Insufficiency is a type of valvular disease characterized by backflow of blood. Instead of flowing in one direction, blood leaks through the valve, resulting in heart failure. Due to the loss of effective blood flow, the heart must work harder, which over time leads to dilation and loss of strength.

In some cases, the valve may be unable to open sufficiently, preventing proper blood flow. This may occur due to thickening of the heart valves, hardening or calcification. The reduction in blood flow forces the heart to work harder and, as in the previous case, may eventually cause it to thicken and lose strength.

Valvular degeneration is the most common cause of valvular heart disease and is closely related to aging.

Years ago, rheumatic fever was the leading cause of valvular disease. It is an immune-mediated disease that may occur after a streptococcal infection (strep throat, scarlet fever...).

In infective endocarditis, a microorganism causes inflammation of the valvular lining and the endocardium. The immune response aimed at controlling the infection may lead to alterations in valve function that can progress to valvular disease.

There are other causes of valvular heart disease related to coronary artery disease, which is the reduced blood supply to the heart muscle. We can also find valvular diseases caused by a congenital malformation of one of the valves. Finally, in some cases it is difficult to identify the cause of valvular heart disease.

Echocardiography is an ultrasound imaging test and therefore does not emit radiation. With echocardiography it is possible to identify the affected valves and assess the severity of the condition. In addition, it allows clinicians to determine the most appropriate treatment according to the structure, physiology and functioning of the heart.

In the diagnosis of valvular diseases, the electrocardiogram allows monitoring of the heart rhythm and confirming its proper functioning or the presence of an arrhythmia.

The diagnosis of a valvular heart disease through the previous tests may indicate that an intervention is advisable for the patient. In that case, a cardiac catheterization will be performed to diagnose a possible associated disease of the coronary arteries. This test consists of introducing contrast fluid into the coronary artery through a catheter placed in the arm.

As in the previous case, if after the diagnosis of a valvular disease an intervention is considered advisable but the probability of coronary artery disease is considered low, a CT scan will be performed. On the other hand, if a possible disease of the aorta is suspected, a thoracic CT scan will also be performed.

There is no pharmacological treatment that cures valvular heart disease. Medication for valvular diseases aims to reduce symptoms, decrease cardiac workload and regulate heart rhythm. Medical treatment of valvular diseases may include drugs to control blood pressure, diuretics to manage fluid retention, or oral anticoagulant therapy and medication to regulate heart rhythm if the valvular heart disease is associated with an arrhythmia.

The two main percutaneous treatments for valvular diseases are the TAVI or transcatheter aortic valve implantation, used for aortic stenosis, and percutaneous edge-to-edge mitral repair for mitral regurgitation.

When a surgical intervention is required to treat valvular heart disease, the first option is valve repair whenever possible. Valve repair helps preserve cardiac function and avoids complications related to the use of prosthetic valves.

However, in some cases of valvular disease, valve replacement will be necessary. For this purpose, biological, mechanical, sutureless or stentless prostheses, as well as homografts, may be used. The cardiovascular surgeon will determine the most appropriate valve based on the patient, the type of valvular disease and the stage of the valvular condition.

Surgical procedures can be performed through the conventional approach, sternotomy, or through minimally invasive surgery. Minimally invasive cardiovascular surgery or Port Access is a type of intervention that allows valve repair and the treatment of valvular diseases through small incisions between the ribs. Thanks to the use of endoscopic instruments and thoracoscopic cameras, it avoids dividing the sternum and preserves the integrity of the chest wall. In addition, our center was the first in Spain to perform this type of surgery with the assistance of a robotic system. The combination of minimally invasive techniques with robotic assistance ensures results comparable to conventional surgery, with better aesthetic outcomes, fewer complications and faster recovery.