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About Heart Valve Surgery

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What are heart valves?

The heart is a pump made of muscle tissue. It has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. The right atrium pumps blood into the right ventricle, which then pumps blood into the lungs where carbon dioxide is given off and oxygen is taken into the blood. From the lungs, blood flows back into the left atrium, is pumped into the left ventricle, then is pumped through the aorta out to the rest of the body. There are four valves in your heart, made of thin flaps of tissue that open and close as your heart pumps. They are there to make sure that blood flows through your heart in only one way

  • Tricuspid valve - located between the right atrium and the right ventricle.
  • Pulmonary valve - located between the right ventricle and the pulmonary artery
  • Mitral valve - located between the left atrium and the left ventricle
  • Aortic valve located between the left ventricle and the aorta

How are the valves damaged?

There are many diseases that can damage heart valves. Common ones are:

  • Rheumatic fever
  • Degenerative diseases
  • Infections
  • Old age

These can result in two types of problems:

  • Valve doesn't open enough, there by enough blood doesn't flow through: called stenosis
  • Valve doesn't close properly and allows blood to leak back: called incompetence, insufficiency or regurgitation

What are the symptoms of valve disease?

Valvular disease can cause the following symptoms

  • Dizziness
  • Chest pain
  • Breathing difficulties
  • Palpitations
  • Edema (swelling) of feet, ankles or abdomen
  • Rapid weight gain due to fluid retentionRapid weight gain due to fluid retention

What are the indications for valve surgery?

Decision to do surgery is taken by your cardiologist and cardiac surgeon after looking at your symptomatic status, response to medical treatment and extent of valve damage assessed by echo cardiogram and sometimes by cardiac catheterization and angiogram.

What is done in valve surgery?

Heart valve surgery is done after your heart is stopped. During this time your blood is circulated using an artificial heart-lung machine. Basically there are two types of surgeries available for valve diseases - repairing your valve or removing it and replacing it with a new artificial valve. Artificial valves may be mechanical (made of metal or plastic) or tissue valves (animal valves or human valves taken from cadavers). What method suits you will be decided by your surgeon in the operating room.

How does one prepare for heart valve surgery?

Both you and your family should have sufficient information about the operation and hospital procedure to relieve your natural anxiety. You should feel free to discuss any concerns with the doctor. Because procedures vary from one hospital to another, be sure to find out about visiting hours, discussions with physicians and any other hospital related concerns you may have.

Are people frightened or nervous before the operation?

It is normal to feel nervous before important events. Nervousness or anxiety before an operation is a normal reaction just as athletes often are nervous before important games. Nervousness often is lessened by understanding the need for the operation, meeting members of the professional team and asking questions. Sometimes mild sedatives may be needed.

The night before surgery

Your anesthesiologist takes a brief medical history and explains your anesthesia to you. You will be given a normal dinner. If you are for surgery early next day, you should not eat or drink anything after midnight. If you are for surgery in the afternoon, you will be given early breakfast and after that you should not take anything. To help prevent infection after surgery, your chest, legs and groin will be shaved and you will be asked to shower before going to bed.

The morning of surgery

Before going for surgery, you are weighed to help your doctor know if you are retaining fluid after surgery. You may be given a mild sedative to help you relax and you are taken to the operating room on a trolley for your safety. Your family or other support people are directed to a waiting area and will be kept informed of the progress of your surgery.

Where will the incisions be made?

Usually the incision used to reach the heart is made along the midline of the chest through the breastbone. Sometimes it is done through an incision below the right breast.

What can be done to help in recovery?

Deep breathing exercises and coughing are important ways to help recover quickly. Coughing reduces the chances of pneumonia and fever and will not disturb the incision or valve. The nurse or therapist will clap her/his hands against the side of your chest, causing internal vibrations that loosen the secretions in the lungs. This makes it easier to cough them up. Most patients, fearing pain or discomfort, do not like to cough after an operation. But it is essential that it be done. Some patients find it easier to cough if the chest is supported by a pillow. You may be asked to inhale or exhale into a spirometer, a device to expand and exercise your lungs.

Will I feel pain after the operation?

Most patients complain of being sore but do not have severe pain. This soreness originates from the surgical incisions and muscle spasms. It can be helped by good posture and frequent movement of the arms and shoulders. If the pain is severe, medication may be obtained from the nurse upon request.

Can I become pregnant?

If you are a woman you may generally be permitted to become pregnant one year after surgery. When you become pregnant, that puts strain on your heart and anticoagulants you are taking may need to be altered. Discuss with your doctor all the details when you are contemplating to get pregnant.

What are the long-term precautions?

1. Diet: Maintain optimum body weight. If you have an artificial mechanical valve, you have to avoid vitamin K rich foods like green leafy vegetables.

2. Regular Exercise: Regular exercise can strengthen your heart muscle and boost its ability to use oxygen. Jogging, brisk walking, swimming and bicycling are all excellent ways to exercise. Your exercise program should start slowly and progress gradually. After heart surgery, an exercise program should only be started with your doctor's supervision.

3. Taking your medications: Medications are usually needed after valve surgery. In case you have a mechanical valve, your doctor may prescribe certain medications which prevent clotting of blood, on the artificial valve (anticoagulants or blood thinning agents). Take exact dose as directed. You may be directed to do Prothrombin time/INR tests to adjust the dose of blood thinning agents. It is essential that you get that test done as advised by your doctor and show him the report so that he can adjust the dose accordingly. INR has to be maintained between 2.5 and 3.5.

Caution: Many over-the-counter medicines like antibiotics and pain killers can cause major problems for people with artificial valves. Always get your doctor's opinion about all medicines that you take. Alcoholic drinks can also alter activity of anticoagulant drugs. Verify with your doctor before you can drink.

4. Avoid injuries: These can result in excess bleeding if you are on blood thinning agents. These can also become a focus for infection to get into your heart

5. Contact your doctor before any surgical procedures like dental surgeries or if you are pregnant or have any suspicion of infection like fever.

6. Always keep a card in your pocket with details of the operation you underwent, drugs you are taking and your blood group and contact numbers of your family members.

7. If you are visiting any other doctor for any health reason, inform him about your surgery and medications. Some drugs can interfere with the action of blood thinning agents. Some procedures like dental work can release bacteria into the bloodstream and cause infection in your heart.

Heart valve repair or replacement surgery is a treatment option when the heart valves are damaged or diseased and do not function properly. Dr.AGKGokhale is the best heart valve replacement surgeons in India performing valve repair surgeries.