How Do The Valves Of The Heart Work
To better understand how valvular heart disease affects the heart, a review of basic heart anatomy and valve function follows.
The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. The right atrium pumps blood into the right ventricle, which then pumps the blood into the lungs where wastes such as carbon dioxide are given off and oxygen and other nutrients are taken into the blood.
From the lungs, the blood flows back into the left atrium, is pumped into the left ventricle, and then is pumped through the aorta out to the rest of the body and the coronary arteries. When the atria are contracting, the ventricles are relaxed in order to receive the blood from the atria. Once the blood from the atria has passed into the ventricles, the atria relax while the ventricles pump the blood out to the lungs and to the rest of the body.
In order to keep the blood flowing forward during its journey through the heart, there are valves between each of the hearts pumping chambers:
- Tricuspid valve. Located between the right atrium and the right ventricle.
- Pulmonary valve. Located between the right ventricle and the pulmonary artery.
- Mitral valve. Located between the left atrium and the left ventricle.
- Aortic valve. Located between the left ventricle and the aorta.
If the heart valve becomes damaged or diseased, a person may experience the following symptoms:
What Is Heart Valve Repair Or Replacement Surgery
Heart valve repair or replacement surgery is a treatment option for valvular heart disease. When heart valves become damaged or diseased, they may not function properly. Conditions which may cause heart valve dysfunction are valvular stenosis and valvular insufficiency .
When one valve becomes stenotic , the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection or congenital heart defects . If one or more valves become insufficient , blood leaks backwards, which means that less blood is pumped in the proper direction. Based on the childs symptoms and overall condition of their heart, the doctor may decide that the diseased valve needs to be surgically repaired or replaced.
Traditionally, repair or replacement of heart valves has involved open-heart surgery, which means that the chest is opened in the operating room and the heart stopped for a time so that the surgeon may repair or replace the valve. In order to open the chest, the breastbone, or sternum, is cut in half and spread apart. Once the heart is exposed, large tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine . The bypass machine is necessary to pump blood because the heart is stopped and kept still while the surgeon performs the valve repair or replacement procedure.
Other related procedures that may be used to assess the heart include:
How Is An Aortic Valve Replacement Carried Out
An aortic valve replacement is carried out under general anaesthetic.
This means you’ll be asleep during the operation and won’t feel any pain while it’s carried out.
During the procedure:
- a large cut about 25cm long is made in your chest to access your heart although sometimes a smaller cut may be made
- your heart is stopped and a heart-lung machine is used to take over the job of your heart during the operation
- the damaged or faulty valve is removed and replaced with the new one
- your heart is restarted and the opening in your chest is closed
The operation usually takes a few hours.
You’ll have a discussion with your doctor or surgeon before the procedure to decide whether a synthetic or animal tissue replacement valve is most suitable for you.
When Do You Need Heart Valve Replacement Surgery
A heart valve disease develops when the valve becomes either stiff, narrow , or leaky . These two disease states of the valve disrupt the flow of blood in and out of the heart.
Heart valve diseases can be present by birth or occur as a complication of other health conditions, such as rheumatic heart disease.
Many people who have heart valve disease may never experience any symptoms. Sometimes, the valve disease is diagnosed when a woman is pregnant. Doctors may still recommend heart valve replacement surgery to prevent the worsening of the heart condition.
With a diseased valve, heart valve replacement surgery becomes an emergency if you experience:
Can A Heart Valve Repair Itself
No, a heart valve cant repair itself. Valve disease doesnt go away. It gets worse with time. As the disease gets worse, youll have more symptoms and your overall health will suffer. These changes often happen slowly, but they can also occur very quickly.
Depending on the type and extent of valve disease you have, you may be able to take medication for the short term. Surgery is the only effective long-term solution, and your healthcare provider will help determine when its time to pursue that option.
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Why Might I Need Heart Valve Repair Or Replacement Surgery
Valve repair or replacement surgery is done to correct the problems causedby one or more diseased heart valves.
