Quick answer: structural heart disease refers to problems with the heart’s valves or internal walls and chambers, as opposed to problems with the coronary arteries or electrical rhythm. The most common are valve disease (a valve that is too narrow or leaks) and holes between heart chambers such as an atrial septal defect. Many of these were once treated only with open-heart surgery; a growing share are now treated with catheter-based procedures done through a small tube in a blood vessel, which is why the field has expanded rapidly in the last decade.
What Structural Heart Disease Actually Means
Cardiology broadly splits heart problems into three groups: coronary artery disease (blocked arteries), electrical problems (arrhythmias), and structural problems — anything wrong with the heart’s physical architecture. That includes:
- Valve disease — a valve that has become too narrow (stenosis) or doesn’t close properly and leaks (regurgitation), most often the aortic or mitral valve
- Holes between heart chambers — an atrial septal defect (a hole between the upper chambers) or, less commonly in adults, a ventricular septal defect (between the lower chambers)
- A patent foramen ovale (PFO) — a small flap-like opening between the upper chambers, present in about a quarter of adults, that failed to seal after birth
- Hypertrophic cardiomyopathy — abnormal thickening of the heart muscle, often genetic
- Paravalvular leak — a leak around a previously replaced valve, where the stitches securing it have loosened
Some structural problems are present from birth (a hole in the heart, hypertrophic cardiomyopathy in its inherited form); others develop from wear over decades, most commonly age-related valve degeneration.
Symptoms and When to Seek Care
Many structural problems, particularly a small PFO or mild valve narrowing, cause no symptoms and are found incidentally. As a problem becomes more significant, symptoms can include breathlessness on exertion, fatigue, swelling in the legs, chest discomfort, palpitations, or fainting.
Seek emergency care for sudden severe breathlessness, chest pain, fainting, or a rapid decline in exercise tolerance over days — these can signal a valve failing acutely or fluid building up rapidly, and should not wait for a routine appointment.
Why Catheter-Based Treatment Changed the Field
For many patients, high-risk open-heart surgery has been replaced by minimally invasive catheter-based procedures, which generally carry lower procedural risk, less trauma and a faster recovery. A thin tube is threaded into a blood vessel, usually in the leg, and guided to the heart, where a device is delivered and expanded into position. These procedures were originally reserved for patients too frail for open surgery; they are now increasingly offered to lower-risk patients as well, once enough long-term outcome data existed to support that expansion.
Common Structural Heart Procedures
| Procedure | Treats |
|---|---|
| TAVR (transcatheter aortic valve replacement) | A narrowed or diseased aortic valve, replaced with a new valve delivered by catheter, usually through the leg |
| TMVr (transcatheter mitral valve repair), e.g. MitraClip | A leaking mitral valve (mitral regurgitation); a clip reduces the leak without replacing the valve |
| PFO or ASD closure | A hole between the upper heart chambers, closed with a device delivered by catheter |
| Left atrial appendage closure (e.g. Watchman) | Reduces stroke risk in atrial fibrillation for patients who cannot take long-term blood thinners |
| Paravalvular leak closure | A leak around a previously placed replacement valve |
Surgical options remain appropriate for some patients — particularly younger patients, certain valve anatomies, or when multiple procedures are needed at once — so the choice between catheter-based and surgical treatment is made jointly by a cardiac surgeon and an interventional cardiologist based on individual anatomy and risk.
Risks to Understand Before Any Procedure
Catheter-based procedures are lower-risk than open surgery on average, but they are not risk-free. Recognized risks include bleeding or injury at the catheter access site, stroke, the need for a permanent pacemaker afterward (particularly with TAVR), a leak around the new valve or closure device, and, rarely, damage to the valve or vessel during placement. Open surgical repair carries its own separate risks, including those of general anesthesia and a longer recovery. Ask your care team what the specific risks are for your procedure and your own anatomy, since these vary meaningfully by patient.
Diagnosis
- Echocardiogram — the primary imaging test, showing valve function and any structural holes directly
- Transesophageal echocardiogram — a more detailed view from inside the esophagus, often used before a procedure
- Cardiac CT or MRI — used for detailed anatomy and procedure planning
- Cardiac catheterization — direct assessment of pressures and blood flow inside the heart
Frequently Asked Questions
Problems with the heart’s valves or internal walls and chambers, as opposed to blocked coronary arteries or electrical rhythm problems. The most common examples are valve disease, such as a narrowed or leaking valve, and holes between heart chambers, such as an atrial septal defect or patent foramen ovale.
Transcatheter aortic valve replacement, a procedure that replaces a diseased aortic valve with a new one delivered by catheter through a blood vessel, usually in the leg, rather than through open-heart surgery. It is one of the most common structural heart procedures performed today.
Catheter-based procedures generally carry lower procedural risk, less trauma and a faster recovery than open-heart surgery, which is why they have become the preferred option for many patients. They are not risk-free, however, and carry their own recognized risks including bleeding, stroke and the need for a pacemaker. Surgery remains the better option for some patients depending on anatomy and other factors, so the choice is individualized.
A leak around a previously placed replacement heart valve, occurring when the stitches securing the valve loosen over time. It traditionally required repeat open-heart surgery to fix, but at some specialist centers it can now be closed using a catheter-based technique instead.
Often, yes, especially with a small defect that causes no symptoms, which may simply be monitored. A large, long-standing atrial septal defect can eventually strain the heart and lungs if left untreated, which is why surgical or device closure is recommended for defects significant enough to cause symptoms or affect heart function.
Sources
- American Heart Association — Heart Valve Problems and Disease.
- National Heart, Lung, and Blood Institute — Heart Valve Disease.
- MedlinePlus — Heart Valve Diseases.
- Cleveland Clinic — Transcatheter Aortic Valve Replacement (TAVR).
Last updated: August 2026. This article is general information and is not medical advice or a diagnosis. Which procedure, if any, is appropriate depends on individual anatomy and risk, and should be decided with a cardiologist and cardiac surgery team. If you have sudden severe breathlessness, chest pain or fainting, call emergency services rather than reading further.
