If you have a heart valve defect, this means that one of your heart valves no longer functions correctly. If a heart valve no longer opens completely, this is called heart valve stenosis. If one of them no longer closes completely, this is called heart valve insufficiency. If both are affected, this places strain on the heart and leads to [cardiac insufficiency] or to other heart diseases over the long term. A heart valve defect often does not cause any symptoms for a long time, so it is often discovered by coincidence during a routine examination.
Overview of the heart valves
The human heart has four heart valves. Two on the left and two on the right side of the heart. On the left side, the mitral valve controls the blood flow between the atrium and the ventricle, while the aortic valves control the blood flow between the ventricle and the aorta (main artery). The tricuspid valve is on the right side of the heart and regulates the blood flow between the atrium and the ventricle; the pulmonary valve controls the blood flow between the ventricle and the pulmonary artery.
In the event of heart valve insufficiency, the valve leaks, causing some of the blood to flow back through the valve. In the event of heart valve stenosis, the valve is constricted and the heart has to work against greater resistance because the valve can no longer open completely. Both place strain on the heart and lead to cardiac insufficiency over time. The most common heart valve diseases are mitral valve insufficiency and aortic valve stenosis.
Causes
Heart valve defects can be attributed to various causes and can either be congenital or develop over time:
Congenital heart valve defects
Congenital heart valve defects are a fairly rare form of heart defect that need to be treated in infancy. These heart defects occur during foetal development and affect the structure and function of the heart valves.
Heart valve inflammation
Heart valve inflammation is often caused by bacterial infections such as endocarditis or inflammatory diseases such as rheumatic fever. Inflammation of the heart valves can cause significant and long-term damage to the heart valves and ultimately lead to a valvular heart defect.
Heart attack
In a heart attack, a sudden blockage of one or more coronary arteries leads to an interruption of the blood supply to the heart muscle. The lack of oxygen causes the affected tissue to die and scar tissue forms. This scarring can have a significant impact on the structure and function of the heart and cause valvular insufficiency (mitral regurgitation).
Natural wear and tear
However, owing to the high life expectancy of the general population, the cause of heart valve defects is increasingly age-related, i.e. caused by ‘natural’ wear and tear on the valves.
Symptoms
The symptoms of heart valve disease vary depending on the valve affected and the extent of the defect. Valve defects often remain asymptomatic for a long time and are only discovered by chance. This is because the heart can initially compensate for the additional strain caused by valvular insufficiency (leakage) or heart valve stenosis (narrowing) by increasing in volume and muscle mass. However, this compensation can only be maintained up to a certain point.
Heart failure as a result of a heart valve defect
If the heart can no longer cope with the increased strain, it gradually weakens, which can lead to heart failure. Heart failure can in turn increase the risk of coronary heart disease (CHD) or, in the worst case, a heart attack. The following symptoms may indicate heart failure:
- Dyspnoea (breathlessness) or shortness of breath, especially during physical exertion or when lying down
- Tiredness and feeling weak, even with little exertion
- Pulmonary oedema (fluid in the lungs)
- Coughing, especially at night or when lying down
- Water retention in the abdomen
- Urination at night (nocturia)
- Feeling of fullness and loss of appetite
High blood pressure as a result of a heart valve defect
Both heart valve stenosis (narrowing) and valvular insufficiency (leakage) can lead to high blood pressure (hypertension). If the heart valve is stenotic (narrowed), the heart has to pump blood through the narrowed opening against increased resistance. This increases the pressure inside the ventricle, which can affect the blood pressure in the entire circulatory system. Insufficiency of the heart valve leads to an additional volume load on the heart, as the blood can flow back into the preceding ventricle or the atrium. To cope with this extra volume of blood, the heart has to pump more blood per contraction, which can increase blood pressure.
