

Primary and secondary valve disease

As a general rule, valve disease can be considered as primary or secondary.

Primary valve disease refers to abnormalities of the valve or valvular apparatus, while secondary valve disease refers to abnormalities of the annulus or chamber in which it sits. For example, infective endocarditis causing a perforation in a mitral valve leaflet would cause primary mitral regurgitation (MR), while dilation of the left ventricle in the context of heart failure would cause mitral annular dilation and secondary MR due to failure of leaflet coaptation. This is important, as the treatment for the same downstream effect will ultimately depend upon the upstream cause.

Acute and chronic valve disease

Valve disease can also be classified as acute or chronic. Acute valve disease, such as the aortic regurgitation (AR) seen in infective endocarditis, can present with significant haemodynamic instability, while chronic valve disease of similar severity may not cause such significant decompensation. This is due to the ability of the heart to adapt to changes in haemodynamic circumstances over time, but without time for this gradual adaptation diastolic filling pressures can increase significantly leading to pulmonary oedema and respiratory failure. As such, acute severe valve disease may be a surgical emergency, whereas chronic severe valve disease may allow for an elective outpatient approach to valve intervention.