Valvular Procedures

Heart valve function
The heart’s job is to pump blood throughout the body. Blood enters the heart and must pass through a series of one-way gates called valves. When a heart valve is not working properly, not enough blood moves forward.

If a valve has problems opening (stenosis), the heart must work harder to push the blood through this smaller opening.

If a valve has problems closing (regurgitation), the valve is leaking some blood backwards. This causes the heart to try to push a greater volume of blood forward.

With stenosis or regurgitation, the heart must work harder to pump blood throughout the body. This may work for awhile, but eventually it will lead to heart failure.

Symptoms of faulty valves
Sometimes people with valve problems will have no symptoms for decades. Symptoms may arise so gradually that they are barely noticed until they become troublesome. Other times, symptoms may appear quite suddenly. Symptoms may include:

  • shortness of breath, especially when lying down, during exertion, or when stressed.
  • pain, pressure, tightness or numbness in the chest, neck, back, or arms (angina)
  • dizziness or lightheadedness
  • fatigue, especially with activity
  • waking up at night coughing
  • irregular or racing heartbeat
  • fluttering feeling in the chest
  • swelling of the ankles or feet

The cause of valve problems
Men and women of all ages may have heart valve problems. People are sometimes born with a problem valve. Age may be a factor in wearing out a valve. Sometimes it’s hard to determine why a valve has failed. Some common causes include:

  • calcium build up or scar tissue on a valve
  • rheumatic fever or other infections or diseases
  • high blood pressure
  • other heart problems, such as coronary artery disease

Surgical treatment for valve problems
If medical treatment options are not sufficient, surgery may be done to correct the faulty valve. There are different options available to repair or replace faulty valves. Age, lifestyle, and other health problems are factors which the surgeon takes into consideration when determining which surgical option is best for any particular patient.

Valve repair: The mitral valve can often by repaired, instead of replaced. This may involve sewing a ring or band around the circumference of the valve to improve its size or shape. Sometimes a more complex repair is required. This may involve removing a small portion of a valve tissue, then suturing the remaining valve tissue together. When a valve isn’t repairable, it is replaced.

Mechanical valve replacement: Mechanical valves are made of metal or hard carbon. They can last for decades. Because blood tends to stick to them, causing blood clots, the patient will need to take a blood thinner called Coumadin.

Tissue valve replacement: Tissue valves are manufactured with tissue that comes from a pig. Patients receiving these valves do not need to take Coumadin for life, because blood does not tend to stick to tissue valves. Tissue valves may wear out faster then a mechanical valve.

Sometimes, there are other heart problems that also need to be fixed. It is common to combine valve surgery with other procedures if they’re necessary. For instance, there may be two faulty valves or there may also be some coronary artery disease which may need to be addressed.

The surgical procedure
To get to the heart, the surgeon makes an incision down the middle of the chest and the breastbone is separated. The patient is placed on a heart-lung machine, which does the job of the heart and lungs while the surgeon works on the heart. Valve surgery takes several hours. If additional problems are fixed, the surgical time increases.

After the surgery has been completed, the breastbone is brought together with stainless steel sire. It will take six to eight weeks for the breastbone to heal.

The surgical team members
The surgical team works together to provide the best and safest patient care possible. The team consists of the surgeon, the surgeon’s assistant, an anesthesiologist, surgical technicians, registered nurses, patient care partners, and sterile processing technicians.

After surgery
The heart surgery patient will experience grogginess and some discomfort, which is common after any surgical procedure. Medications are provided to ease the discomfort.

The patient will likely have a breathing tube for a short time after surgery. Drainage tubes help to remove any fluid which collects around the heart. A catheter drains urine from the bladder. IV lines are used to give fluid and medications. As the patient progresses, these tubes and lines are removed.

Increasing the activity level of the heart surgery patient increases muscle strength, blood flow, and resistance to illness. It is important to sit up and walk as soon as possible after surgery. Respiratory therapists assist the patient with deep breathing and coughing exercises which help to prevent lung problems.

Heading home!
The patient is instructed on medications, nutritional guidelines, smoking cessation, and physical activities. A follow-up appointment is made. It will take about six to eight weeks of healing before the patient is ready to return to their normal daily routine.

The incision site may appear bruised and it may be itchy or numb. Wound care instructions are provided before dismissal from the hospital.

Warning signs to be aware of
The patient should call (800) NHI DOCS if any of the following occur:

  • shortness of breath while resting or after only slight exertion
  • racing heartbeat or missed beats
  • swelling of the legs or gaining more than 2 pounds in 1 day or 5 pounds in 1 week (a sign of fluid retention)
  • dizziness or lightheadedness
  • chills or fever of 100 F or higher
  • the incision changes for the worse (swelling, oozing, redness, tenderness)
  • chest pain gets worse instead of better
  • breastbone clicks or grinds