Valvular heart disease: numerous causes and complications

Valvular heart disease encompasses conditions affecting the various heart valves. This may involve the aortic valve, located between the left ventricle and the aorta; the mitral valve, between the left atrium and the left ventricle; the pulmonary valve, between the right ventricle and the pulmonary artery; or the tricuspid valve, between the right atrium and the right ventricle. This may involve a “leak” in the valve, known as insufficiency, or an “obstruction,” known as stenosis. Valvular heart disease causes the heart valve to malfunction and can have consequences both upstream and downstream.

There are many causes of valvular heart disease. The most common is age-related degeneration of the valve. Other causes are possible, such as acute rheumatic fever, congenital malformations, functional causes during heart failure, or the consequences of endocarditis, myocardial infarction, chest radiation, or medication.

Risk factors for valvular heart disease depend on the cause of the condition. Valvular heart disease related to degenerative valve calcification or myocardial infarction can be prevented by addressing modifiable cardiovascular risk factors (hypercholesterolemia, smoking, hypertension, etc.). Other risk factors for these diseases are non-modifiable, such as the patient’s age. Valvular heart diseases linked to acute rheumatic fever, which are on the decline in France, can be prevented through antibiotic treatment of Group A streptococcal tonsillitis.

Thus, in recent years, a shift in the distribution of causes of valvular heart disease has been observed. Indeed, improved management of Group A streptococcal tonsillitis has led to a decrease in the incidence of acute rheumatic fever in Western countries. Conversely, the aging population is leading to an increase in the incidence of valvular heart disease due to valve calcification.

Valvular heart diseases are conditions that may remain asymptomatic or have few symptoms for a long time but can worsen. They can then lead to serious cardiac complications (infectious endocarditis, heart failure, atrial fibrillation, thromboembolic complications, sudden death, etc.) and an increased risk of death. This underscores the importance of early diagnosis, regular follow-up, and appropriate management of patients with valvular heart disease. Management is medical or surgical (valve repair or replacement) depending on the severity of the condition and the patient’s clinical tolerance. New therapeutic methods have been developed in recent years, particularly percutaneous techniques, and have changed the management of certain patients with valvular heart disease.