Increased risk of stroke as a result of a heart valve defect
A heart valve defect can also increase the risk of a stroke as blood clots can form on the diseased heart valves. This can lead to a blood vessel becoming blocked, interrupting the blood supply to the brain. The symptoms of a stroke can occur suddenly and vary depending on the area of the brain affected. The most common symptoms include:
- Sudden numbness or weakness
- Sudden confusion or speech problems
- Sudden vision problems
- Sudden headache
- Sudden balance and coordination problems
Diagnosis
Heart valve defects cause heart murmurs that can be identified by a cardiology specialist during auscultation, i.e. listening to the heart with a stethoscope. However, the most important diagnostic examination for recognising a heart valve defect is an echocardiogram – a cardiac ultrasound. It provides real-time images of the heart to enable doctors to diagnose valve stenosis and valvular insufficiency as precisely as possible.
Treatment
Treatment for a heart valve defect depends on the severity of the defect. Mild forms do not require immediate surgery and can initially be treated with a conservative (non-surgical) approach. If permanent damage to the heart is imminent or has already occurred, heart valve surgery is recommended. Depending on the situation, various surgical and interventional treatment options are available.
Conservative treatment for valvular heart defects
Mild forms of valve defects do not always require surgery straight away. Instead, a conservative approach can be followed initially to alleviate the symptoms and slow down the progression of the disease. Conservative treatment includes the following measures:
Avoiding physical exertion
Limiting vigorous physical activity can reduce the strain on the heart.
Medication therapy
Drugs such as diuretics can be used to reduce the accumulation of excess fluid in the body, which can be particularly helpful in mitral regurgitation. Anticoagulants (blood thinners) are used to reduce the risk of blood clots, which can occur with heart valve defects such as aortic valve stenosis.
Quitting smoking
Smoking is a risk factor for heart disease, including valvular heart disease. Quitting smoking can therefore help to reduce the risk of developing heart valve defects.
However, the course of the disease should be monitored at regular check-ups so that any necessary surgery can be recognised and planned at an early stage.
Interventional procedures
Interventional procedures are minimally invasive medical techniques that are performed via catheters and often serve as an alternative to traditional surgical procedures. These procedures enable heart valve diseases to be treated via small incisions or punctures, which reduces the stress on the patient and shortens recovery time.
Balloon valvuloplasty
A catheter with a balloon is inserted into the narrowed heart valve and inflated to widen the valve. This procedure is often used for aortic valve stenosis.
Transcatheter aortic valve implantation (TAVI)
A minimally invasive method of replacing the aortic valve without open heart surgery, often used in patients with a high surgical risk.
MitraClip procedure
In this procedure, a special clip is inserted into the femoral vein (a vein in the groin) via a catheter and guided through the vein to the mitral valve. The clip connects the leaflets of the mitral valve to reduce the retrograde flow of blood. It is usually necessary to use several MitraClips to ensure the mitral valve is repaired effectively. This procedure is often used for mitral regurgitation.
Surgical treatment
Surgical procedures to treat heart valve defects are necessary if conservative and interventional measures are not sufficient to control the symptoms or improve the function of the heart valve. The choice of procedure depends on several factors, including the type and severity of the heart valve defect and the patient’s general health.
Heart valve repair
In this procedure, the defective or faulty heart valve is repaired to restore normal function. This can include suturing flap tears, removing excess tissue or reinforcing the flap. Valve flap repair is often the preferred method when the structure of the flap is still largely intact.
Heart valve replacement
If a heart valve is severely damaged and beyond repair, the diseased valve can be replaced with a mechanical or biological prosthesis:
Mechanical valves
Mechanical heart valves are made of durable materials such as metal (e.g. titanium or carbon fibre) and can last a lifetime. However, patients with mechanical valves must take blood-thinning medication for the rest of their lives to reduce the risk of blood clots.
Biological valves (tissue valves)
Biological heart valves are made from animal tissue (e.g. porcine or bovine heart valves) or from human donor tissue. They do not normally require patients to take blood thinners for life, but have a limited lifespan.
Prevention
The prevention of heart valve defects is crucial in order to avoid serious health problems. The following measures can prevent heart valve defects or help with early diagnosis:
- Healthy lifestyle: balanced diet and regular physical exercise
- Regular medical check-ups to detect heart problems early
- Infection prevention
- Controlling blood pressure to reduce stress on the heart
- Early treatment of rheumatic fever
- Medication therapy to control risk factors
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24-hour emergency centre
Schänzlihalde 11
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