Fatigue, swelling and a fading appetite can be accepted as part of growing older. As treatment options expand, Kuwait’s Dr Altayyeb Yousef AlQallaf explains why families should look more closely at changes they may have learned to live with.
The symptoms that concern Altayyeb Yousef AlQallaf can be easy to explain away: an older parent who tires more quickly, persistent swelling in the legs, an appetite that has faded. In his experience, these changes are often attributed to age before their cause has been properly examined. “Age is just a number,” he says, pointing to the considerable differences in health between people born in the same year. Accepting a gradual decline can mean overlooking a condition that deserves treatment.
His concern centres on the tricuspid valve, a small part of the heart with consequences well beyond it. Long known in cardiology as the “forgotten valve”, it can leak for years before the effects become unmistakable. By then, the problem may involve the liver and kidneys as well as the circulation, making a symptom first noticed at home part of a much more complicated illness with late consequences.
Speaking to News Kuwait on 31 October, Dr AlQallaf describes that connection through the experience of two patients his team recently treated at Al-Adan Hospital’s Salman Al-Dabbous Cardiac Centre. Both went home the morning after receiving replacement valves through a vein in the neck. The early results have encouraged him, but much of what he wants to discuss concerns how long symptoms can go unrecognised before treatment is considered.
A disease that can look like getting older
The tricuspid valve is the first valve that blood returning to the heart encounters. It helps direct blood from the heart’s right upper chamber into its lower chamber, which pumps it towards the lungs. When the valve does not close properly, some blood escapes backwards. Small leaks are common and cause no difficulty; significant leakage, known as severe tricuspid regurgitation, can impair circulation. The European Society of Cardiology estimates that at least moderate leakage affects about 4% of people over 75, roughly one in 25, drawing on international research.
For Dr AlQallaf, the way the disease presents helps explain why it received less attention than other valve conditions. Tiredness and reduced appetite may build gradually; some patients feel full unusually quickly when eating. These changes are easier to accommodate than a sudden episode of chest pain or fainting. He describes repeatedly confronting the assumption that being old means being tired, even when persistent symptoms suggest that something else needs investigation.
Medicine’s options also shaped that history. Open-heart surgery could carry substantial risks for patients already coping with frailty or other illnesses, leaving treatment concentrated on relieving fluid retention. Dr AlQallaf recalls the emphasis on “Lasix, Lasix, Lasix”, referring to a commonly used diuretic. Such medicines could ease swollen legs while leaving other difficulties unresolved: “That in itself has managed the symptoms of leg edema, but did not manage the symptoms of being tired, being fatigued,” he explains. Removing excess fluid did not correct the underlying leak.
Fear of treatment can also lead families to accept symptoms that deserve attention. Dr AlQallaf says this is particularly relevant in Kuwait and the wider region, where some families, anxious to protect an older relative, may tolerate a decline in health because they fear a poor outcome from intervention. He wants them to understand that newer transcatheter treatments have been developed for patients at high surgical risk. For suitable patients, these can offer a less invasive alternative to open-heart surgery and meaningful improvements in symptoms and quality of life. A specialist assessment can help families weigh those potential benefits against the risks for their relative.
The damage beyond the heart
A leaking valve can affect the liver because the two organs are connected by the circulation. Blood returning from the body passes through the right side of the heart; when severe leakage raises pressure in that system, congestion can extend back towards the liver and the kidneys. “The liver becomes congested and it becomes soggy,” Dr AlQallaf says. Over time, he explains, persistent injury can produce fibrosis, or scarring, which may progress to end stage cirrhosis. What appears to be a liver problem may therefore have a cardiac cause.
That connection gives earlier assessment particular importance, although treating the valve does not settle every question about recovery. Dr AlQallaf distinguishes early damage from advanced cirrhosis, where the evidence is insufficient to establish whether correcting the circulation could allow a patient to avoid liver transplantation. “We don’t know what would happen in advanced cases,” he says. His uncertainty concerns how much an already damaged organ can recover after the source of congestion has been addressed.
The expanding range of transcatheter treatments makes these questions increasingly relevant. The 2025 European valve-disease guidelines recognise a role for transcatheter treatment in selected patients with severe, symptomatic tricuspid regurgitation who face high surgical risk. This allows specialist teams to consider options beyond conventional surgery, with the choice depending on the valve’s anatomy, the condition of the heart and the patient’s wider health. Dr AlQallaf’s experience in Kuwait forms part of that broader change.
Recovery continues after discharge
The team used LuX-Valve Plus, delivered through the jugular vein in the neck. Dr AlQallaf explains that approaching from above reduces the bends the delivery system must negotiate inside the heart. For the two patients, he says, the first changes were already apparent within a week. At least one had previously needed very high doses of diuretics; after implantation, “we stopped them fully”, he says of the medication. He also reports improved kidney function and forward blood flow, observations from their early follow-up rather than a measure of longer-term outcomes.
Discharge the following morning was followed by repeated reviews. By the interview, Dr AlQallaf had seen the patients two or three times in the first ten days and had prescribed blood-thinning medication to reduce the risk of clotting on the implanted valves. His emphasis is on watching how recovery develops and identifying any complications promptly, because “patient care does not end with doing procedures in themselves”. The next stage is to establish how well the improvements last.
For families, the immediate decision comes much earlier. Recurrent breathlessness, continuing swelling despite medication or unexplained fatigue warrant a proper assessment, he says. These symptoms have several possible causes; an echocardiogram can help establish whether a leaking valve is involved. His advice to those watching a parent struggle is direct: “You should come and seek attention.” A change that has become familiar at home may still need an explanation in the clinic.
