Why is this procedure done?
The heart is a muscle that pumps blood through the body. The heart has four chambers, which are separated by valves. The blood is pumped through the heart and body in one direction. Blood with oxygen moves away from the heart. Blood without oxygen moves toward the heart. The valves make sure that blood flows in the right direction. ‚
The mitral valve helps control the flow of blood into the heart. Sometimes, a valve may be abnormal since birth. A valve may also become damaged with age. Blood may flow backward through a damaged valve. This is mitral regurgitation. Other times, the valve is narrow and blood has problems moving through it at all. This is mitral stenosis. There will not be enough blood pumped through the valves when this happens, or the blood can back up and cause heart, lung, or other health problems. ‚
If your valve is damaged, you may have chest pain or dizziness. Other times, you may have problems breathing. You may notice these signs more when you are doing heavy exercise. ‚
You may need to have surgery to put a new valve in place of your damaged one. This is a mitral valve replacement. There are different ways to do this surgery and different kinds of valves to choose from. Your doctor will decide the best plan of care for you. The surgery may be done with: ‚
- Bigger cuts through the chest to get to the valve. This is open heart surgery.
- Smaller cuts between the ribs to get to the valve. This is minimally-invasive heart surgery.
Your doctor may replace your damaged heart valve with one made of: ‚
- Plastic, carbon, or metal. These are strong and built to last a long time. Blood tends to stick to the material of these valves. You need to take a blood thinning drug for life after the procedure. This is a mechanical valve.
- Animal or human tissue. They are not as strong as mechanical valves. You may need a replacement after 10 years or so. Blood clotting is not common and blood thinning drugs are not needed. This is a biological valve.
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What will the results be?
Your blood flow should improve. This may help your signs go away. ‚
What happens before the procedure?
- You and your doctor will talk about what kind of valve is best for your condition.
- Your doctor will take your history. Talk to the doctor about:
- All the drugs you are taking. Be sure to include all prescription and over-the-counter (OTC) drugs, and herbal supplements. Tell the doctor about any drug allergy. Bring a list of drugs you take with you.
- Any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin ‚ ®, ibuprofen, Aleve ‚ ® (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding. You may need to stop these drugs as well. Talk to your doctor about them.
- When you need to stop eating or drinking before your procedure.
- If you are not feeling well. An infection from a cold or sore throat may raise the risk of infection.
- If you need to go to the hospital the day before your procedure.
- You may be asked to take a bath with a special soap. This will help to lower the amount of germs on your skin.
- Your doctor will do an exam and may order:
- Tests on your heart
- MRI scan
- Lab tests
- Chest x-ray
- Cardiac catheterization
What happens during the procedure?
- Once you are in the operating room, the staff will put an I.V. in your arm to give you fluids and drugs. You will be given a drug to make you sleepy. It will also help you stay pain free during the surgery. Small stickers will be placed on your chest so the doctor can see your heart rate and rhythm. Staff will watch you closely during the procedure.
- When you are asleep, the doctors put a tube in your mouth to help you breathe. They also put another small tube in your nose. This one goes down to your stomach to drain out any food or fluid that might come out during surgery. The doctor may place other I.V. lines in your arms or neck to give you drugs and fluids during surgery. You will have a tube in your bladder to drain urine.
- Open heart surgery: Your doctor will make a cut on the skin and bone of the chest. The chest will be opened so the doctor can see where to operate. A heart and lung bypass machine will be connected. This machine will pump blood and give it oxygen while your heart is being worked on during surgery. The doctor will replace the damaged valve and you will be taken off of the heart and lung machine.
- Minimally-invasive heart surgery: You may not need a heart-lung machine if you are having minimally-invasive surgery. With one type of minimally-invasive surgery, your doctor may make a few small cuts between the ribs. Then, using special tools, the doctor replaces the damaged valve. Another minimally-invasive way the doctor may choose uses a long thin flexible tube to place the new valve. With this, a small cut is made in the groin or neck and the tube is advanced to the heart. The new valve is put in place of the old one and the tube is removed. With another method, a specially programmed computer helps with the surgery. This is called a robotically-assisted heart surgery.
- Your cuts will be stitched closed and covered with a bandage.
- This procedure takes about 2 to 6 hours.
What happens after the procedure?
- You will go to the Intensive Care Unit (ICU) to recover after surgery.
- You may still have machines and tubes connected to you. These may include a heart monitor, the pacemaker wires, and tube to drain your urine. You may have a tube in your chest to drain blood and air from your cut site. You may still have a tube in your mouth to help you breathe.
- Your family will be able to visit you for short periods while you are in the ICU.
- The staff will take out your breathing tube when you are awake and strong enough to breathe. The staff will give you drugs in your I.V. to keep you sleepy while the breathing tube is in place. You may have a sore throat afterwards. The other tubes and wires will all be taken out in a few days. You will wear tight socks on your legs to help increase blood flow.
- Within a day or two, you will get out of bed to a chair. The staff will help you begin to walk around. Doing coughing and deep breathing exercises will help keep your lungs clear. Put a pillow against your chest when you cough and take deep breaths. You will get drugs through your I.V. to help with your pain.
- You will need to stay in the hospital for 5 to 7 days after open heart surgery. If your doctor used a minimally-invasive approach, you may only have to stay for 1 or 2 days.
- Your doctor will move you to a regular hospital room when you are stable.
What lifestyle changes are needed?
- Keep a normal weight. If you are too heavy, lose weight.
- Keep blood pressure, cholesterol, and high blood sugar under control.
- Eat a heart healthy diet. Eat foods low in fats, sugars, and salt. Eat high-fiber foods which include fruits and vegetables. Your doctor can help you make a plan about the changes in your diet.
- Work out often. Ask your doctor what kinds of exercises are safe and best for you.
- Avoid smoking and beer, wine, and mixed drinks (alcohol). Your doctor can help you learn about how to stop smoking or drinking gradually.
What drugs may be needed?
The doctor may order drugs to: ‚
- Help with pain
- Prevent infection
- Thin your blood
What problems could happen?
- Abnormal heartbeat
- Infection
- Kidney failure
- Heart attack
- Pneumonia
- Blood clots
- Stroke
- Bleeding
When do I need to call the doctor?
Activate the emergency medical system right away if you have signs of a heart attack or stroke. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery. Call for emergency help right away if you have: ‚
- Signs of heart attack:
- Chest pain
- Trouble breathing
- Fast heartbeat
- Feeling dizzy
- Signs of stroke:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
Call your doctor if you have: ‚
- Signs of infection. These include a fever of 100.4 ‚ °F (38 ‚ °C) or higher, chills, very bad sore throat, cough, more sputum or change in color of sputum, pain with passing urine, wound that will not heal, or pain.
- Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
Helpful tips
- Let your dentist or doctor know you had heart valve surgery. You may need to take drugs before having dental procedures or other surgery. This may help keep you from getting infections.
- Some kinds of heart valves will make a very soft clicking noise each time your heart beats.
- The staff at the hospital will give you a card that tells about the kind of valve that you have. Carry the card with you in your wallet.
Where can I learn more?
National Heart, Lung, and Blood Institute ‚
http://www.nhlbi.nih.gov/health/health-topics/topics/hvd/treatment.html ‚
The Society of Thoracic Surgeons ‚
http://www.nhs.uk/ipgmedia/national/british%20heart%20foundation/assets/heartvalvedisease.pdf ‚
Consumer Information Use and Disclaimer
This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚
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