Treatments

Heart valve disease can develop before birth (congenital), be acquired during your lifetime, or be the result of an infection. Acquired heart valve disease is the most common. Sometimes the cause is unknown, but it involves changes in the structure of your heart valves as a result of mineral deposits on the valve or surrounding tissue. Infective heart valve disease causes changes to your valves because of diseases, such as rheumatic fever or infections.

Symptoms

There are a number of symptoms that may indicate heart valve disease, including:

• Shortness of breath or difficulty catching your breath, especially after you have been active or when you lie down flat in bed.
• Often feeling dizzy or too weak to perform your normal activities.
• Pressure or weight in your chest, especially when you are active or when you go out into cold air.
• Heart palpitations or a feeling that your heart is beating irregularly, skipping beats, or flip-flopping in your chest.
• Swelling in your ankles, feet, or belly. Sudden weight gain with possibly as much as 2 to 3 pounds in 1 day.

Symptoms can range from mild to none at all and do not always indicate the seriousness of heart valve disease.

Diagnosis

Your doctor can detect a heart valve problem and find out the nature of your valve damage by talking with you about your symptoms and performing a number of tests. These tests may include:

• Listening to your heart to hear the valves opening and closing and the rush of blood through them
• Conducting an echocardiogram, which uses sound waves to produce detailed images of your heart valves moving as your heart beats
• Ordering a magnetic resonance imaging (MRI) scan, which uses a magnetic field and radio waves to get detailed images of the inside of your heart
• Taking an x-ray image of your chest to check your heart, its major vessels, and your lungs for abnormalities
• Using an ECG to measure the electrical impulses given off by your heart. An ECG gives your doctor important information about your heart’s rhythm and its size

Heart valve disease may be treated with medication, minimally invasive procedures, or open-heart surgery. If your doctor determines that heart valve repair or replacement is the best treatment for you, there are a variety of Medtronic products designed to address heart valve disease.

Heart Valve Repair

Heart valve repair is a surgical or minimally invasive procedure that corrects a heart valve that is not functioning properly. Heart valve repair usually involves the heart valve leaflets that open and close to pump blood through the heart. In some cases, your doctor may find that repairing your heart valve is the best way to treat your heart valve disease.

Heart Valve Replacement

When repair is not an option, replacing your damaged heart valve may be the most effective treatment for your condition. Heart valve replacement is a surgical procedure that replaces a damaged heart.

One treatment option for heart valve disease may be to implant a small annuloplasty ring or band from Medtronic to reshape the valve. Or, your doctor may decide to replace the valve entirely with an artificial one. Either option gives you confidence to once again find pleasure in your favorite pursuits.

Heart valve surgery

Heart valve surgery is used to repair or replace diseased heart valves. Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must also flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four valves in your heart:

• Aortic valve
• Mitral valve
• Tricuspid valve
• Pulmonic valve

The aortic valve is the most common valve to be replaced because it cannot be repaired. The mitral valve is the most common valve to be repaired. Only rarely is the tricuspid valve or the pulmonic valve repaired or replaced.

Description

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.

In open heart surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. You are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart, providing oxygen and removing carbon dioxide.

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques are used:

• Percutaneous surgery (through the skin)
• Robot-assisted surgery

If your surgeon can repair your mitral valve, you may have:

• Ring annuloplasty. The surgeon repairs the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.
• Valve repair. The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve. Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one in place. The main types of new valves are:

• Mechanical — made of man-made materials, such as metal (stainless steel or titanium) or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological — made of human or animal tissue. These valves last 12 – 15 years, but you may not need to take blood thinners for life.

In some cases, surgeons can use your own pulmonic valve to replace the damaged aortic valve. The pulmonic valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure may be useful for people who do not want to take blood thinners for the rest of their life. However, the new aortic valve does not last very long and may need to be replaced again by either a mechanical or a biologic valve.

You may need surgery if your valve does not work properly.

• A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
• A valve that does not open fully will limit forward blood flow. This is called stenosis.

Some of the heart valve problems treated with surgery are:

• Aortic insufficiency
• Aortic stenosis
• Congenital heart valve disease
• Mitral regurgitation – acute
• Mitral regurgitation – chronic
• Mitral stenosis
• Mitral valve prolapse
• Pulmonary valve stenosis
• Tricuspid regurgitation
• Tricuspid valve stenosis

Before the Procedure

Your preparation for the procedure will depend on the type of valve surgery you are having:

• Aortic valve surgery – minimally invasive
• Aortic valve surgery – open
• Mitral valve surgery – minimally invasive
• Mitral valve surgery – open

After the Procedure

Your recovery after the procedure will depend on the type of valve surgery you are having:

• Aortic valve surgery – minimally invasive
• Aortic valve surgery – open
• Mitral valve surgery – minimally invasive
• Mitral valve surgery – open

The average hospital stay is 5 – 7 days. Complete recovery will take a few weeks to several months, depending on your health before surgery.

Outlook (Prognosis)

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

Mechanical heart valves do not often fail. Artificial valves last an average of 8 – 20 years, depending on the type of valve.

Talk to your doctor before having any type of medical procedure. The clicking of mechanical heart valves may be heard in the chest. This is normal.

After Surgery – Heart Valve Replacement

It is not unusual for you, your family, or your caregivers to have some concerns following heart valve replacement surgery. This may be especially true during the first 3 months with your new heart valve.

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they were not removed before leaving the hospital.

You should not drive until your doctor tells you to. Other activity restrictions may apply.

Notify your physician to report any of the following:

• Fever and/or chills
• Redness, swelling, or bleeding or other drainage from the incision site
• Increase in pain around the incision site

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Recovery

In the intensive care unit (ICU), the staff will keep a close watch on your heart rate, temperature, blood pressure, and other vital body signs. You may feel a little uncomfortable because of all the monitoring equipment attached to you. The nurses will try to keep you as comfortable as possible. Friends and family are usually welcome to visit you.

When intensive care monitoring is no longer needed, you’ll be moved to a regular hospital room. Typically, you may be in the hospital for 3 to 7 days, depending on how quickly you recover. Many patients are amazed at how much better they feel and how soon they can resume normal activities.

Checkups and Monitoring

After you’re released from the hospital, you will have to see your doctor for follow-up visits. During these visits, your doctor may order lab tests, such as an echocardiogram, an x-ray or an electrocardiogram, to make sure you are healing properly.

If you’re taking anti-coagulants, you need to have regular blood tests to monitor your dosage. You’ll usually go periodically to a hospital, doctor’s office, or laboratory to have these tests done.