Herzklappenkrankheit

The heart has four valves, aortic, mitral, tricuspid and pulmonary, that keep blood moving in one direction. Valve disease means a valve is narrowed and obstructs flow (stenosis), or fails to close and leaks backwards (regurgitation), or both.

Mild valve disease is common and harmless. Severe disease overloads the heart, and if left too long causes irreversible muscle damage. Medicines ease symptoms but cannot fix a valve; the real decision is when to repair or replace it, by surgery or by catheter.

Symptome

• Breathlessness on exertion, later when lying flat
• Fatigue and falling exercise capacity, often blamed on age
• Chest tightness on effort, especially with aortic stenosis
• Dizziness or fainting on exertion
• Palpitations, often from atrial fibrillation in mitral disease
• Swollen ankles or abdomen
• A murmur heard at a check-up, with no symptoms

Ursachen und Risikofaktoren

In higher-income countries the main cause is age-related degeneration: calcium stiffening the aortic valve, and floppy (prolapsing) mitral leaflets or stretched rings. About 1 to 2 in 100 people are born with a bicuspid aortic valve that tends to fail in middle age. Rheumatic fever following untreated streptococcal throat infection remains the leading cause worldwide and typically scars the mitral valve. Other causes include endocarditis, heart attack or cardiomyopathy distorting the mitral valve (secondary regurgitation), chest radiotherapy, connective tissue disorders and carcinoid.

Wie es diagnostiziert wird

• Stethoscope examination: Murmurs are the usual first clue.
• Echocardiography: Identifies the valve, mechanism and severity, and measures the heart's response. It drives nearly all decisions.
• Transoesophageal echo: Detailed mitral anatomy to judge repairability and to guide catheter procedures.
• Exercise testing: Unmasks symptoms in people who report none.
• Cardiac CT: Essential planning for TAVI; calcium scoring when stenosis severity is uncertain.
• Cardiac MRI and catheterisation: Quantify leaks when echo is unclear; coronary angiography before surgery.

Behandlungsmöglichkeiten

• Surveillance: Echo every 6 months to 3 years depending on severity, with prompt reporting of new symptoms.
• Medicines: Diuretics, blood pressure control, and rate control and anticoagulation for atrial fibrillation. They do not halt valve degeneration.
• Surgical valve repair or replacement: Mitral repair for prolapse; mechanical or tissue replacement for aortic and rheumatic disease.
• TAVI: Catheter aortic valve implantation for older or higher-risk patients with aortic stenosis.
• Transcatheter edge-to-edge mitral or tricuspid repair: A clip such as MitraClip or a similar device for selected patients unsuitable for surgery.
• Balloon valvuloplasty: For pliable rheumatic mitral stenosis and for congenital pulmonary or aortic stenosis.

Wenn es dringend ist

Seek emergency help locally for fainting, chest pain at rest, severe breathlessness especially when lying flat or with frothy sputum, or a sudden fast irregular heartbeat. People with severe aortic stenosis who develop any of these should not fly until assessed. Persistent fever with a known valve problem needs prompt blood cultures.

Reisen nach Türkiye zur Behandlung

Valve disease is one of the clearer cases for planned cardiac travel, because intervention is scheduled and single-episode: about 3 weeks for open surgery, 10 to 14 days for TAVI, 6 to 8 days for balloon valvuloplasty. Send your echo for review first. Anticoagulation monitoring for mechanical valves and yearly echo follow-up must be arranged at home.

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