Cardiovascular Institute and Center for Cardiovascular Health

Heart Valve Surgery

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our heart has four chambers. The upper two are called the "atria"; the lower two are called the "ventricles". The two chambers on the right pump blood to your lungs. The two chambers on the left pump blood to all the other parts of your body.

The heart also has four valves which consist of strong flaps of tissue that open and close. They are called, the "tricuspid", the "pulmonary", the "mitral", and the "aortic" valves. These valves play an important role in pumping blood throughout your body. The valves are one-way doors which allow blood to flow as your heart contracts and relaxes.

The heart pumps oxygen and nutrient rich blood through the aortic valve into blood vessels. which carry the blood throughout your body, but not to your lungs. After circulating and delivering oxygen to all the cells and tissues, the blood returns to the right atrium of your heart. Then it passes through the tricuspid valve into the right ventricle. The heart pumps the blood from the right ventricle through the pulmonary valve into blood vessels which lead to your lungs. The lungs add oxygen to the blood and remove carbon dioxide. Then the blood returns to your heart, moving from the lungs into the left atrium. From there, the blood passes through the mitral valve into the left ventricle. Finally, the blood is pumped through the aortic valve, and goes through the circuit again.

What can go wrong with my valves?
Some people are born with abnormal heart valves and have reparative surgery shortly after birth. Others have a minor birth defect which becomes apparent only after the condition has worsened over time

Certain diseases, such as rheumatic fever or bacterial endocarditis can affect the valves and may scar or totally destroy them.

The aging process can harden or weaken the valves. Hardening is known as "calcification", and is the most frequent reason for surgical intervention. When a valve thickens and hardens, it can fail to open properly and the blood is blocked. This is called, "stenosis".

Sometimes a heart valve becomes weak, stretched, or thinned. The valve's supportive structures may be loose or torn. When this happens, the valve may not close properly. Blood can leak through the opening and go back in the wrong direction through the valve. This condition is variously known as "incompetence," "insufficiency, or "regurgitation."

What are the symptoms of valve disease?
You may have valve disease without experiencing any symptoms. You may also have one or more of the following symptoms:

Difficulty in breathing when lying down; wheezing, coughing, or shortness of breath upon exertion; coughing or shortness of breath that awakens you; weakness or tiredness; dizzy spells, fainting spells, swollen ankles or feet; a fast pounding heartbeat, or chest pain or pressure.

All the above symptoms also are associated with other diseases. Consult your physician to obtain the correct diagnosis and proper treatment.

How are valve problems diagnosed?
Even if you have no symptoms, your doctor may be alerted to the existence of a valve problem through regular examination. When he listens to your heart, he may hear a sound called a "murmur". A murmur is caused by an abnormal flow of blood. Your doctor may order additional diagnostic tests which may include: an electrocardiogram, an echocardiogram; a chest x-ray or cardiac catheterization.

What are the treatment options for valve problems?
Sometimes your doctor will prescribe medication to treat your valve problem.

Another option is surgical repair of the stenosis or insufficiency. Often,, the valve is so badly damaged, that it must be replaced.

How are valves repaired?
Stenotic valves are cut so that their parts may be separated to open wider. An insufficient valve can be sewn and/or parts of it can be shortened to prevent leakage.

What are the replacement valves made of?
There are two types of valves used in replacement surgery. They are mechanical and biological (tissue) valves.

Mechanical valves are created from manmade materials such as metal or plastic. They are attached to the heart with a fabric ring made of Dacron Ò or Teflon Ò. There are several different types of mechanical valves. Your doctor can explain them to you in detail.

Biological valves are actual valves taken from a pig, cow or human. Pig or cow valves are mounted in a cloth-covered metal or plastic frame prior to transplant surgery. Human valves are preserved by freezing methods and are transplanted directed into the heart.

What are the differences between the valves?
Mechanical valves last a long time. They come in all sizes. They require lifetime anticoagulation therapy (such as Coumadin), to prevent blood clots from forming on or around them. Anticoagulants are called, "blood thinners", but they really don't thin your blood. These medications should be taken at the same time every day. Anticoagulation medicine may cause problems for women of child bearing age and athletes who engage in high-risk-of-injury sports.. The effect of the anticoagulation medicine must be checked regularly by a blood test.

