Understand heart valve disease: causes, symptoms, and treatment. Valve repair or replacement surgery (Valve Repair or Replacement Surgery). Which one should I choose?

What is a Heart Valve?

Heart valves are thin, flexible tissue flaps that act like doors or valves controlling the flow of blood within the heart. There are 4 main valves, including:

• Tricuspid valve located between the right atrium and right ventricle
• Pulmonary valve located at the exit of the right ventricle to the pulmonary artery
• Mitral valve located between the left atrium and left ventricle
• Aortic valve located at the exit of the left ventricle to the aorta

Functions and Importance of Heart Valves

The main function of heart valves is to control the direction of blood flow so that it flows in only one direction. The valves open when blood needs to pass through and close immediately after to prevent backflow. If the heart valves work perfectly in coordination, the heart can pump blood efficiently to nourish various organs. However, if the valves malfunction, such as not opening or closing properly, it can cause blood to flow backward or cause obstruction, making the heart work harder and potentially leading to heart failure or other serious health problems.

Common Heart Valve Diseases

Common heart valve diseases are mainly divided into two types based on abnormal valve function:

• Valve stenosis: A condition where the valve cannot open fully as normal, narrowing the passage for blood flow. This causes the heart to work harder to pump blood through. Without treatment, it may lead to heart failure.
• Valve regurgitation: A condition where the valve does not close completely, causing blood to flow backward. The heart must work twice as hard to pump the same amount of blood repeatedly to supply the body adequately.

There are also other conditions such as valve prolapse, where the valve bulges, protrudes, or sags abnormally into the preceding heart chamber, which may lead to valve regurgitation in some cases.

Causes of Valve Stenosis or Regurgitation

• Age-related degeneration is the most common cause, where the valve wears out, thickens, stiffens, or accumulates calcium over time, resulting in incomplete valve opening and closing, leading to stenosis or regurgitation.
• Rheumatic fever caused by group A Streptococcus bacterial infection in the throat, where the infection and inflammation may spread to the heart valves.
• Congenital abnormalities such as incomplete valve leaflets or abnormal valve shapes.
• Infective endocarditis caused by bacteria or fungi entering the bloodstream and directly damaging the valve tissue.
• Coronary artery disease and ischemic heart disease causing damage to the heart muscle and affecting the structures supporting the valves, leading to valve dysfunction and regurgitation.
• Other diseases and conditions such as hypertension, chronic diabetes, or certain genetic disorders affecting connective tissue, which may cause valve degeneration or abnormalities.

What Symptoms Might Indicate Valve Stenosis or Regurgitation?

In the early stages of valve stenosis or regurgitation, there may be no symptoms, especially if mild. However, as the condition progresses or worsens, the body will start to show warning signs through symptoms such as:

• Shortness of breath or wheezing: The most common symptom, especially during exertion or even when lying flat, due to blood congestion in the lungs caused by abnormal valves.
• Fatigue and easy tiredness: Caused by the heart working harder to compensate for valve dysfunction, resulting in insufficient blood and oxygen supply to the body.
• Chest pain or tightness: May occur when the heart is overworked, enlarged, or in some cases due to ischemic heart disease.
• Palpitations or irregular heartbeat: Abnormal valve function may cause irregular heart rhythms, making you feel your heart beating fast, strong, or skipping beats.
• Dizziness or fainting: Caused by insufficient blood flow to the brain, especially when changing positions or exerting effort.
• Swelling in legs, feet, and rapid weight gain: Due to fluid retention in the body, which is an important sign of heart failure.
• Chronic cough: Especially at night or when lying down, possibly caused by blood congestion in the lungs from valve problems.

However, these symptoms may also indicate other diseases and are not exclusively specific to valve stenosis or regurgitation.

How is Valve Stenosis or Regurgitation Diagnosed?

Diagnosing valve stenosis or regurgitation involves several steps, and the choice of diagnostic methods depends on the patient’s symptoms, initial diagnosis, and the physician’s judgment. Generally, the examination includes:

• Medical history and physical examination, such as listening for heart murmurs, which are important signs indicating abnormal blood flow through the valves.
• Electrocardiogram (ECG/EKG) to assess heart rhythm, which can indicate certain abnormalities like heart enlargement or arrhythmias caused by valve problems.
• Chest X-ray to view the size and shape of the heart and detect fluid accumulation in the lungs, often seen in heart failure caused by valve disease.
• Echocardiogram using high-frequency sound waves, which is the most important test as it shows detailed valve structure, movement, function, and blood flow through the valves. It can determine the severity of stenosis or regurgitation. There are two main types: transthoracic echocardiogram (TTE), a non-invasive initial test, and transesophageal echocardiogram (TEE), which provides clearer and more detailed images, usually performed if TTE results are insufficient.
• Additional tests if necessary, such as exercise stress testing (EST) to evaluate heart and valve function, or cardiac MRI for detailed images of heart structure, valves, and function.
• Cardiac catheterization to assess coronary arteries for blockages, measure pressures inside heart chambers and major vessels, evaluate the severity of valve stenosis or regurgitation, and measure cardiac output.

When Should Heart Valve Repair Be Done and Why Is It Better Than Valve Replacement?

The decision to “repair” or “replace” a heart valve is carefully considered by the physician. Valve repair is a good option to preserve the patient’s natural valve as much as possible because it often provides better long-term outcomes, especially in cases of valve regurgitation. However, whether to repair or replace the valve depends on important factors such as:

Type, Severity, and Characteristics of the Valve

• Mitral valve regurgitation often caused by degeneration of the valve or chordae tendineae, with valve prolapse, sagging, or minor chordae rupture. This type is usually treated with repair due to a high success rate.
• Certain types of valve stenosis, especially when the valve is not severely calcified, often found in younger patients or caused by non-degenerative factors. Balloon valvuloplasty may be considered as an indirect repair without valve replacement.

Valve repair has the advantage of not requiring lifelong anticoagulant medication because the repaired valve remains the patient’s natural tissue, reducing risks of blood clots and abnormal bleeding. It also preserves the heart’s natural structure and function better and lowers the risk of complications from prosthetic valves, such as infection or long-term deterioration. It is also a suitable option for women planning pregnancy, as it avoids the use of anticoagulants that may harm the fetus.

Valve Repair vs Valve Replacement: What Are the Differences?

Valve stenosis or regurgitation is a condition that should not be overlooked because if not diagnosed and treated promptly, it may lead to severe complications or death. If you have suspicious symptoms, you should be evaluated by a specialist promptly to plan appropriate treatment, whether medication, valve repair, or valve replacement surgery. At Phyathai Phaholyothin Hospital, a team of heart disease specialists is ready to provide standard diagnosis and treatment of valve diseases with advanced technology to ensure safe care and help patients return to a quality life.

Dr. Thanapoom Pongkitpisan

Cardiologist

Phyathai Phaholyothin Hospital