Can Heart Valve Diseases Be Treated Without Surgery?

Noting that heart valve diseases become more common with advancing age, Cardiology Specialist Prof. Dr. Can Yücel Karabay stated that thanks to developing interventional methods, many valve diseases can now be treated without opening the ribcage. Prof. Dr. Karabay said, "We can intervene on heart valves by entering through the groin or arm artery. Most of our patients stay in the intensive care unit for one day and can be discharged on the second or third day."
Prof. Dr. Can Yücel Karabay, a Cardiology Specialist at Yeditepe University Hospitals, provided information about the causes, symptoms, and non-surgical treatment methods of heart valve diseases.

What Is Heart Valve Disease?

Cardiology Specialist Prof. Dr. Can Yücel Karabay stated: "In fact, our heart has four valves, and each of these valves has a function. They ensure blood flows in one direction while preventing it from flowing backward. Any mechanical problems occurring in these valves due to various reasons are called heart valve disease. This is a common condition both in the world and in our country. Actually, age is the most important factor; just as the face wrinkles with an aging population, our valves also wrinkle and cause problems. In the elderly age group, degenerative valve diseases can be more common in women due to their longer life expectancy. The frequency of rheumatic valve diseases has decreased significantly compared to the past, but it is still seen in a significant patient group in our country. Although its frequency is gradually decreasing today, rheumatic valve diseases still appear in some regions of our country. Valve diseases related to throat infections, especially between the ages of 5 and 15, occur during childhood, but their symptoms appear years later. Poor oral and dental hygiene can increase the risk of infection (development of endocarditis) in the heart valves. Therefore, we must pay attention to oral and dental health. Sometimes there can be congenital hereditary valve diseases, but this is mostly a disease group we see in advanced age. When we also count rheumatic valve diseases, we see more female patients."

How Is a Problem in the Heart Valve Noticed?

Stating that the most important symptom of heart valve diseases is shortness of breath with exertion, Prof. Dr. Karabay said: "Most of our patients come with complaints like 'Professor, I used to climb two or three flights of stairs very easily, but now when I climb one flight, I have to stop.' So they talk about exertion-induced shortness of breath. Some patients, especially those with aortic stenosis, experience severe chest pain, and this chest pain is often a pressure-type sensation. People usually describe it as feeling like they are in a vise or as if something heavy is sitting on their chest, and they may present with this chest pain. Sometimes there is palpitation, and patients may say 'I suddenly feel like a bird is fluttering inside me.' Very rarely, it can manifest with fainting, but the most common complaint is exertion-induced shortness of breath."

How Is a Heart Valve Treated Without Surgery?

Stating that open-heart surgeries are still performed safely, but that non-surgical treatment options have become widespread thanks to developments in interventional cardiology, Prof. Dr. Karabay said: "For many years, open surgery—that is, surgery performed by opening the patient's ribcage—has been performed safely and appropriately for patients, and it still is today. What do we cardiologists do? By entering through the groin or sometimes the arm artery, using angiographic methods—that is, without opening the ribcage—we can intervene on heart valves, and this requires technology. Aortic valve interventions have been performed safely since approximately 2002, and mitral valve interventions since the 2010s. As I said, we have the chance to intervene on all valves by entering through the arm or leg vessels."

To Whom Are TAVI and MitraClip Methods Applied?

Mentioning the methods used in non-surgical treatment, Prof. Dr. Karabay said: "Actually, there are two methods that are well-known among the public. One of these is the aortic valve intervention method called TAVI. Using a catheter about the thickness of a little finger inserted through the groin artery, along with a technologically placed bioprosthetic valve inside it, we enter the aortic valve and place the new valve inside the existing one. As I said, we do this with about a 1-centimeter incision in the groin artery. There is no incision or surgical scar elsewhere on the body. Most patients go home after one day in intensive care and the second day in the ward. Mitral and tricuspid valve interventions are known among the public as 'clipping therapy'—MitraClip or TriClip treatment. In this method, we enter through the groin vein and use small clips, which we place on leaky valves with the help of catheters to prevent leakage. This patient group also stays in intensive care for one day, moves to the ward the next day, and is discharged two days later. During the procedure, for example, in a very serious patient group like those undergoing TAVI, we can even perform aortic valve intervention under light sedation while talking to the patient, without general anesthesia."

Can Congenital Heart Disease Be Prevented?

Stating that congenital valve diseases cannot be prevented but some risks can be reduced, Prof. Dr. Karabay said: "Some are preventable risk factors in life, while others are non-preventable risk factors. If you have a congenital valve disease, you cannot prevent it. However, it is very important to pay close attention to throat infections during childhood and to oral and dental health in adulthood. Even in the absence of symptoms, routine cardiology check-ups and follow-ups after the age of 40 are also very important. Because these diseases do not progress suddenly. There is usually an initial stage that progresses gradually. When diagnosed correctly at an early stage, progression and serious problems can be prevented. Especially for those with hypertension, diabetes, smoking, high cholesterol, or a family history, check-ups can be started at younger ages."

What Should Heart Patients Pay Attention To?

Emphasizing that heart valve patients should have regular doctor check-ups, Prof. Dr. Karabay said: "After being diagnosed with heart valve diseases, patients should not neglect their routine follow-ups. According to their doctor's recommendations, in some valve diseases—especially in our country where salt consumption and hypertension are very common—patients need to pay attention to their blood pressure and make a habit of eating without salt. They should pay great attention to oral and dental health, and follow general lifestyle recommendations. Obesity is also an increasing problem in our country and poses serious difficulties for heart valve diseases. Therefore, exercise at least three times a week, diet, 'Mediterranean-type nutrition, salt restriction, ideal weight, and regular exercise'—or rather a balanced life—these general health recommendations also apply to this patient group."