Surgical treatment for valvular heart disease: a single centre experience from Sri Lanka

Etiologically, a variety of underlying mechanisms can damage the heart valves and lead to stenosis, regurgitation, or a combination of both. Although rheumatic heart disease (RHD) has been reduced in the world, it remains the commonest cause of VHD in many countries [1]. It affects 33.4 million people worldwide and its long-term effects on heart valves are still seen in developing countries [2]. RHD, predominantly but not exclusively, affects the mitral valve and can often involve multiple valves [3]. In countries such as the USA and UK, age-associated degeneration of the valves has become the major contributor to valve disease [4]. With better living standards, as the longevity of people increases, the diagnosis and referral of diseases improve. Therefore, overall surgical treatment for VHD in the world is increasing [4]. Degeneration of the aortic valve is mainly caused by calcification, and usually causes aortic stenosis [5], whereas degeneration of the mitral valves tends to be myxomatous, and usually causes mitral valve prolapse, which could subsequently lead to mitral regurgitation [6]. Acute infective endocarditis (IE), caused by a highly virulent organism, can deform a previously normal valve, while endothelial damage present in RHD can predispose to subacute bacterial endocarditis. Congenital valvular disease can involve all four valves and can present at any age, but the congenital bicuspid aortic valve is the commonest type and is present in 1% of the world population [8]. Dilatation of the annulus is the key mechanism of functional regurgitation [9]. Coronary artery disease that causes ischemic changes of the mitral papillary muscles can cause ischemic mitral regurgitation [10].