Heart valve disease is one of the most common reasons Sri Lankan patients seek cardiac care in India. Whether caused by the natural ageing process, rheumatic fever from childhood, or a congenital abnormality, a damaged or dysfunctional heart valve places the heart under increasing strain – and if left untreated, leads to progressive heart failure.
The good news is that valve disease, when identified and treated at the right time, has excellent outcomes. Modern cardiac surgery and catheter-based techniques have transformed what is possible – and many procedures that once required open heart surgery with weeks of recovery can now be performed through small incisions or even through a blood vessel, with patients walking within days.
This guide explains the options available, and how Sri Lankan patients can access them at Amrita Hospitals in Kochi.
Why Heart Valve Disease Matters for Sri Lankan Patients
Two factors make heart valve disease particularly relevant for the Sri Lankan population.
The first is rheumatic heart disease. Rheumatic fever – a delayed complication of streptococcal throat infection – remains prevalent in Sri Lanka, particularly in rural communities. Repeated episodes of rheumatic fever cause progressive scarring of the heart valves, most commonly the mitral and aortic valves. This means that valve disease in Sri Lankan patients often presents at a younger age than in Western populations, where degenerative age-related valve disease is more common.
The second is the growing burden of age-related valve disease driven by Sri Lanka’s ageing population and the increasing prevalence of diabetes, hypertension, and cardiovascular risk factors – all of which accelerate the degenerative changes that affect heart valves over time.
Together, these factors mean that a significant number of Sri Lankan patients across all age groups are living with heart valve disease that requires specialist assessment, monitoring, and in many cases, intervention.
Understanding Heart Valve Disease
The heart has four valves – the mitral, aortic, tricuspid, and pulmonary – each of which acts as a one-way gate ensuring blood flows through the heart in the correct direction and does not leak backwards.
Heart valve disease occurs when one or more valves fails to work correctly. There are two fundamental types of valve dysfunction:
Stenosis
The valve opening narrows, making it harder for blood to pass through. The heart must work harder to force blood across the narrowed opening, leading to pressure buildup behind the valve and progressive strain on the heart muscle.
Regurgitation
The valve does not close completely, allowing blood to leak backwards. This reduces the heart’s efficiency and causes the affected chamber to handle an increased volume of blood, leading to progressive enlargement and weakening over time.
Both types can affect any of the four valves, though the mitral and aortic valves are most commonly involved in adults requiring treatment.
The Four Heart Valves and What Can Go Wrong
Mitral Valve
Located between the left atrium and left ventricle. The most commonly treated valve in South Asian populations.
- Mitral stenosis – predominantly caused by rheumatic heart disease. The valve leaflets fuse together, narrowing the opening. A catheter-based treatment (balloon mitral valvotomy) is available for suitable cases
- Mitral regurgitation – the valve leaks. Caused by degenerative prolapse, rheumatic disease, ischaemic heart disease, or infective endocarditis. Often amenable to repair rather than replacement
Aortic Valve
Located between the left ventricle and the aorta.
- Aortic stenosis – the most common valve condition in elderly patients, caused by calcium buildup on the valve leaflets. When severe and symptomatic, it carries a poor prognosis without treatment. Treatable by either surgical valve replacement or transcatheter aortic valve implantation (TAVI)
- Aortic regurgitation – the aortic valve leaks. Causes include bicuspid aortic valve, rheumatic disease, and aortic root dilatation
Tricuspid Valve
Located between the right atrium and right ventricle. Tricuspid regurgitation is common and frequently occurs secondary to left-sided valve disease. Often repaired at the same time as mitral or aortic valve surgery.
Pulmonary Valve
Located between the right ventricle and the pulmonary artery. Pulmonary valve disease in adults is less common and often relates to congenital heart disease.
How Is Heart Valve Disease Diagnosed?
Echocardiography
The echocardiogram is the primary diagnostic tool for heart valve disease. It provides real-time ultrasound images of valve structure, leaflet motion, and degree of stenosis or regurgitation.
- Transthoracic echocardiography (TTE) – the standard first investigation
- Transoesophageal echocardiography (TOE) – a probe passed into the oesophagus providing higher-resolution images. Used when TTE images are insufficient and routinely used during cardiac surgery and catheter-based procedures
Additional Investigations
- ECG – assesses heart rhythm and chamber enlargement
- Chest X-ray – may show cardiac enlargement or pulmonary congestion
- CT angiography – used for detailed anatomical planning before TAVI and catheter-based procedures
- Cardiac MRI – provides accurate quantification of valve regurgitation and ventricular function
- Cardiac catheterisation – invasive pressure measurements and coronary artery assessment before valve surgery
When Does Heart Valve Disease Require Treatment?
