What are the medical symptoms that require replacement or repair of a heart valve?
The human heart contains 4 valves which open and close intermittently thus assisting the human pump to maintain blood flow in the right direction, from the left ventricle of the heart to the aorta. These valves can ware out and their function become impaired over time due to a number of processes, such as congenital heart defects, rheumatic heart diseases, infections, injuries, weakening of the tissue and calcification due to calcium accumulation at an older age. These medical conditions impair normal blood flow and result in dysfunction of the heart as a pump. During the first stage of valvular heart disease the patient is treated conservatively by medications that stabilize and improve valve functionality.
At a later stage, however, surgery is usually required in order to repair or replace the valve, depending upon the type of valve and the nature of its medical condition. Valvular heart disease could be the forerunner of heart failure which in turn could lead to death. Prior to reaching a decision regarding surgery, it is important to consult with Cardioheal physicians (heart surgeon and cardiologist) in order to discuss the different types of procedures, the advantages and disadvantages of each, and the risks involved.
Heart valve repair or replacement surgery has been carried out successfully worldwide for over thirty years, and is considered to be one of the most common surgical procedures. While some heart valve procedures are done during open heart surgery, others are performed by a minimally-invasive procedure via a small incision between the ribs, particularly when replacing or repairing the aortal or mitral valve. In both the minimally-invasive and direct open heart techniques, where the surgeon reaches the heart through the sternum, a special surgical tool is used which enables the surgeon to fix the defect without obstructing normal blood flow through the valve. In cases where the surgeon finds that the valve cannot be repaired, either during or prior to the procedure , the impaired valve is removed and replaced by a biological valve (either from an organ donation, or from the heart of a pig or cow) or by a mechanical valve.
Biological valve
Advantage: No need for any long-term anticoagulation treatment (Coumadin).
Disadvantage: Lack of durability (between 8-15 years). The biological valve, therefore, is more suitable for elderly patients or for patients who practice physical exercise and would prefer not taking Coumadin.
Mechanical valve
Advantage: Its durability which extends for many years.
Disadvantage: The patient will need anticoagulation therapy throughout his/her life. The mechanical valve, therefore, is more suited for younger patients, but each case would need to be reviewed on its own merits after consultation with the surgeon.
Much like any other invasive procedure valve surgery is not risk-free, and therefore it is important to be aware of this prior to making the decision to undergo surgery. In order to reduce possible risks and complications, it is extremely important to provide both the surgeon and anesthesiologist with all personal and medical history in order for them to select the most suitable treatment compatible with your needs.
Valve surgery is an elective procedure considered to be relatively safe, with very low mortality and complication risks. However, patients suffering from left ventricular systolic dysfunction, patients who have undergone a myocardial infarction resulting in an impaired heart muscle, patients suffering from cardiovascular diseases, or from chronic obstructive pulmonary disease, are considered to be at high risk for surgery. Risk from anesthesia is also relatively low.
Valve surgery is performed under general anesthesia. This allows patients to undergo the entire procedure without the distress and pain they would otherwise experience. Anesthesia is generally administered by an intravenous injection. Moments later the patient will fall into a state of drowsiness, followed by semi-consciousness and then a deep sleep. An anesthesiologist monitors the patient's medical condition at all times to insure that he/she is in a state of deep sleep, that the muscles are completely relaxed and that a state of total lack of awareness is maintained. After the surgical part of the operation is completed the anesthesiologist wakes the patient up by halting the administration of the anesthetics.
Once the patient is awake, he/she is transferred to the recovery ward in order to insure a safe and monitored recovery period.
In preparation for valve repair or replacement surgery the patient must undergo a complete blood count, which includes the following: a biochemical analysis, electrolyte, liver function and blood clotting tests. An ECG and chest x-ray will also be performed. Furthermore, the patient will also need to have in his possession all the cardiac imaging tests that were performed, such as the diagnostic cardiac catheterization/virtual catheterization, cardiac CT, cardiac stress test etc.
It is important for the patient to prepare an entire medical portfolio in order to be able to share his/her entire medical history with the surgeon and the anesthesiologist. It is especially important that the medical team be informed of prior surgical procedures and hospital admissions, chronic ailments, prescription drugs, diet supplements and allergies. Patients who suffer from secondary ailments are required to a consult with their individual specialists (e.g. internist, gynecologist, dermatologist) prior to undergoing surgery. One week prior to surgery and in accord with the surgeon's recommendations, the patient should stop taking anticoagulation drugs such as Coumadin. It is important to confer with your family physician or your surgeon regarding substitutes.
On the day of the operation, from 6 hours prior to surgery, the patient must be on a complete fast, including water intake. Before surgery, dentures, jewelry and personal items of clothing will be removed by a staff member, and it is advised to refrain from smoking. Should the operating site include bodily hair, this will be shaved off by a hospital staff member. It is advised to shower afterwards. Moments before the surgery, the patient will be hooked up to an infusion into which the anesthesiologist will introduce sedatives that will assist in relieving anxiety and stress.
After a short stay in an intensive care unit, the patient will be transferred to a cardiac surgery ward where he/she will receive continued treatment from the medical and nursing staff. This will include general care and continuous heart monitoring by an ECG monitor connected to the body. A few hours later the patient will be assisted in getting off the bed in order to sit in an armchair. It is important to take into consideration that recovery is gradual and prolonged and could takes 3 to 4 months.
During the first days after hospital discharge most patients feel weak due to the trauma of undergoing surgery. It is recommended to increase activity levels gradually: start off by doing small tasks that require no physical effort or strain, and gradually pace yourself up in accordance with your general feeling.
About two weeks after surgery an appointment will be scheduled with one of Cardioheal's doctors in order to review the patient's current medical status. At this time, it is important to inform the doctor of any new sensations or medical conditions that have arisen, and update him about your general current state of health. If a patient has a fever over 38°C or if he/she suffers from chest pain or any other alarming symptom, the surgeon or nurse on call must be informed immediately and without delay. It is recommended that the patient should not engage in any heavy lifting or strained physical exercise during the first 6 to 8 weeks following surgery. Should the patient suffer from dizziness or fatigue, it is also recommended to abstain from driving until these sensations pass.
Joining a cardiac rehabilitation program is also recommended and might assist and improve the recovery process. The initial rehabilitation period is generally in a hotel or designated center, and later at a community clinic or hospital. A rehabilitation period is highly recommended since it provides education and guidance in healthy nutrition, a custom-made exercise plan, and a general individual care and monitored program.
