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Heart valve pathology: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Any heart valve can develop stenosis or insufficiency, causing hemodynamic changes long before any symptoms appear. Most often, stenosis or insufficiency is found in a single valve, but multiple valve lesions are possible.
Treatment depends on the severity of the disease. It usually involves catheter-based valvuloplasty (eg, percutaneous balloon commissurotomy, valvotomy) or surgical correction (eg, surgical commissurotomy, valve repair, or replacement). Two types of valve prostheses are used: bioprosthetic (porcine) and mechanical (metal).
Traditionally, mechanical valves have been implanted in patients younger than 65 years and in older patients with a long life expectancy, because bioprosthetic valves last only 10 to 12 years. Patients with mechanical valves require lifelong anticoagulation to maintain an INR of 2.5 to 3.5 (to prevent thromboembolism) and antibiotics before certain medical or dental procedures (to prevent endocarditis). Prosthetic valves that do not require anticoagulation have been implanted in patients older than 65 years, in younger patients with a life expectancy of less than 10 years, and in certain right heart valve diseases. However, newer bioprosthetic valves may last longer than first-generation valves; therefore, patient selection for which valves are implanted now needs to be reconsidered.
If a woman of childbearing age who plans to have a child in the future requires valve replacement, the physician must weigh the risk of teratogenicity of warfarin (given lifelong after mechanical valve implantation) against the risk of accelerated degradation of bioprosthetic valves. These risks can be reduced by using sodium heparin instead of warfarin during the first 12 weeks and the last 2 weeks of pregnancy or by frequent echocardiographic examinations.
Almost all patients with heart valve pathology are also shown endocarditis prophylaxis.
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