TAKE THE PRESSURE OFF YOUR HEART
Asian Heart Institute
1 . When do you need a heart valve surgery?
Just as a valve controls the flow of water; we have four valves to control the flow of blood in & out of the heart - Aortic, Mitral, Pulmonary & Tricuspid Valve. Heart valve disease occurs when a valve doesn't work right. A valve may not open all the way. Or, a valve may have problems closing. If this happens, blood doesn't move through the heart's chambers the way it should. For some time and to certain extent this is tolerated by the body & heart but beyond that it needs to be corrected. In such a case, the valve is either repaired or replaced.
2. What are the problems you could face with your heart valves?
If a valve doesn't open all the way (a condition called Stenosis), less blood moves through to the next chamber. If a valve doesn't close tightly (a condition called Regurgitation), blood may leak backward.
3. What are the symptoms of a valve disease?
In case of stenosis, since less blood moves through, it could cause breathlessness, swelling in legs or bloating of whole body. In case of regurgitation, the heart has to work harder at pumping the same amount of blood. Sooner or later its capacity gets exhausted & this may cause blood to back up in the lungs or body because it's not moving through the heart as it should. At a later stage things get further complicated & patient may develop rhythm disturbances, heart failure, stroke, etc. A damaged valve (stenosis or regulation) is at risk of valve infection called endocarditis.
4. What happens during a Heart Valve Surgery?
Valve surgery is of two types- repair & replacement (tissue or metallic). Repair means that the valve is mended to help it work better. During valve repair, a valve ring may be sewn around the opening of the valve to support it. Replacement means your diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can be decided based on certain parameters but final decision can be taken only once surgery has begun. Valve replacement is most often used to treat aortic valves and severely damaged mitral valves.
5. What are the types of valves?
Broadly they can be of two types-mechanical & biological.
• Mechanical (metallic): Made of metal, these generally have a longer durability but require additional precautions. Since blood tends to stick to mechanical valves creating blood clots, patients with these valves need to take blood-thinning medicines (called anticoagulants) for lifetime. Such cases are at a risk of both valve & anticoagulant related complications.
• Biological (tissue): Made from animal or human tissue these function better but wear out over time. They require lesser restrictions on lifestyle. Here the patient is at a risk of only valve related & not anticoagulant related complications.
6. How is the surgery done?
Reaching your heart
To get to your heart, one or more incisions must be made in your chest.
Stopping Your Heart
During valve surgery, the heart is stopped & connected to the heart lung machine, which does the work of adding oxygen to the blood & circulating it to the other part of the body during surgery. Once the valve surgery has been completed, your heart & lungs take over again.
Repairing or Replacing the Valve
To reach the valve, an incision is made on your heart. If the valve can be mended, the needed repairs are done. If the valve must be replaced, part or the entire damaged valve is removed. The proper-sized replacement valve is positioned and sewn firmly into place. The incision made is closed & the heart is then started again, and the patient is weaned off from the heart & lung machine. The surgery takes between 2 to 4 hours or more, depending on the number of valves that need to be repaired or replaced.
Hospital stay is about 8-10 days, including at least 1 to 3 days in the Intensive Care Unit (ICU). Recovery after valve surgery may take a long time. You will have to rest and limit your activities. If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.
Life after Valve Replacement
Patients with mechanical valves say they sometimes hear a quiet clicking sound in their chest. Unnerving as it may seem, this is just the sound of the new valve opening and closing, and it is nothing to be worried about. In fact, it is a sign that the new valve is working the way it should. Such sound is not heard in biological valves.
7. How is valve surgery different from bypass surgery?
In brief, valve surgery requires surgeons to work inside the chambers of the heart & therefore the heart needs to be stopped (unlike a beating heart surgery where the heart is not stopped). Valve replacement means a foreign material (valve) is placed inside the chambers of the heart in the blood stream.
8. What precautions are to be taken after surgery?
• Blood thinners (Anticoagulants) - Since artificial valves are foreign bodies they tend to produce clots causing blockages. For this reason, blood thinners (anticoagulants) needs to be given so that chance of clot formation is minimized. The dosage & duration of blood thiner varries from person to person & also depends on type of valve & requires regular blood test (INR test). Blood thinners are required for three months for Bio valves & for life for Mech valve.
• Prevention of Infection (Bacterial Endocarditis) - The artificial valves are vulnerable to serious type of infection, so patient needs to take precautions to treat all body infections seriously & cover all surgical procedures (minor or major) properly with antibiotics. Do inform your doctor and dentist that you have had a valve surgery. If you are having a surgical or dental procedure, take an antibiotic before the procedure because bacteria can enter the bloodstream during these procedures. If bacteria get into a repaired or artificial valve, it can lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.
• Regular checkup - Valves are subjected to wear & tear. In addition, function of the artificial valve may change over time due to various reasons. Any change in valve function can affect the performance of the heart. Sometimes the patient may not know of the worsening of heart function until its too late. For this reason they should undergo regular checkup preferably once every year. This checkup is usually in the form of 2D Echo & color doppler.
9. Why do anticoagulants require repeated blood tests?
To prevent clot formations blood is required to be maintained at a certain level. If anticoagulation is higher, patients experience spontaneous bleeding from body parts (e.g. gums, in stools, in sputum, or in vomiting). lf less, blood may clot in the valve. You are therefore advised to get a regular blood test called PT/INR (International Normalized Ratio) done as per your Doctors advice. These PT/INR numbers tells you exactly how fast your blood is clotting, information that is absolutely necessary to decide whether your dosage of anticoagulant needs to change.
10. Why is the anticoagulant dosage changed often?
The effect of anticoagulants varies from person to person and also from time to time depending on the state of the body (illness, pregnancy), medications or diet changes. So a regular check of INR level is necessary, after which the dosage is adjusted accordingly.
11. Anticoagulants have to be taken for how long?
For mechanical valves, it is for a lifetime. For biological valves, it is usually discontinued after 3 months, but if the heartbeats are irregular it may be continued for lifetime.
12. Are there any diet restrictions while on an anticoagulant?
A normal balanced diet is always advisable. Avoid too much of green leafy vegetables and certain vegetable oils. These substances contain large amounts of Vitamin K which can lower the effect of your anti coagulant medicine.
Other foods that need to be avoided include:
• Cauliflower, Broccoli, Cabbage
• Fruits like guava, papaya, jackfruit
• Red meats & egg
The following information is important for your Doctor
• Date of surgery
• Present INR & date of testing
• Last INR & date of testing
• Present dose of anticoagulant
• Dose of anticoagulant when INR was last tested
• Range of INR recommended by your Doctor
The Asian Heart Institute (AHI) Advantage
The latest trend in healthcare is to have lesser invasive surgeries, i.e. surgeries which involve minimal cuts & ensure that patient has a faster recovery. Keyhole or Minimally Invasive Surgery (MIS) is a modern innovative surgical technique that reduces the patient's post surgery distress & allows them to return back to their normal life in just a couple of days. In Minimally Invasive Surgery, surgeons operate through tiny incisions with the help of long instruments and HD cameras. Valve surgeries are regularly performed at AHI using the Minimally Invasive Surgery approach. Depending on your conditions, your surgeon will decide whether you can undergo valve surgery through Minimally Invasive Technique.