Valvulopathies

Valvulopathies are diseases affecting one or more of the heart valves, leading to disturbed valve function. They are most commonly classified by the abnormal flow they cause: stenosis, a narrowing that impedes forward flow, or regurgitation (insufficiency), where the valve leaks. Any of the four valves—the aortic, mitral, tricuspid, or pulmonary—can be affected. Causes include congenital abnormalities, degenerative calcific changes, rheumatic heart disease, infective endocarditis, ischemic heart disease, or post-surgical changes.

Pathophysiology and clinical features vary with the valve and defect. Stenosis creates pressure overload in the upstream chamber, while regurgitation causes volume overload downstream, both reducing cardiac efficiency and potentially leading to heart failure. Symptoms may be absent or include dyspnea on exertion, angina, syncope, fatigue, or edema. A characteristic heart murmur often prompts further evaluation.

Diagnosis relies on imaging and hemodynamic assessment. Transthoracic echocardiography is the primary tool to define valve anatomy and quantify severity using gradients and regurgitant volumes. Additional tests may include electrocardiography, chest radiography, and advanced imaging such as computed tomography or magnetic resonance imaging; invasive hemodynamic assessment by catheterization is used selectively.

Management aims to relieve obstruction or correct regurgitation, control symptoms, and prevent complications. Medical therapy supports heart function and comorbidities but does not cure the disease. Definitive treatment involves valve repair or replacement, with options including transcatheter approaches such as TAVR for aortic stenosis and various interventions for mitral or tricuspid disease. Anticoagulation is indicated for mechanical prostheses or certain rhythm disorders; endocarditis prophylaxis follows current guidelines.

Prognosis depends on severity, etiology, and access to timely treatment. Degenerative and rheumatic valvulopathies remain common, with outcomes improved by early detection and appropriate intervention. Prevention focuses on managing risk factors and preventing rheumatic fever and endocarditis where relevant.