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Deo Medical Cardiology
Condition · Valve Disease

Valve Disease

Valvular heart disease — disorders of the valves that direct blood flow through the heart — ranges from mild conditions managed by observation to severe ones that benefit from procedural intervention. The most important work in valve disease is matching the right monitoring cadence to the severity, recognizing when intervention is appropriate, and choosing the right procedure when the time comes. Less-than-severe valve disease is well-managed by a virtual cardiology relationship with periodic echocardiograms.

Dr. Rahul C. Deo Reviewed by Rahul C. Deo, MD, PhD · Last updated May 20, 2026

The valves and what can go wrong

Four valves direct blood through the heart: aortic, mitral, tricuspid, and pulmonic. Each can develop stenosis (narrowing), regurgitation (leakage), or both. The most clinically important forms in adults:

Aortic stenosis

Narrowing of the aortic valve, most often from age-related calcification. The most common severe valve disease in adults. Classic symptoms: exertional breathlessness, chest pain, syncope. Severe symptomatic aortic stenosis benefits substantially from valve replacement — either transcatheter (TAVR) or surgical (SAVR). The TAVR option has expanded the population who can be treated, including patients previously considered too high-risk for surgery.

Mitral regurgitation

Leakage of the mitral valve. The most common mitral disorder. Two main causes: primary (the valve itself is abnormal — mitral valve prolapse, ruptured chord) and secondary (the valve is structurally normal but the geometry of the heart distorts its function, often from heart failure or AFib). Treatment depends on the type: primary severe regurgitation often benefits from mitral valve repair or replacement; secondary regurgitation benefits from treating the underlying heart failure first, with MitraClip or surgical intervention in selected cases.

Mitral stenosis

Less common in the US than it used to be (rheumatic disease has declined), but still seen. Causes left atrial enlargement, increased risk of AFib, and pulmonary congestion. Severe cases benefit from balloon mitral valvuloplasty or surgical intervention.

Aortic regurgitation

Leakage of the aortic valve. Often slowly progressive over years. Severe asymptomatic AR with left ventricular dilation or dysfunction benefits from valve replacement.

Tricuspid regurgitation

Common, especially in older adults with heart failure or pulmonary hypertension. Treatment used to be limited; new transcatheter therapies (TriClip, EVOQUE) have changed the landscape and severe symptomatic TR now has more options.

How valve disease is followed over time

The work is matching surveillance to severity:

What modern valve intervention looks like

Transcatheter approaches have dramatically expanded the population who can be treated:

The right procedure depends on the valve, the anatomy, the severity, the surgical risk, and the patient's preferences and life expectancy. A cardiologist familiar with the current landscape helps walk through the options.

How virtual cardiology handles valve disease

The longitudinal monitoring and decision-making work fits virtual cardiology well:

  1. First visit by video. History, review of prior echoes and records, classification of severity, plan for surveillance.
  2. Echoes ordered to imaging centers near you at the appropriate interval. Reviewed by your cardiologist.
  3. Follow-up visits by video to review imaging, assess symptoms, optimize medical therapy.
  4. Referral for intervention when criteria are met — to a procedure-equipped local cardiac center. Pre-procedure decision-making and post-procedure management coordinated virtually with the local intervention team.

Valve disease is also one of the conditions for which a cardiac second opinion is especially worth getting before any major procedure.

Frequently Asked Questions

Common questions

How is valve disease diagnosed?

Echocardiogram is the gold standard — it visualizes each valve, quantifies how much it leaks (regurgitation) or how narrow it is (stenosis), and measures the consequences for the heart's structure and function. A specialty cardiac MRI or transesophageal echo is sometimes added when the standard echo doesn't fully answer the question. The diagnosis often starts with a murmur on physical exam or an incidental echo finding.

What's the difference between stenosis and regurgitation?

Stenosis is narrowing of a valve, making it harder for blood to flow through. Regurgitation (or insufficiency) is leakage — the valve doesn't close properly, allowing blood to flow backward. Both can be mild, moderate, or severe. Aortic stenosis is the most common severe valve disease in adults; mitral regurgitation is the most common form of mitral valve dysfunction.

How often should I have my echocardiogram repeated?

Depends on the valve, the severity, and whether symptoms are present. General guidelines: mild disease — every 3-5 years; moderate disease — every 1-2 years; severe disease without symptoms — every 6-12 months; severe with symptoms — closer to weekly-to-monthly as we plan intervention. Your cardiologist tailors this to your specific situation; the cadence may change as the disease progresses or stabilizes.

When does valve disease need a procedure?

When the valve becomes severe AND either symptoms develop (chest pain, breathlessness, exertional limitation) OR the heart's structure starts to change (left ventricular enlargement or dysfunction). Asymptomatic moderate disease is watched; severe symptomatic disease usually needs intervention. The timing is critical — too early means an unnecessary procedure, too late risks irreversible heart damage. This is exactly the decision a cardiology second opinion is often valuable for.

Can virtual cardiology manage valve disease?

Yes for the longitudinal monitoring side — periodic echos at imaging centers near you, results reviewed by video, symptom assessment, medical optimization of comorbidities (hypertension, AFib, lipids), and decision-making about when to refer for intervention. The intervention itself (TAVR, surgical valve replacement or repair, MitraClip, etc.) happens at a procedure-equipped cardiac center coordinated with local cardiology and surgery. Most of the workup, monitoring, and post-procedure management runs cleanly through a virtual relationship.

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Cardiac Second Opinion

An independent cardiology review — records, imaging, and decisions reviewed by a board-certified, Harvard-trained cardiologist.

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