Multivalvular heart disease: Challenges in diagnosis and optimal treatment strategies

What is Multivalvular Heart Disease?

Multivalvular disease (MVD) is a condition characterized by damage to two or more heart valves, which can manifest as stenosis (failure of the valve to open fully) or regurgitation (failure of the valve to close tightly) [1]. It is a common presentation within valvular heart disorders, accounting for a significant proportion of total patients suffering from heart valve disease and requiring surgical valve intervention [1].

Historically, rheumatic heart disease was the primary cause of multivalvular disease. However, in recent decades, particularly in developed countries, age-related degenerative valve diseases have become increasingly prevalent and now represent the leading cause [1].

1. Causes of Multivalvular Heart Disease

Multivalvular heart disease can stem from various etiologies, typically resulting from a combination of factors:

Rheumatic Fever

This was once the leading cause of heart valve disease worldwide. Rheumatic fever is a complication of streptococcal pharyngitis, representing an inflammatory response following streptococcal infection. This inflammation can cause permanent damage to heart valve leaflets, leading to stenosis or regurgitation [1].

Age-Related Degenerative Valve Disease

As people age, heart valves can undergo calcification, thickening, or structural degeneration, impairing their normal function. This is an increasingly common cause of multivalvular disease, especially among older adults [1].

Other Causes

Infective Endocarditis: Infection of the inner lining of the heart and valves can destroy valve tissue, causing regurgitation or stenosis [1].
Chest Radiation Therapy: Radiation therapy for thoracic cancers can induce progressive heart valve damage over time [1].
Connective Tissue Disorders: Conditions such as Marfan syndrome can affect the structural integrity of heart valves [1].
Congenital Anomalies: Some individuals are born with structural valve abnormalities, which may manifest as multivalvular disease later in life [1].

2. Symptoms of Multivalvular Heart Disease

Symptoms of multivalvular heart disease are often non-specific and may be masked by the complex hemodynamic interplay among the damaged valves [1].

Typical Symptoms

Shortness of Breath: Particularly upon exertion or when lying flat (orthopnea).
Fatigue: A sensation of low energy and decreased exercise capacity.
Palpitations: A feeling of rapid, pounding, skipped, or irregular heartbeats.
Chest Pain: May occur, especially with physical exertion.
Peripheral Edema (Swelling of Legs and Ankles): Caused by fluid retention due to impaired cardiac pumping efficiency [1].

Atypical or Masked Symptoms

Because multiple valves are affected simultaneously, the symptoms of one valvular lesion can sometimes mitigate or conceal the symptoms of another, complicating the diagnostic process [1]. For example, mitral stenosis may protect against the volume overload typically caused by aortic regurgitation [1].

3. Diagnosis of Multivalvular Heart Disease

Diagnosing multivalvular heart disease requires a combination of diagnostic modalities to accurately assess the severity of damage to each individual valve and its overall impact on cardiac function [1].

Clinical Examination and Auscultation

The physician will auscultate the heart to detect abnormal murmurs that may suggest valvular pathology. Vital signs, peripheral edema, and other clinical manifestations are also evaluated [1].

Imaging Studies

Echocardiography: This is the cornerstone and most vital diagnostic tool for evaluating heart valve structure and function, determining the severity of stenosis or regurgitation, and assessing the disease's impact on cardiac chambers. Doppler echocardiography helps quantify blood flow velocities and intracardiac pressures [1].

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): These modalities provide more detailed anatomical assessments of valve morphology, calcification extent, and cardiac structure, which are particularly helpful when echocardiographic results are inconclusive or discordant [1].

Supportive Tests

Cardiac Catheterization: May be indicated in cases where non-invasive findings remain inconclusive or contradictory, allowing for direct pressure measurements within cardiac chambers and the pulmonary artery [1].

4. Treatment Methods for Multivalvular Heart Disease

Management of multivalvular disease must be individualized based on the patient's specific clinical status, the severity of valvular impairment, presenting symptoms, and comorbidities [1].

Medical Management

Medications are utilized to control symptoms, reduce cardiac workload, and prevent complications. Regimens may include diuretics to reduce edema, beta-blockers for heart rate control, and ACE inhibitors to lower blood pressure and protect cardiac function. However, medical therapy cannot permanently cure structural valve damage [1].

Surgical Valve Intervention

Surgery represents the definitive treatment for structural valve damage through repair or replacement. For multivalvular disease, surgery carries a higher risk profile compared to single-valve interventions [1].

Percutaneous Interventions

Less invasive percutaneous techniques are evolving rapidly and are particularly suitable for high-surgical-risk patients. Examples include:

Transcatheter Aortic Valve Implantation (TAVI): For aortic stenosis [1].
Percutaneous Mitral Valve Repair: For mitral regurgitation [1].

Endoscopic Valve Surgery

Endoscopic valve surgery represents a major breakthrough in the management of valvular heart disease, offering superior advantages over traditional open-heart surgery.

