Procedures at Cardiovascular Clinical Associates

Heart Valve Surgery

Your heart valves are doorways that open and close to let blood move between the chambers of your heart. Problems with your heart valves can mean that blood doesn't flow through your heart and to your body the way it should. This can keep you from feeling

Trouble with Your Heart Valves:

How You Might Feel:

If you have heart valve trouble, you may have experienced one or more of the following:

Problems breathing when you're lying down.
Wheezing, coughing, or shortness of breath when you exert yourself.
Waking up at night coughing or short of breath
Weakness or tiredness.
Dizzy spells, fainting spells.
Swollen ankles or feet.
A fast, pounding heartbeat or fluttering feeling in your chest.
Chest pain or pressure.

How Your Doctor Can Help:

Whether or not you've felt symptoms, your doctor has probably heard your heart make a sound called a murmur. A murmur is usually present when you have a heart valve problem. To find out what kind of valve problem you have, your doctor may have ordered various tests, including an echocardiogram, an electrocardiogram, a chest x-ray, or cardiac catheterization. You may have taken medications to help treat your valve problem Now your doctor is recommending heart valve surgery. During this surgery, problem heart valves can be either repaired or replaced.

Life After Valve Surgery:

Valve surgery may give your heart the boost it needs so you feel better. Feeling better can let you get back to doing the things you enjoy. After your surgery, take care of yourself and your heart to keep your new valve working right. For many people, this includes taking medications called anticoagulants every day. Your doctor will talk to you about these medications and other things you can do to help keep your heart valves healthy in the future.

Heart Valves (Doorways in Your Heart):

Your heart is a pumping muscle that works nonstop to keep your body supplied with oxygen rich blood. Four heart valves act like one way doors to keep blood moving in one direction through the heart. Problems with one or more valves may mean that the heart has to work harder to get blood out to the body.

How Normal Heart Valves Work

The heart is divided into four chambers. The upper chambers are called atria and the lower chambers are called ventricles. The heart muscle squeezes blood from chamber to chamber. At each squeeze, the valves open to let blood through to the next chamber. Then the valves close to stop blood from moving backward. In this way, the valves keep blood moving as efficiently as possible through the heart and out to the body.

Heart Valve Problems:

Valve disease occurs when a valve doesn't work the way it should. If a valve doesn't open all the way, less blood can move through the smaller opening. If a valve doesn't close tightly, blood may leak backward. These problems may mean the heart has to work harder to pump the same amount of blood. Or blood may back up in the lungs or body because it's not moving efficiently.

Problems Opening:

Stenosis occurs when a valve doesn't open completely. The valve may have become hardened or stiff with calcium deposits or scarring, so it's hard to push open. Blood has to flow through a smaller opening, so less blood gets through the valve into the next chamber.

Problems Closing:

Insufficiency (also called regurgitation) results when the valve doesn't close tightly. The valve's supportive structures may be loose or torn. Or the valve itself may have stretched or thinned. Blood then may leak back in the wrong direction through the valve.

What Causes Valve Disease?

Valve disease can have several causes. You may be born with a problem valve. Rheumatic fever or a bacterial infection can damage heart valves. Coronary artery disease (blocked blood vessels in the heart) can sometimes cause heart valve problems. Or your valves may simply wear out as you grow older.

Heart Valve Surgery:

During heart valve surgery, one or more heart valves can be repaired or replaced. Repair means that the valve is tailored to help it work better. Replacement means your own diseased valve is removed and a new valve is inserted in its place. The decision whether to repair or replace a valve often can't be made until after surgery has begun. You and your surgeon can discuss plans for surgery and any other procedures you may need.

Replacing the Valve:

If a valve can't be repaired, it may be replaced with a prosthetic valve. Two kinds of prosthetic heart valves are available:

Mechanical valves are created from manmade materials. Lifetime therapy with anticoagulant medication, to prevent blood clots on or around the valve, is necessary when these types of valves are used.
Biological (tissue) valves are taken from pig, cow, or human donors. Biological valves don't last as long as mechanical valves. However, when biological valves are used, long-term therapy with anticoagulant medication often isn't necessary. You and your doctor can discuss which type of valve is best for you. Factors considered are your age, your occupation, the size of your valve, how well your heart is working, your heart' s rhythm, your ability to take anticoagulant medications, and how many new valves you need.

Before Your Surgery:

When you're admitted to the hospital, a patient educator or a nurse may talk with you and your family about what you can expect while you're in the hospital. You'll probably feel a little nervous before surgery, but the hospital staff will do everything they can to answer your questions and help make you comfortable. If you need dental work, it should be done prior to surgery. This is because dental procedures often allow bacteria to enter the bloodstream, which may cause infection around the new valve. Tell your doctor what medications you're taking, especially aspirin or anticoagulants, and ask if you should stop them. If you smoke, stop immediately to improve your blood flow and breathing. To prevent vomiting during surgery, don't eat or drink anything after midnight the night before surgery. Your anesthesiologist will talk with you about your medical history and explain how anesthesia will be given to keep you asleep and free of pain during surgery. To help prevent infection, any chest hair will be shaved. You may also be asked to wash with an antibacterial soap.

Knowing the Risks

The risks of valve surgery include:

Breathing problems or other lung complications
Bleeding
Problems with your hearts rhythm, requiring a pacemaker or medications.
Infection
Problems due to anticoagulant therapy
Heart attack, stroke, or death

During Your Surgery:

You can feel confident knowing that your valve surgery is being performed by a skilled heart surgery team. With the help of highly advanced technology, these surgeons and specialists will ensure the safest possible surgery for you.

Your Valve Surgery Team:

Each person involved in your surgery plays a vital role. The heart surgeon and surgical assistants perform the surgery, with support from several specially trained nurses.

Reaching Your Heart:

To get to your heart, your surgeon makes an incision down the middle of your chest and separates your breastbone. After the surgery, your breastbone is rejoined with stainless steel wires and the incision is sewn up. Your breastbone will heal in about six to eight weeks.

Circulating Your Blood:

Before the delicate valve surgery can begin, your heart must be stilled. During this time, your blood is passed through a heart-lung machine. The machine supplies your blood with oxygen and pumps it back through your body. Your heart and lungs will take over their functions again once the surgery is completed.

Replacing the Valve:

An incision is made in your heart or aorta. Part or all of the damaged valve and its supportive structures may be cut and removed. The right sized replacement valve is selected, positioned in the valve opening, and sewn firmly into place. The incision in your heart is then closed and your heart is started so it beats on its own again.

After Your Surgery:

Immediately after your surgery, you'll be taken to a special care unit (often called the intensive care unit or ICU), where your recovery will be constantly monitored. You might spend a day or two in the ICU, though everyone recovers at a different rate. When you leave the ICU, you'll move to another area of the hospital.

The ICU:

When you wake up after surgery, you may feel groggy, These are common aftereffects of this type of surgery-but they won't last long. If you feel pain, your nurses can give you medication. Don't be surprised to see that a variety of surgical tubes and wires were attached to your body during surgery.

Vital Connections:

At first, you'll breathe through a tube in your throat. You won't be able to talk while this tube is in place. Chest tubes collect blood and fluid, a heart monitor records your heart rate, and a bladder catheter drains urine. The intravenous (M lines used during and after your surgery continue to give you fluid, blood, and medications. These tubes and lines are removed when you no longer need them.

Respiratory Therapy:

During your hospital stay, a nurse or therapist will assist you with deep breathing and coughing exercises that will help prevent lung problems.