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| SURGERIES OF THE HEART |
Heart Valve Replacement
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Heart Valve Replacement is a surgical procedure to replace a damaged heart valve. The heart's four valves, which open and tightly close, allow blood to flow from one chamber to another and also allow blood to leave the heart through the large blood vessels.
Usually only one valve is replaced at a time, but at times one or more valves have to be replaced. Heart valves are either mechanical (metal and plastic), such as a St. Jude valve, or made of tissue. Tissue valves most commonly come from a pig (porcine valve) or a cow (bovine valve), but they may also be supplied by a human donor or even manufactured from one's own tissues.
REASONS FOR THE PROCEDURE
* Congenital valvular defects
* Narrowed, stiff valves that obstruct the free flow of blood
* Loose, leaky valves that allow blood to flow the wrong way through the heart
* Infected heart valves
* Replace infected or diseased tissue or mechanical valves
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
* Pre-existing heart or lung condition
* Advanced age
* Recent or chronic illness
* Stroke
* Kidney or liver failure
* Recent infection
* Poor dental care
BEFORE THE PROCEDURE
The patient may be asked by the doctor to likely undergo the following: * Physical exam
* Echocardiogram – a test that uses sound waves to visualize functioning of the heart, including the valves
* X-ray – a test that uses radiation to take a picture of structures inside the body
* Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle
* Cardiac catheterization (possibly) – the insertion of a tube-like instrument into the heart through an artery (usually in the leg) to detect problems with the heart and its blood supply. It can also accurately define the valve problem.
* Have blood ready for surgery
And in the days before the surgery,one should -
* Not take aspirin or other anti-inflammatory drugs for two weeks before surgery, unless told otherwise by the doctor.
* Stop all blood thinners a week before surgery.
* See a dentist and get the teeth checked out.
* Arrange for a ride to and from the hospital.
* Arrange for help at home after returning from the hospital.
* The night before, eat a light meal and do not eat or drink anything after midnight, unless told otherwise by the doctor.
DURING THE PROCEDURE
The patient is given the following during the surgery -
* IV fluids
* Oxygen
* General Anesthesia
* Diversion of circulation through a heart-lung machine
PROCEDURE
The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart to a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation.
The surgeon stops the heart, makes an incision, and removes the damaged valve. The new valve is stitched into place and checked to make sure it opens and closes properly. The incision in the heart is closed and the heart restarted. Once the heart is working fine, the patient will be removed from the heart-lung machine and the chest will be closed with wires. The skin will be closed with absorbable sutures.
AFTER THE PROCEDURE
The patient will be closely monitored in the intensive care unit (ICU)with the help of the following devices:
* Heart monitor
* Breathing tube until the patient can breathe independently, then an oxygen mask
* Chest tubes to drain accumulated fluids from the chest
* A line into an artery in the arm to measure pressure
* A tube through the nose and into the stomach (a nasogastric tube) to keep the stomach drained of accumulated fluids and gas
* Bladder catheter
TIME TAKEN FOR THE PROCEDURE
3-5 hours, depending on the number of valves to be replaced.
POSSIBLE COMPLICATIONS
* Infection
* Blood clots around the valve, which can cause a stroke, kidney damage, or damage to the extremities
* New valve does not work properly
* Sac around the heart may become inflamed and painful
* Excessive bleeding
* Pneumonia
* Phlebitis (blood clots of a vein)
* Anesthesia-related problems
* Infection of breast bone
* Death
POSTOPERATIVE CARE
* Breathe deeply and cough 10-20 times every hour.
* The day after surgery, expect to walk with help.
* The patient may be started on anticoagulant medications (blood thinners) to prevent blood clots from forming around the valve. If the patient has a tissue valve, a blood thinner is not required after surgery, but if the patient has a mechanical valve, the patient will be placed on a blood thinner for the rest of his/her life.
* Only take medications approved by the doctor.
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| Last Modified :
Monday, May 11, 2009 |
Compiled and edited by the Editorial team and
approved by Expert panel of h4heart.com
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