HEART VALVE SURGERY
Heart valves ensure flow of blood in right direction through the chambers of your heart. If there is a problem in one of your heart valves, blood flow in your heart and blood circulation in your body will be disturbed. This will cause deterioration of your well being.
HOW YOU FEEL:
If there is a problem in your heart valves, you would mostly have one of following symptoms: Shortness of breath during exercise, difficulty in breathing while lying down, waking up at night with shortness of breath, cough and air hunger, weakness and dizziness, swelling in the ankles, palpitations, chest pain and pressure in the chest.
HOW DOCTORS MAY HELP:
You might have an extra sound during auscultation of your heart called ‘murmur’ regardless of presence of the above listed signs and symptoms. Murmurs are heard when you have problems with the heart valves. There might be some tests carried out to better identify the problem such as EKG, echocardiogram, chest X-Ray and coronary angiography. You might have prescribed medications for heart valve problems before however now your doctors have recommended heart valve surgery. Heart valves may be repaired or replaced during this procedure.
LIFE AFTER THE SURGERY:
Your heart may regain strength and energy after valve surgery. You will feel better and will be able to perform activities you were able to perform before. A number of patients will have to take ‘blood thinners’ –medications to prevent blood clots following heart valve surgery.
WHAT IS VALVE SURGERY?:
Your heart is responsible to pump oxygenated blood to your body. The four valves in your heart ensure transport of blood in the right direction through the chambers of the heart. If there is a problem in one of the heart valves, your heart has to work a lot harder in order to be able to perform its duty.
HOW NORMAL HEART VALVES WORK:
The heart is divided into four chambers. The heart valves open and close sequentially during each heart beat so that blood will be pumped to your body in the most efficient way.
TYPES OF VALVE PROBLEMS:
You will have problems with your heart valves if one of the valves does not open or close adequately. If the valve does not open, blood has to flow through a small opening with difficulty. If the valve does not close, some of the pumped blood will leak back into the heart. Your heart will have to work harder either way to able to pump same amount of oxygenated blood to your body. This will eventually lead to enlargement of the heart and cause heart failure.
Narrowing of the Valve (Valve Stenosis):
If the heart valves do not open properly, this will result in valve stenosis. Calcification in the heart valve tissue and valve thickening due to past history of rheumatic fever are the most common causes of narrowing in the heart valve orifice. This problem usually progresses over time.
Leaking Valve (Valve Regurgitation):
This problem arises when valve tissues are abnormally elongated or shortened or if there is a weakening of the tissues supporting the valves. A incompetent heart valve will cause blood to leak back, will result in decreased efficiency of heart and will eventually lead to heart failure.
WHY HEART VALVE PROBLEMS DEVELOP:
Problems in your heart valves develop due to a variety of disease processes. Some patients have a congenitally abnormal valve. Valves can also be damaged by rheumatic fever or other infectious diseases. Coronary artery disease can lead to valve failure. Aging may also cause calcification and degeneration in the valves.
HEART VALVE SURGERY:
Diseased valves can be either repaired or replaced during surgery. Repair of a valve will improve an existing valve and hence make it function better. Valve replacement is the removal of the diseased valve and replacement with a new artificial valve. Sometimes your surgeon may decide to repair or replace a diseased valve at the time of surgery. You will be notified before the surgery in such a case.
HEART VALVE REPAIR:
If your surgeon elects to repair the diseased valve, parts of the valve maybe restructured or parts of the valve may be removed in order to improve the valve function. If you have leaky valve, removal of some of the redundant valve tissue may decrease the valve orifice and make the valve competent. If you have a stenotic valve, release of valve components may improve valve opening.
ARTIFICIAL VALVES:
The valve may be replaced with an artificial valve if repair is not possible. There are two kinds of artificial heart valves:
Mechanical Valves:
These valves are made out of non-biological material. Implantation of a mechanical valve mandates life long Coumadin (blood-thinner) medication.
Biological Valves:
These valves are made out of animal or sometimes human tissues. There is no need to take blood thinners after implantation of biological valves. However, biological valves may not last as long as mechanical valves in younger patients.
Your surgeon will decide which valve type is best for you depending on your age, profession, your heart rhythm, feasibility of life long blood-thinner medication administration and the number of diseased heart valves that needs intervention.
BEFORE THE SURGERY:
A member of Dr. Gurbuz’s team will meet you and your family after admission to the hospital and will explain hospital course in detail. It is normal to be a bit anxious before the procedure.
PREPARATION FOR SURGERY:
It is important to notify your surgeon if you have any dental work that needs to be completed prior to surgery. The reason for this is that bacteria can access the blood stream at the time of dental procedures and can infect your new heart valve. Please let your doctor know all of your medications including aspirin. Stop smoking immediately if you are a smoker. This will help with your blood circulation and prevent possible lung complications following surgery. Do not eat or drink anything after midnight on the day of surgery. The anesthesiologist will also ask you detailed questions regarding your health history and current medications. It may be necessary to shave certain parts of your body to prevent infection during the procedure.
