Valvular Stenosis

The heart is composed of two upper chambers called atria and two lower chambers called ventricles. The upper chambers are responsible for carrying blood from the heart to the lungs to be oxygenated while the lower chambers are responsible for carrying oxygenated blood to the body.

In between the right atrium and the right ventricle is a one-way tap (valve) called the tricuspid valve and from the right ventricle going to the pulmonary artery (a large vessel connected to the lungs), is a tap called the pulmonary valve. A tap is also positioned between the left atrium and left ventricle. This is called the mitral valve. Another tap is located between the left ventricle and the aorta (the largest vessel of the heart that carries blood going to the body).


Valvular stenosis (Heart Valve Disease) occurs when one or more valves are narrowed, stiffened, thickened or blocked. When this happens, the heart will have a hard time pumping blood. If not treated, this may lead to heart failure.


If a person is having valvular stenosis, he or she will experience the following signs:

  • Shortness of breath at midnight especially while lying down
  • Fatigue
  • Chest pain
  • Swelling (oedema) of the legs, arms and other parts of the body
  • Dizziness and fainting
  • Palpitations
  • Unproductive cough, sometimes with a tinge of blood in the sputum
  • Bluish colouration of the skin due to the absence of oxygen in the body
  • Stroke
  • Multiple heart symptoms


If the valves are defective, there are four conditions that will occur:

Tricuspid stenosis: Defective valve between the right atrium and the right ventricle. If there is narrowing of the tricuspid valve, the right atrium will become enlarged and affects pressure and blood flow. Severe cases may require surgery.

Causes: The below are the causes of tricuspid stenosis.

  • Rheumatic fever (a childhood illness which occurs after an untreated sore throat)
  • Birth defects or tumours of the heart (rare)

Symptoms: The below are the symptoms of tricuspid stenosis :

  • Palpitations
  • Fluttering of the heart
  • Cold skin
  • Fatigue

Pulmonic stenosis: Defective valve between the right ventricle and pulmonary artery. It limits blood flow to the lungs and adds pressure to the right ventricle which will lead to heart enlargement. In mild cases, the heart can still perform its normal function; however, positive outcomes are achieved from successful surgical procedures.

Causes: The below is a cause of pulmonary stenosis.

  • Congenital heart defect

Symptoms: The below are the symptoms of pulmonary stenosis.

  • Easily gets tired during exercise
  • Fatigue
  • Fainting
  • Expanded abdomen due to accumulation of gas or fluid (abdominal distension)
  • Poor weight gain
  • Shortness of breath
  • Chest pain
  • Bluish skin due to absence of oxygen

Mitral stenosis: Defective valve between the left atrium and left ventricle. It reduces the flow of blood to the left ventricle causing the enlargement. Medications are given to treat the symptoms, but if it gets worse, the valve can be repaired or replaced.

Causes: The below are some of the causes of mitral stenosis.

  • Rheumatic fever

Aortic stenosis: Defective valve between the left ventricle and aorta. Among the four valve dysfunctions, this is the most common and most dangerous.

Symptoms: The below are some of the symptoms of mitral stenosis.

  • Shortness of breath
  • Chest pain, tightness
  • Fainting
  • Palpitations
  • Reduced ability to perform normal activities


The primary approach to diagnose a defective heart valve is by listening to the heart for unusual sounds (auscultation) using a stethoscope. You may be asked to change your position or bear down with your abdominal muscles to check if there are changes to the murmur sounds of your heart.

After listening to your heart, your doctor may perform further tests to get all the needed information regarding your heart’s condition. An echocardiogram (cardiac echo) takes images of your heart which helps in deciding what kind of treatment plan should be provided or if there is a need for further treatment.

Further tests may or may not be given, which include:

  • Exercise test (e.g. treadmill)
  • Chest X-rays
  • CT scan
  • Exploratory cardiac catheterisation which involves a long thin tube that is inserted into an artery or vein and threaded into the heart (if necessary)


People diagnosed with mild valvular stenosis continue to live a normal life and may not require surgery. However, a plan of treatment may still be given such as:

  • Protecting the heart from further damage
  • Taking medication to manage the symptoms
  • Repair the valve if there is a need
  • Planning for management, self-care and follow-up care

For further treatment:

  • Valve repair, requires minimal surgery, and preserves the heart’s valve and flaps
  • Valve replacement