Aortic Valve Disease
Treatment planning via TAVI or referral for surgery.
Areas of Expertise
Heart Valve Disease Treatment in İzmir
Assessment and treatment planning for aortic, mitral, tricuspid and pulmonary valve disease are among Prof. Dr. İstemihan Tengiz's areas of expertise. He has published scientific work on paravalvular leak closure devices (J Geriatr Cardiol, 2015). Procedures in this area include TAVI, balloon valvuloplasty and carotid stenting.
The heart valves and how they fail
The heart has four valves that keep blood flowing in one direction: aortic, mitral, tricuspid and pulmonary. They fail in two ways. If a valve cannot open fully there is 'stenosis', and the heart must work harder to push blood through a narrow opening. If a valve cannot close fully there is 'regurgitation', and some blood leaks backwards, which over time enlarges the heart chambers.
The main causes are age-related degenerative calcification, previous acute rheumatic fever, congenital structural differences such as a bicuspid aortic valve, infective endocarditis, and structural changes following a heart attack.
Aortic stenosis: the most common severe valve disease
Aortic stenosis is the valve disease most often requiring intervention in older populations. It can remain silent for years; the first symptoms are typically breathlessness on exertion, chest pain, fatigue and fainting or near-fainting. The appearance of these symptoms indicates advanced disease and calls for prompt assessment.
Diagnosis and grading are made by echocardiography, which measures valve area, mean pressure gradient and flow velocity. Valve replacement is recommended in symptomatic severe aortic stenosis or when the pumping function of the heart begins to decline. At this stage medication does not relieve the obstruction; it only eases symptoms.
TAVI or surgical valve replacement?
Transcatheter aortic valve implantation (TAVI) places a new valve inside the diseased one via a catheter advanced from the femoral artery. The breastbone is not opened, the heart is not stopped and the heart-lung machine is not used. Recovery is therefore markedly shorter than with surgery, and patients are often discharged within a few days.
The choice of approach is made by the Heart Team, weighing age, surgical risk score, vascular anatomy, valve morphology, accompanying coronary disease and life expectancy. Broadly, TAVI comes to the fore in older patients at higher surgical risk, and surgical replacement in younger, low-risk patients — but the decision is individual and requires detailed planning with pre-procedural CT angiography.
Mitral, tricuspid and pulmonary valve disease
In rheumatic mitral stenosis, if valve morphology is suitable, balloon dilatation (percutaneous mitral balloon valvuloplasty) can be an alternative to surgery. Suitability is determined by leaflet thickness and mobility, degree of calcification and the state of the subvalvular apparatus. Significant regurgitation or a clot in the left atrium precludes the procedure.
In mitral regurgitation, treatment depends on the mechanism, the severity, and the size and function of the left ventricle. Tricuspid and pulmonary valve disease less often requires intervention; balloon valvuloplasty can be performed in suitable cases. Transoesophageal echocardiography is frequently decisive in assessing these valves.
Paravalvular leak
A paravalvular leak is a gap between the rim of a previously implanted prosthetic valve and the native tissue. Small leaks may cause no symptoms; as they enlarge they lead to heart failure and to anaemia caused by the destruction of red blood cells.
In selected patients the gap can be sealed with closure devices delivered by catheter, avoiding repeat surgery. Prof. Dr. İstemihan Tengiz has published scientific work on paravalvular leak closure devices (Journal of Geriatric Cardiology, 2015).
Carotid artery stenosis
Narrowing of the carotid arteries supplying the brain is one of the preventable causes of stroke. It is often silent and is detected through a bruit heard on examination or by colour Doppler ultrasound. Transient ischaemic attack symptoms such as temporary loss of vision, one-sided weakness or speech disturbance require urgent assessment.
Treatment depends on the degree of stenosis, whether it has caused symptoms, and the patient's overall risk profile. In symptomatic severe stenosis, opening the vessel with carotid stenting or surgical endarterectomy reduces stroke risk; in a large proportion of asymptomatic cases, intensive medical therapy and risk-factor control are sufficient.
Regular follow-up for valve patients
Valve disease that does not yet require intervention still needs monitoring. Follow-up intervals depend on type and severity: echocardiography every few years in mild disease, annually in moderate disease and every six months in severe but asymptomatic disease is the general approach. New breathlessness, palpitations, fainting or a fall in exercise capacity warrant presentation without waiting for the scheduled date.
Patients with a prosthetic valve or previous endocarditis may need antibiotic prophylaxis before dental and certain surgical procedures. Regular oral and dental care is the most effective way of preventing infective endocarditis in this group.
Procedures Performed
Mitral Valve Disease
Balloon valvuloplasty and assessment with advanced imaging.
Tricuspid and Pulmonary Valve
Balloon valvuloplasty procedures.
Carotid Artery Stenosis
Reducing stroke risk with carotid stenting.
Frequently Asked Questions
A murmur was heard in my heart — is it serious?
A murmur is the sound of blood flowing turbulently through the heart and does not always mean disease. Entirely innocent murmurs are common, particularly in young people and during pregnancy. Echocardiography settles the question, as it shows valve structure and function directly.
Is valve replacement without surgery really possible?
Yes. With TAVI a new aortic valve is delivered by catheter from the femoral artery; the chest is not opened and the heart is not stopped. However, the method is not suitable for every patient or every valve. Eligibility is determined by the Heart Team, weighing echocardiographic and CT angiographic findings together with surgical risk.
How long does a TAVI valve last?
These valves are made of biological tissue and can degenerate over time. Available long-term data show that most contemporary valves continue to function at ten years and beyond. Durability is one of the main considerations in choosing the approach, particularly in younger patients.
Can I exercise with valve disease?
In mild valve disease regular moderate-intensity exercise is generally recommended and beneficial. In conditions such as severe aortic stenosis, intense and competitive exercise may be unsafe. Your exercise programme should be set with your physician based on your echocardiographic findings.
Do I need antibiotics before dental treatment?
Antibiotic prophylaxis is recommended before procedures involving the gums or the region around the tooth root in patients with a prosthetic valve, previous endocarditis or certain congenital heart conditions. It is not required for every valve patient; your cardiologist makes the decision.
Can valve disease be cured with medication?
Medication does not reverse the structural abnormality of the valve. It relieves symptoms such as breathlessness and oedema, controls arrhythmia and reduces clot risk. When the valve itself must be corrected, the only option is interventional or surgical treatment.
Content reviewed by Prof. Dr. İstemihan Tengiz. Last reviewed:
The information on this page is for general information only and is not a substitute for medical advice. Please consult your physician about your symptoms.