RISKS OF SURGERY:
There are certain risks for heart valve surgery: Infection, bleeding, lung problems and respiratory failure, disturbances in the heart rhythm that might require pacemaker placement, problems with blood coagulation due to blood thinner medication therapy, heart attack and stroke.
DURING THE SURGERY:
You can be sure that your surgery is performed by an experienced surgical team. Every member of the surgical team takes an essential part during your surgery. Your surgeon will perform the procedure with the help of the assistants. Your anesthesiologist will ensure your safety and painless operation. The perfusionist will operate the heart lung machine. Your vital signs will be monitored constantly during surgery.
SURGERY:
Your surgeon will get to your heart through the breast bone. This bone will be put back together with stainless steel wires at the end of the procedure.
BLOOD CIRCULATION DURING THE SURGERY:
Your heart will be stopped temporarily during the valve surgery. The blood circulation will be maintained by the artificial heart lung machine while your heart is stopped. The heart and the lungs will take over circulation and breathing at the end of the procedure.
HEART VALVE REPLACEMENT:
Your surgeon will have to expose the heart valve which requires opening one of the chambers of the heart. The diseased valve will either be replaced or repaired. The heart will then be closed and restarted. The procedure will take around 4 hours including the preparations.
Patient will be taken to the intensive care unit after the surgery. The family can see the patient a few hours after the procedure. The intensive care unit stay is 1-2 days. Your vital signs will be constantly monitored during this period.
AT THE INTENSIVE CARE UNIT:
It is normal to feel thirsty and cold after the surgery. Your nurses will administer analgesics for pain. You should not be surprised to see various tubes and monitors attached to your body. These will be monitoring your heart rate, blood pressure and oxygenation. The tubes will help to monitor any abnormal bleeding and a catheter will drain your bladder and ensure adequate kidney function. A breathing machine will help you breath until you are fully awake. These tubes and catheters will be removed when they are no longer needed.
You will be taken to the monitored floor after the intensive care unit. Early ambulation after cardiac surgery is required to reestablish muscle strength and regulating the blood pressure. Your nurses and the physical therapist will assist you in sitting up and walking exercises.
ADJUSTMENT OF MEDICATIONS:
You will be given several new medications during your hospital stay. The medication dosages will be adjusted according to the blood test result before hospital discharge. Your doctor and your nurses will give you detailed information regarding these medications.
HEALING PERIOD:
Healing period is different for every patient however you can expect to regain your strength approximately 6-8 weeks after the surgery. It is important to stay in touch with your doctor and take your medications as prescribed during this period.
DOCTOR CONTROLS:
Your follow-up visits are important part of your healing process. Your doctor might want a chest X-Ray, blood tests or an EKG. A control echocardiography may be required to check your new heart valve.
IMPORTANT NOTES:
It is important to notify your doctor if you have one of the following: Excessive weight gain in a short time period, chills and fever over 101.4 F, shortness of breath while lying down, chest pain, swelling or redness or drainage from the wound, unexplained bleeding or excessive bruising.
WOUND CARE:
It is normal to have some pain, bruising and itching around the incision for several weeks after the surgery. You may shower however it is not advised to swim or take a bath. Wash your incision with soap and water in the shower. Do not put any ointments or cream on the incision since it may increase the risk of infection.
ABOUT NEW MEDICATIONS:
Your new medications will prevent formation of blood clots on your new valve. You might be prescribed antibiotics during certain invasive procedures to prevent infection on the valve. It is utmost important for you to take these medications as prescribed.
COUMADIN:
If you had a valve replacement, you may have taken a medication called Coumadin (Warfarin). You might have to continue this medication for several weeks or life long depending on the type of artificial heart valve your surgeons implanted. Everybody taking Coumadin should monitor the effect of this medicine with a blood test called INR (International Normalized Ratio) in regular intervals. You should also carry a bracelet or a medication card indicating that you are taking Coumadin.
RISKS OF COUMADIN:
There are certain risks to long term Coumadin therapy:
Excessive bleeding
Congenital abnormalities in pregnant patients
Alcohol and other medications may increase or decrease the Coumadin effect. Please refer to your doctor’s office for a detailed list of medications and nutrients and Coumadin effect.
ANTIBIOTICS:
Patients who have had heart valve surgery will have to receive antibiotic therapy prior to any oral or dental procedure. The antibiotics will prevent the bacterial infection of your new valve. Notify all your physicians and especially your dentist that you have an artificial heart valve.
AFTER DISCHARGE:
You will notice that you will be getting stronger everyday after discharge. You may have good days and some better days. This is a part of normal healing process. The best way to speed up recovery is walking.