The biological valve is similar to your own valve. Usually, long term anticoagulation therapy is not required. These valves are not as durable as mechanical ones.

Your doctor and you will consider many factors to determine the best valve for you.

What are the risks of valve surgery?
The risks of valve surgery include: breathing problems, bleeding, rhythm problems, infection, difficulties due to anticoagulant therapy, heart attack, stoke, or death. These complications are all rare. The last three are very rare.

How should I prepare for valve surgery?
Take care of any impending dental work well in advance of the surgery. This can prevent infection around the new valve.

Discuss your medications with your doctor. Stop smoking to improve your blood flow and breathing. Don't eat or drink anything after midnight on the night before surgery.

What happens prior to the surgery?
You will be admitted to the hospital. You will meet with the health care team who will explain the procedure and their roles in it. Your doctor will explain the risks of the procedure and ask you to sign a consent form

Do not hesitate to ask any questions and voice your concerns.

Sometimes a blood transfusion is needed during the surgery. You can prepare for several weeks in advance by banking your own blood. You will have to do this over two or three visits and should leave sufficient time for recovery, between banking blood and surgery. Some hospitals allow your family members to donate blood.

Don't be concerned if you are unable to bank blood. If you do need a transfusion, the blood will be tested first for diseases, including HIV.

What happens during the surgery
Your chest hair will be shaved to allow for cleansing and to prevent discomfort and infection.

You will be put to sleep and will be monitored by an anesthesiologist.

The surgeon will make an incision down the middle of your chest and will spread apart your breastbone. Your blood will be passed through a heart-lung machine which will keep it circulating throughout your body. Then the surgeon will make an incision in your heart or aorta. She will cut and remove part or all of the damaged valve and its supportive structures. The replacement valve is positioned in the valve opening and sewn into place. The incision will be closed, and you will be taken off the heart-lung machine.

How long does the operation take?
Heart valve operations usually take 3 to 5 hours.

What happens after the operation?
You will awaken in the intensive care unit feeling groggy, thirsty, cold, or in pain. The nurse. can give you a pain killer.

Don't be surprised to find yourself surrounded by tubes and wires. One of these is a breathing tube in your mouth.. The nurse will test your breathing.. As soon as you are breathing on your own, the tube will be removed. You will not be able to talk while the tube is in your mouth, but the nurse will teach you how to communicate for that brief period of time.

Other tubes include a chest tube to collect blood and fluid and a bladder catheter to drain urine. A heart monitor will record your heart rate and intravenous lines will give you fluid, blood and medications.

Your family will be able to visit you briefly, soon after your operation. You may still be asleep.

During your stay at the hospital a nurse or therapist will assist you with deep breathing and coughing exercises to help prevent lung problems. You will continue to have EKGs, chest x-rays and blood tests throughout your stay.

Within a day or two you will be able to sit in a chair. Usually, you will be walking a day later. Moving about will help the healing process. Walking also prevents the formation of blood clots and reduces ankle swelling.

You will probably shower or bathe within a few days of the operation. You will slowly gain your strength and will feel a little better every day. Your stay in the hospital will last about a week.

What should I do at home?
When at home, you should follow your doctors' instructions concerning medications. You should inform your other doctors and dentists about your surgery. You must take antibiotics before any new dental work is performed, including routine cleaning.

Your doctor will tell you how to care for your incision. You will have to weigh yourself daily. Call your doctor if you gain more than three pounds in one day or five pounds in one week.

Will I have any symptoms after the surgery?
You should call your doctor if you have any of the following symptoms:

  1. Chest pain or tight pressure;
  2. Sudden, severe shortness of breath;
  3. Temporary blindness in one eye or a grey curtain coming over an eye;
  4. Weakness or clumsiness;
  5. Numbness of the face, arm, or leg on one side of your body;
  6. slurred speech;
  7. Retention of fluid or swollen ankles;
  8. Fatigue, especially along with a fever;
  9. Unusual bleeding; or
  10. Loss of consciousness

Call your doctor even if the symptom is temporary. Don't worry about bothering him. Prompt medical attention can save your life. Carry your doctor's phone number with you.

Obtain the phone number of a hospital near you that can perform open heart surgery in an emergency. Discuss a plan of emergency action with family, neighbors and co-workers.

Consult with your doctor before taking any over-the-counter medications, including aspirin.

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