The four heart valves regulate blood flow through the atria and ventricles. Each ventricle is composed of thin layers of tissue. It opens like a swing door—but only in one direction.
Generally, a distinction is made between the tricuspid valve (the pulmonary valve in the right ventricle) and the mitral valve (the aortic valve in the left ventricle).
The four heart valves are like well-oiled valves that direct our blood in the right direction with every heartbeat @ elvira gerecht / AdobeStock
The reasons for heart valve replacement can be congenital or acquired. In this context, we speak of congenital or acquired heart valve defects (dysfunctions).
The older a person is, the more likely it is that the aortic and mitral valves will thicken. This makes the aorta less elastic and causes blood pressure to rise.
The aortic valve is subjected to greater strain and requires additional oxygen. This leads to the following defects in the heart valves:
- The heart valves “leak” (valvular insufficiency or failure)
- The heart valves do not open properly, partially blocking blood flow.
In both cases, the heart can no longer pump at full capacity. This is referred to as impaired cardiac function. Heart murmurs and abnormal heart sounds usually occur, which can be detected using ultrasound (echocardiography).
Echocardiogram of an older man @ Peakstock / AdobeStock
The heart valves can be damaged by inflammation, e.g., due to a bacterial infection of the inner lining of the heart (endocarditis).
So-called rheumatic fever, which can occur after a streptococcal infection, can also lead to heart valve disease.
Congenital adhesions or narrowings are also possible. Valves with malformations tend to calcify.
There are various options for treating diseased heart valves:
For example, the doctor may prescribe medications such as beta-blockers or ACE inhibitors.
- Transcatheter Aortic Valve Implantation (TAVI)
In addition, there are numerous minimally invasive procedures to correct heart valve dysfunction or defects. One well-known minimally invasive procedure is transcatheter aortic valve implantation (TAVI).
TAVI is particularly suitable for cases of aortic valve stenosis. This method involves inserting a new valve through the aorta. The “new” heart valve is housed in a foldable metal scaffold. Using a catheter, doctors guide the new valve from the groin toward the heart. The new valve then unfolds mechanically and takes over the functions of the old heart valve.
- Transcatheter Mitral Valve Repair (Mitra-Clip)
Another minimally invasive procedure is the Mitra-Clip procedure, which is now considered a well-established standard of care. The Mitra-Clip treatment is suitable for severely leaky mitral valves.
During the procedure, doctors insert a mitral clip into the patient using a catheter. This plastic clip holds the “old” heart valve—which no longer closes properly—together. This allows blood to continue flowing in the correct direction.
General anesthesia is not required for this procedure. The patient can be discharged from the hospital after a few days. This treatment can significantly improve symptoms of heart failure.
- Surgical Heart Valve Replacement
A procedure known as surgical heart valve replacement is also an option. The surgery is performed on an open heart under general anesthesia.
During this procedure, the heart must be stopped. For this reason, doctors connect the patient to a heart-lung machine during the operation. The heart-lung machine takes over the functions of the heart and lungs during the procedure.
The surgeon then removes the defective heart valve and replaces it with an artificial one. Options include mechanical or biological heart valves.
If the patient receives a mechanical heart valve, they must take anticoagulants (blood thinners) for the rest of their life. Mechanical heart valves generally last a lifetime.
A biological heart valve lasts only 10 to 15 years before it needs to be replaced. However, taking anticoagulants is not necessary in this case.
Various mechanical heart valve prostheses @ pirke / AdobeStock
The length of recovery after heart valve replacement surgery or a minimally invasive procedure varies from patient to patient. In most cases, patients receive clear instructions from their cardiologist on how to care for themselves afterward.
Some patients are given a special diet plan, medication, and specific exercises. Cardiac rehabilitation is also recommended.
Patients should avoid physical exertion during the healing phase. Athletic activities are usually possible again after about two to three months.
As with other medical procedures, complications can arise during heart valve replacement.
The following problems can occur with any surgery:
- Blood clots
- Postoperative bleeding
- Nerve damage or
- Infections
- Pericarditis
- Cardiac arrhythmias
- Endocarditis
If a heart valve defect is present, the prognosis depends primarily on which valve is affected and whether heart function is impaired.
A severe heart valve defect should be treated immediately, as failure to do so can lead to heart failure. If heart valve defects are detected and treated in a timely manner, the therapies mentioned above can significantly improve the patient’s quality of life.
Specialists from various medical fields are typically involved in the diagnosis and treatment of heart valve defects:
Your primary care physician is your first point of contact, ideally located as close to your home as possible. They should be well acquainted with your individual medical history, living circumstances, and lifestyle habits. They compile individual test results from specialists and hospitals and, based on this comprehensive overview, should determine which medications and other treatments to recommend. Many primary care physicians are general practitioners or internists.
The specialist in internal medicine (internist) brings specialized knowledge gained through their residency training that is important for the treatment of heart patients. They are particularly knowledgeable about all diseases of the internal organs—including the blood vessels and the heart—and are especially skilled in treatment with medications.
A cardiologist is a specialist in internal medicine and also a specialist in cardiology, which means they have even more advanced knowledge in the treatment of heart diseases.
