A follow-up program for the regular evaluation of aortic, mitral, tricuspid, and pulmonary valve diseases through echocardiography and clinical findings.
Indication
- Aortic stenosis or regurgitation (calcific, rheumatic, or congenital)
- Mitral stenosis or regurgitation (rheumatic, degenerative, or ischemic)
- Tricuspid and pulmonary valve diseases
- Mitral valve prolapse
- History of rheumatic heart disease
- Patients who have previously undergone valve surgery or a transcatheter valve procedure (TAVI/MitraClip)
- Follow-up after endocarditis (infection of the inner lining of the heart)
Preparation
- Symptoms (shortness of breath, palpitations, syncope, chest pain) and daily activity capacity
- Previous echocardiogram, ECG, and CT/MRI reports if available
- List of current medications (especially blood thinners)
- Information about dental procedures, planned surgery, or pregnancy planning (for endocarditis prophylaxis)
How it's performed
- Detailed examination, including murmur assessment and pulse and blood pressure measurement
- Transthoracic echocardiography (TTE) to evaluate valve structure, severity of stenosis, and degree of regurgitation
- Where indicated, transesophageal echocardiography (TEE), cardiac CT, or MRI for advanced imaging
- Exercise testing and, if needed, stress echocardiography to assess functional capacity
- For patients requiring surgical or transcatheter intervention, heart team meeting and risk calculation with EuroSCORE II and STS scores
- Treatment plan: monitoring, medical therapy, transcatheter intervention (TAVI, MitraClip), or surgical valve repair/replacement
Post-procedure
- Echocardiogram every 2-3 years for mild valve disease, every 1-2 years for moderate disease, and every 6-12 months for advanced disease
- Regular INR monitoring with warfarin in patients with mechanical valve prostheses
- Early-period anticoagulation in bioprosthetic valves followed by guideline-based monitoring
- Endocarditis prophylaxis before dental and invasive procedures in selected cases
- Management of heart failure, atrial fibrillation, and other accompanying conditions
Risks
- Development of heart failure as the valve disease progresses
- Atrial fibrillation and the associated stroke risk
- Infective endocarditis (valve infection)
- Thrombosis, paravalvular leak, or structural deterioration of valve prostheses
- Procedure-related complications during surgical or transcatheter interventions
FAQ
I have a murmur — does that mean I'll definitely need surgery?
No. Most murmurs do not indicate significant valve disease. Echocardiography is used for evaluation, and many patients only need monitoring.
Is medical therapy alone enough for valve disease?
Medical therapy reduces symptoms and helps control associated conditions; however, surgery or transcatheter intervention may be needed for advanced stenosis or regurgitation.
Who is suitable for TAVI?
TAVI (transcatheter aortic valve implantation) is performed by a heart team's decision, particularly in older patients with severe aortic stenosis who are at high or intermediate surgical risk.
If I have a valve prosthesis, should I take antibiotics before dental treatment?
Endocarditis prophylaxis is recommended before bleeding dental procedures in patients with mechanical or biological valve prostheses; the decision is individualized by the physician.
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