The timing of treatment is guided by:
- Severity – mild disease is monitored; severe disease requires assessment for intervention
- Symptoms – breathlessness, chest pain, reduced exercise tolerance, or fainting significantly narrows the window for safe intervention
- Effect on heart function – even without symptoms, evidence of progressive cardiac enlargement or decline in heart muscle function is an indication for intervention
- Valve type and cause – different valves and different causes have different natural histories and treatment thresholds
The key message for Sri Lankan patients is this: the right time to treat valve disease is before the heart becomes significantly enlarged or weakened. Once the heart muscle is damaged from years of compensating for a faulty valve, outcomes from intervention are less favourable than when surgery is performed at the optimal timing.
Regular follow-up with serial echocardiography is the cornerstone of managing valve disease – not as a substitute for treatment, but to identify the right moment to act.
Repair vs. Replacement: What Is the Difference?
Valve Repair
The patient’s own valve is reconstructed rather than replaced. This is the preferred approach when technically feasible, for several important reasons:
- Preserves native valve tissue and its more natural biomechanical properties
- Avoids the need for lifelong anticoagulation
- Associated with better long-term heart function compared to replacement
- Lower operative risk in experienced hands
Repair is most commonly performed for mitral valve regurgitation and tricuspid regurgitation. Selected cases of aortic valve regurgitation and congenital valve abnormalities can also be repaired.
Amrita Hospitals operates the dedicated Amrita Valve Repair Centre, reflecting a specific institutional commitment to repair over replacement wherever clinically appropriate.
Valve Replacement
When repair is not technically feasible, the diseased valve is removed and replaced with a prosthetic valve.
Mechanical valves – made from durable synthetic materials and last indefinitely, but require lifelong anticoagulation with warfarin. Preferred in younger patients.
Biological (bioprosthetic) valves – made from treated animal tissue. Do not require long-term anticoagulation but have a finite lifespan of 10 to 20 years. Preferred in older patients or those who cannot safely take anticoagulation.
The choice between mechanical and biological valve takes into account the patient’s age, lifestyle, ability to manage anticoagulation monitoring, and personal preferences.
Modern Surgical Techniques: Minimally Invasive and Robotic Approaches
Traditional open heart surgery for valve repair or replacement requires a full sternotomy – division of the entire breastbone. This remains the approach for complex combined procedures.
However, for many single-valve procedures, minimally invasive surgical approaches are now available:
Minimally Invasive Mitral Valve Surgery
Performed through a small incision between the ribs on the right side of the chest, without dividing the breastbone. Benefits include:
- Significantly less post-operative pain
- Shorter hospital stay – typically 3 to 5 days vs 7 to 10 days for sternotomy
- Faster return to normal activities – most patients return to light activities within 2 to 3 weeks
- Smaller, less visible scar
- Lower risk of sternal wound infection
Robotic-Assisted Mitral Valve Repair
Amrita Hospitals performs robotic-assisted mitral valve surgery through very small incisions with enhanced visualisation and instrument precision. This offers the highest level of minimally invasive cardiac surgery currently available, with excellent outcomes for appropriate candidates.
Minimally Invasive Aortic Valve Replacement
For isolated aortic valve replacement, a partial upper sternotomy or right anterior mini-thoracotomy approach is used, reducing recovery time while providing adequate access for the procedure.
Catheter-Based Valve Procedures: TAVI, TMVR, and Balloon Valvotomy
One of the most significant advances in cardiology has been the development of catheter-based valve procedures – treating heart valve disease without any surgical incision.
Transcatheter Aortic Valve Implantation (TAVI)
TAVI has transformed the treatment of severe aortic stenosis, particularly in elderly patients or those with significant other medical conditions making open surgery higher risk.
In TAVI, a new prosthetic valve compressed within a delivery catheter is inserted through the femoral artery in the groin. The catheter is guided to the aortic valve under imaging, and the new valve is deployed within the diseased native valve, immediately taking over valve function.
Most TAVI patients are discharged within 2 to 5 days and experience significantly faster recovery than after open aortic valve surgery.
Transcatheter Mitral Valve Repair (MitraClip)
For patients with significant mitral regurgitation who are not suitable for surgery, catheter-based repair using the MitraClip device offers an alternative. A clip is delivered through a catheter and attached to the mitral valve leaflets, reducing the degree of regurgitation.
Balloon Mitral Valvotomy (BMV)
Of particular relevance to Sri Lankan patients with rheumatic mitral stenosis. BMV is a catheter-based procedure in which a balloon is inflated across the narrowed mitral valve, separating fused leaflets and widening the valve opening – without open surgery.
In suitable patients with rheumatic mitral stenosis – pliable, non-calcified valves without significant regurgitation – BMV produces excellent results and avoids surgery entirely. It is one of the most cost-effective cardiac interventions available and is the procedure of choice for suitable rheumatic mitral stenosis cases.
Rheumatic Heart Disease: A Sri Lanka-Specific Concern
Rheumatic heart disease deserves specific attention in the context of Sri Lankan patients.
Rheumatic fever is a delayed immune response to streptococcal throat infection. Each episode causes additional scarring and damage to the heart valves. Over years and decades, this cumulative damage leads to significant valve stenosis, regurgitation, or both.
