25 Questions and Answers
The heart contains four valves that ensure blood flows in one direction. When a valve narrows (stenosis) or fails to close properly (regurgitation), the pressure balance inside the heart is disrupted. Blood flows backward or cannot move forward in sufficient amounts. This forces the heart to work harder, gradually weakening the heart muscle. Over time, heart failure, arrhythmias, and increased pulmonary pressure may develop.
The heart has four valves: mitral, aortic, tricuspid, and pulmonary. The most commonly affected are the mitral and aortic valves. The mitral valve sits between the left atrium and left ventricle, while the aortic valve is located at the entrance of the main artery leaving the heart. The tricuspid and pulmonary valves are on the right side and are generally less prone to disease.
The main causes include rheumatic fever, congenital defects, age-related calcification (degenerative process), valve damage following a heart attack, and infections (endocarditis). Certain medications and radiation therapy can also damage valve tissue. In developed countries, calcification with age is the most common cause; in developing countries, rheumatic disease predominates.
The most common symptoms are shortness of breath, easy fatigue, palpitations, leg swelling, dizziness, and chest pain. As the narrowing progresses, the heart cannot pump enough blood and the patient has difficulty climbing stairs. In regurgitation, blood flows backward and fluid accumulates in the lungs.
Yes, because it can progress undetected for a long time. As valve function deteriorates, the heart muscle gradually thickens and loses its pumping strength. This can lead to irreversible heart failure.
The primary diagnostic method is echocardiography (ECHO). This ultrasound device shows valve movement, the heart's pumping strength, and the direction of blood flow. ECG, chest X-ray, and MRI may also be required. The detection of a "murmur" during physical examination is an important diagnostic clue.
In stenosis, the valve cannot open fully, restricting blood flow out of the heart. In regurgitation, the valve does not close completely and blood flows backward. Some patients have both conditions simultaneously. In both cases the heart is strained; the treatment approach is similar: reducing the load and, when necessary, surgical repair or replacement.
Medication can relieve symptoms and protect the heart but cannot restore damaged valve tissue to its original state. In advanced stages, the only permanent solution is valve repair or replacement. However, medications (diuretics, ACE inhibitors, beta blockers, anticoagulants) improve quality of life and prepare the patient for surgery.
The damaged valve is not removed; instead, the surgeon repairs the leaflets, tightens the edges, or reinforces the valve with a support ring (annuloplasty). This reduces backward blood flow. After repair, the valve retains its natural structure and the risk of clotting is lower. Repair is frequently preferred, especially for the mitral valve.
If the valve is severely damaged, a mechanical or biological prosthetic valve is implanted instead of repair. Mechanical valves last a lifetime but require lifelong blood thinners (e.g., warfarin). Biological valves are made from animal tissue, carry a lower clotting risk, but may need replacement after 10–15 years.
Valve repair or replacement is performed through a small incision without fully cutting the sternum. It offers cosmetic advantages, involves less blood loss, and has a shorter recovery time. It is particularly preferred in elderly or lower-risk patients.
A new biological valve is inserted into the aortic valve via a catheter through the groin artery. The chest is not opened and general anesthesia is not required. It is a safe alternative especially for elderly patients and those at high surgical risk.
Risk varies depending on the patient's age, general health condition, and the severity of the valve disease. In experienced centers, the risk for elective (planned) surgeries is around 1–3%. In emergency situations, the risk may be higher.
The patient is typically discharged within 1 week. Mild chest pain and fatigue in the first few days are normal. The recovery process takes 4–6 weeks. Full recovery is achieved with regular walking, a balanced diet, and follow-up appointments.
Patients with mechanical valves must take blood thinners for life. For biological valve recipients, it is generally required only for the first 3 months. Blood pressure, heart rhythm, and heart failure medications must also be taken regularly.
Yes. Stenosis or regurgitation may start mild but can worsen over the years. Regular follow-up with echocardiography is therefore very important.
The streptococcal bacteria that causes throat infections can trigger the immune system to attack the heart valves. Years later, this leads to valve thickening, narrowing, and leakage. Early antibiotic treatment largely eliminates this risk.
Yes. Blood volume increases during pregnancy and the heart works harder. A stenotic or regurgitant valve may not be able to handle this increased load. Women planning pregnancy should undergo a cardiological evaluation beforehand.
Some congenital valve anomalies (such as bicuspid aortic valve) can be hereditary. If a similar condition exists in the family, early echocardiographic screening is recommended.
Patients with mild valve disease can do low-intensity exercises such as walking and swimming with their doctor's approval. However, strenuous exercise is not recommended for those with severe stenosis or regurgitation, as it increases the load on the heart.
Salt intake should be restricted, fluid balance maintained, and consumption of fresh fruits and vegetables increased. Excess weight increases the load on the heart. Caffeinated drinks and excessively salty foods should also be avoided.
Yes. A microbial inflammation called "infective endocarditis" can damage the valves. Antibiotic prophylaxis should be administered before dental procedures.
When valve flow is disrupted, the turbulent passage of blood creates a sound. This sound, heard with a stethoscope, is called a "murmur." Not every murmur indicates disease, but all murmurs should be evaluated.
Timely treatment of rheumatic infections, avoiding smoking, and controlling blood pressure and cholesterol protect valve health. Age-related calcification cannot be prevented but can be slowed.
Echocardiography is recommended once a year for mild cases, and every 6 months for moderate to severe cases. If new shortness of breath, palpitations, or chest pain develops, a doctor should be consulted without delay.
