The aortic valve functions as a ‘one-way’ valve allowing blood to be ejected from the left ventricle to the aorta. Aortic regurgitation is the backwards ‘leak’ of blood from the aorta into the left ventricle.

Commonly, a small amount (trivial) of aortic regurgitation can be detected via echocardiography. However, with advancing age, hypertension or other conditions (such as valve infection) – the degree of aortic regurgitation can range from mild to severe

Progressive exertional breathlessness is the most common symptom. When the heart is unable to cope with amount of aortic regurgitation, or if it occurs very quickly patients may experience ankle swelling and breathlessness when laying flat (orthopnoea).

• Like aortic stenosis, severe regurgitation is a ‘mechanical’ problem, that in most cases requires a ‘mechanical’ solution.
• Mild or moderate degrees of regurgitation don’t generally require intervention. Instead, medications to reduce blood pressure are often used to slow the progression.
• Severe regurgitation requires valve replacement surgery if the patient is considered ‘fit’ enough. Generally speaking, transcatheter aortic valve replacement is not indicated / suitable in pure aortic regurgitation due the absence of calcium to anchor the device.

The mitral valve consists of a large anterior leaflet and a smaller posterior leaflet. It allows the passage of blood from the left atrium to the left ventricle.

Mitral stenosis is a condition that leads to progressive thickening and restriction of the mitral leaflets that make it more difficult for blood to flow into the left ventricle. The two most common causes of mitral stenosis are rheumatic heart disease (long-term consequence of childhood rheumatic fever), and mitral annular calcification (usually seen in older patients, advanced kidney disease – particularly if on dialysis).

As the condition worsens, the pressure in the left atrium becomes higher to ‘force’ the blood into the left ventricle. Eventually, this puts strain on the blood vessels in the lung circulation and right-side of the heart.

Exertional breathlessness is the most common symptom

Later in the course of disease patients may develop arrhythmias (atrial fibrillation) which significantly increase the risk of stroke.

• Invasive treatment for mitral stenosis is required when it becomes severe (either at rest or with exercise).
• Depending on the appearance of the mitral valve and age of the patient, some people may be offered a balloon valvuloplasty.
• Many patients will require a valve replacement, particularly is there is a lot of ‘calcium’ in the leaflets / supporting structures

The mitral valve consists of a large anterior leaflet and a smaller posterior leaflet. It allows the passage of blood from the left atrium to the left ventricle, and prevents ‘backwards’ flow during ventricular contraction, so that blood is only permitted to flow into the aorta.

Mitral regurgitation is where blood travels ‘backwards’ from the left ventricle to the left atrium during ventricular contraction – this reduces the amount of blood pumped into the aorta.

As this condition worsens, the left atrium becomes larger to accommodate the ‘extra’ blood and this in turn places increased strain on the vessels in the lung (causing breathlessness).

If severe and untreated, this can lead to heart failure.

Exertional breathlessness is the most common symptom

Later in the course of disease patients may develop arrhythmias (atrial fibrillation) which significantly increase the risk of stroke

• Invasive treatment for mitral regurgitation is generally required when it becomes severe and associated with symptoms or heart muscle impairment (even in the absence of symptoms).
• Depending on the appearance of the mitral valve, it may be possible to repair the leaflets, or a valve replacement (tissue or mechanical) may be required in more complex abnormalities