Sri Lanka continues to see cases of rheumatic heart disease across all age groups, but particularly in younger adults who experienced recurrent streptococcal infections in childhood. Valve disease in Sri Lankan patients is not only a condition of the elderly – it is a real concern for patients in their 20s, 30s, and 40s.
Key points for Sri Lankan patients with rheumatic heart disease:
- Secondary prevention with penicillin – patients with established rheumatic heart disease should be on long-term penicillin prophylaxis to prevent further streptococcal infections and additional valve damage
- Regular cardiac follow-up – serial echocardiography to monitor valve function and identify the optimal timing for intervention
- Balloon mitral valvotomy – for suitable cases of rheumatic mitral stenosis, BMV can defer the need for surgery by years
- Surgery when needed – valve repair or replacement when disease progression or symptoms indicate intervention
For Sri Lankan patients with rheumatic heart disease who have not had a recent cardiac assessment or echocardiogram, now is the right time to arrange one.
Why Do Sri Lankan Patients Choose Amrita Hospitals for Valve Treatment?
- Dedicated Amrita Valve Repair Centre – a specialist programme with a specific institutional focus on valve repair over replacement, staffed by surgeons with extensive repair experience
- Full spectrum of surgical and catheter-based options – conventional sternotomy, minimally invasive surgery, robotic-assisted valve repair, TAVI, MitraClip, and balloon mitral valvotomy, all available under one roof
- Specific expertise in rheumatic heart disease – highly relevant to the Sri Lankan patient population
- Heart Team approach – cardiologists and cardiac surgeons review complex cases together, ensuring the most appropriate treatment recommendation
- One-hour flight from Colombo – reducing the access barrier that currently prevents many Sri Lankan patients from receiving timely valve treatment
For patients with an existing valve disease diagnosis, our article on heart surgery in India for Sri Lankan patients provides a broader overview of the cardiac surgical programme at Amrita Hospitals.
To explore the full range of cardiac services, visit cardiac and heart valve treatment options in India.
How Do Sri Lankan Patients Access Valve Treatment in India?
- Gather your existing cardiac investigations – echocardiography reports, ECG, chest X-ray, and specialist letters
- Share these with Amrita Info Centre Sri Lanka for forwarding to the valve team at Amrita Hospitals
- Receive an initial clinical assessment covering the type and severity of valve disease, the recommended treatment approach, and optimal timing
- Confirm your appointment and travel arrangements
- Apply for your medical visa with support from our team
For guidance on the visa process, our article on the Complete Guide to Medical Visa for India from Sri Lanka covers documentation requirements and application steps in full.
Frequently Asked Questions
How do I know if my valve disease needs treatment now or if it can be monitored? The decision depends on the severity assessed by echocardiography, whether you have symptoms, and whether there is evidence of progressive impact on heart function. If your most recent echocardiogram was more than 12 months ago and you have known moderate to severe valve disease, an updated assessment is appropriate.
Is minimally invasive valve surgery available for all patients? Minimally invasive approaches are suitable for the majority of patients requiring isolated mitral or aortic valve surgery. They may not be appropriate for combined procedures or where anatomy makes the approach technically challenging. Your surgical team will assess suitability based on echocardiography and CT imaging.
Will I need lifelong blood thinners after valve surgery? Mechanical valves require lifelong anticoagulation with warfarin. Biological valves and successful valve repairs generally do not require long-term anticoagulation. TAVI patients require dual antiplatelet therapy for a defined period after the procedure.
What is balloon mitral valvotomy and is it available at Amrita Hospitals? Balloon mitral valvotomy is a catheter-based procedure that widens a narrowed mitral valve by inflating a balloon across it, separating fused leaflets caused by rheumatic disease. It is the treatment of choice for suitable rheumatic mitral stenosis cases and is performed at Amrita Hospitals.
How long is the hospital stay for TAVI? Most TAVI patients are discharged within 2 to 5 days. Recovery is significantly faster than after open aortic valve surgery. Most patients are mobile and able to manage daily activities within a week.
Can a previously repaired valve be repaired again if it fails? In some cases, a failed valve repair can be re-repaired surgically. In many cases if a repair fails, valve replacement is required. Redo surgery is more complex than primary surgery, but at experienced centres it is performed with acceptable outcomes.
Conclusion
Heart valve repair in India offers Sri Lankan patients access to the full spectrum of modern valve treatment – from catheter-based balloon valvotomy for rheumatic mitral stenosis to robotic-assisted valve repair and TAVI for aortic stenosis – at a dedicated valve programme within an internationally accredited hospital.
Whether your valve disease is newly diagnosed or has been monitored for years, the most important step is an up-to-date specialist assessment that determines where you are in the natural history of your disease and what treatment is appropriate at this stage.
Amrita Info Centre Sri Lanka is here to help Sri Lankan patients access that assessment and coordinate the full care pathway from Colombo.