Key Advantages:

Aesthetics: Small incisions (approximately $3\text{ cm}$) minimize tissue trauma and scarring, facilitating smoother recovery.
Rapid Recovery: Patients can recover swiftly, being discharged within 3 days and returning to normal life within a few weeks.
Reduced Pain: Small surgical incisions significantly lessen postoperative pain.
Lower Complication Risks: Minimizes the incidence of surgical site infections and postoperative complications.
Optimal Treatment Outcomes: Ensures faster, superior recovery and enhanced cosmetic results compared to older surgical methods.
Broad Applicability: With recent advances, endoscopic techniques can now be applied to multi-valve procedures involving concurrent damage to multiple heart valves (aortic, mitral, and tricuspid) [1].

5. Dangerous Complications of Multivalvular Heart Disease

If left untreated, multivalvular heart disease can lead to severe complications:

Heart Failure

This is the most common complication when the heart loses its pumping efficiency required to meet the body's metabolic demands [1].

Arrhythmias

Particularly atrial fibrillation, which can exacerbate clinical symptoms and increase the risk of blood clot formation and stroke [1].

Pulmonary Hypertension

Blood congestion within the heart secondary to valvular dysfunction can elevate pressure within the pulmonary circulation, impairing respiratory function [1].

6. Strengths of University Medical Center Ho Chi Minh City in Managing Multivalvular Disease

University Medical Center Ho Chi Minh City stands as a leading medical institution for managing complex cardiovascular disorders, including multivalvular heart disease. The hospital continuously develops and applies advanced techniques to deliver optimal therapeutic outcomes.

Expertise in Endoscopic Multi-Valve Surgery: Backed by extensive experience, University Medical Center Ho Chi Minh City has successfully pioneered total endoscopic procedures addressing multiple damaged heart valves simultaneously (aortic, mitral, and tricuspid). This enables multi-valve intervention through small incisions while delivering exceptional benefits in terms of recovery and aesthetics.

Multidisciplinary Cardiovascular Team: The hospital features leading cardiac surgeons, interventional cardiologists, imaging specialists, intensivists, and geriatricians. Close collaboration across specialties ensures comprehensive, personalized, and optimal treatment decisions for every patient [1].

Advanced Equipment: University Medical Center Ho Chi Minh City is equipped with state-of-the-art cardiovascular diagnostic and therapeutic technologies, including advanced endoscopic surgical systems that support complex, high-precision procedures.

7. Prevention of Multivalvular Heart Disease

While certain causes of multivalvular heart disease cannot be controlled, maintaining a healthy lifestyle can help reduce risks and slow disease progression:

Adopt a Healthy Lifestyle: Maintain a balanced diet rich in vegetables, fruits, and whole grains while limiting sodium, sugar, and saturated fats. Exercise regularly for at least 30 minutes a day, 5 days a week. Avoid smoking and limit alcohol consumption.
Manage Underlying Conditions: Effectively treat medical conditions such as hypertension, diabetes, and hyperlipidemia, as these represent risk factors that can damage heart valves.
Routine Health Screenings: Facilitate early detection of cardiovascular abnormalities for prompt intervention, which is especially important for individuals with a family history of heart disease or other risk factors.

8. When to See a Doctor

Patients should consult a cardiovascular specialist if they experience any of the following symptoms:

Onset of new symptoms such as shortness of breath, unexplained fatigue, palpitations, or leg edema.
Existing diagnosis of heart valve disease accompanied by worsening or significantly changing symptoms.
History of rheumatic fever or other conditions known to affect heart valves.

Note: Do not attempt self-diagnosis or self-treatment. Always consult a qualified cardiovascular specialist for appropriate guidance and management.

9. Frequently Asked Questions (FAQ)

Can multivalvular heart disease be completely cured?

Multivalvular heart disease generally cannot be completely cured, but it can be managed effectively through medical therapy or surgery to alleviate symptoms, prevent complications, and enhance quality of life.

Is endoscopic valve surgery safe, and who is an appropriate candidate?

Endoscopic valve surgery is considered safe, offering advantages such as minimal invasiveness, reduced pain, and rapid recovery. Suitable candidates are carefully evaluated by a multidisciplinary cardiovascular team based on overall health status and the severity of valvular damage.

What lifestyle modifications should I make to support my treatment?

Maintaining a healthy diet, exercising regularly, quitting smoking, limiting alcohol, and properly managing underlying conditions like hypertension and diabetes are crucial lifestyle changes to support treatment and slow disease progression.

How often do I need follow-up appointments after diagnosis or treatment?

The frequency of follow-up visits depends on disease severity, the chosen treatment approach, and individual health status. Your cardiovascular specialist will establish an appropriate follow-up schedule.

Is multivalvular heart disease hereditary?

In rare instances, heart valve disease can have a genetic component, particularly congenital valve anomalies or connective tissue disorders. However, the majority of multivalvular disease cases are acquired, resulting from conditions such as rheumatic fever or age-related degeneration.

10. References

[1] Unger, P., Clavel, M.-A., Lindman, B. R., Mathieu, P., & Pibarot, P. (2016). Pathophysiology and management of multivalvular disease. Nat Rev Cardiol, 13(7), 429–440. https://pmc.ncbi.nlm.nih.gov/articles/PMC5129845/. Accessed: 2025-12-26.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.