If your heart valve becomes damaged or diseased, you may have thefollowing symptoms:
The repaired or replaced valve doesn’t work correctly
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.
When Is Heart Valve Surgery Necessary
You may have been born with a valve problem or developed a leak, stiffness or narrowing in your valve.
Youll most likely need treatment for heart valve disease if youre having symptoms like:
Note: While medication can help improve your symptoms and quality of life, surgery is the only effective long-term option. Ask your healthcare provider when you should start considering heart valve surgery.
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Surgical Repair Or Replacement Of The Aortic Valve
Symptomatic patients who have severe aortic stenosis or chronic, severe aortic regurgitation may be candidates for aortic valve heart surgery. Aortic valve disease that requires surgery is usually treated with either repair of the damaged valve, or, if the damage is too severe, replacement of the damaged valve.
There are risks with every surgery, varying with each person and the procedure performed. Our approach is to ensure patients receive the best surgical option available at the lowest risk. Your risk depends on your heart function, age and overall health. Your cardiac surgeon will answer your questions and discuss in detail:
- Type and severity of valve disease
- Coexisting medical conditions or problems
- Surgery options
- Surgical risks
- Your specific plan of care
What Are The Advantages Of Heart Valve Surgery
Heart valve surgery can ease your symptoms, improve your life expectancy and help prevent death.
The potential advantages of heart valve repair vs. valve replacement are:
- Lower risk of infection.
- Less need for lifelong anticoagulant medication.
Valve surgeries, including valve repair and valve replacement, are the most common minimally invasive procedure.
The benefits of minimally invasive surgery include:
- Lower risk of infection.
- Other medical conditions you have.
- How many procedures you have in a single operation.
Your cardiologist and surgeon will talk to you about these risks before your surgery.
If youve had a valve fixed or replaced, you may be at a higher risk of getting infective endocarditis. But this can also happen with a faulty valve that isnt repaired. In certain cases, your healthcare provider may prescribe antibiotics to keep you from getting endocarditis from some types of dental work. You can reduce the risk of endocarditis yourself by taking good care of your teeth.
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What Makes The Mitral Valve Such An Important Component Of A Healthy Heart
A properly functioning mitral valve, situated between the left atrium and left ventricle, opens as the left atrium fills with blood. As the heart expands, blood flows into the hearts main pumping chamber, the left ventricle. The mitral valve then closes as the heart contracts, pushing oxygenated blood into the bodys largest artery, the aorta.
When the mitral valve doesnt work as it should, however, your heart might not pump enough of the oxygen-rich blood to your body. Mitral valve regurgitation, the most common heart-valve disorder, is a leaky valve that allows blood to flow backward into the left atrium. A diseased valve can cause shortness of breath, dizziness, fatigue, chest discomfort, migraines and many other symptoms.
At Hartford HealthCares Heart & Vascular Institute, our goal is to repair — whenever possible — your own living valve. Our results, and multiple studies, confirm that repair is better than replacement, with a reduced risk of complications, no blood thinners , better quality of life and greatly enhanced chances of a longer life.
But not every patient is a candidate for mitral valve repair. Patients too ill for either repair or replacement now have a nonsurgical option: the MitraClip, a mesh clip delivered through a catheter that reinforces the mitral valve and prevents blood backflow.
Surgery: What To Expect Heart Valve Repair
In most cases, heart valve repair is an open heart operation. This means that the surgeon opens your chest and heart to repair the defective heart valve.
How long the operation takes depends on how much heart disease is present. Your surgeon will discuss this with you before the operation.
To help you learn about the procedure, your doctor may suggest a number of actions, including:
- Talking with different members of the surgical team, such as the anaesthetist, surgeon, cardiologist, respiratory therapist, and nurses
- Discussing with family members the details of the operation
- Visiting the intensive care unit where you may be sent for postoperative recovery
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What Can Go Wrong With Your Hearts Valves
Your heart has four valves mitral, aortic, tricuspid and pulmonary. The valves may have problems from birth, or your lifestyle choices and behavior may prompt a need for surgical intervention later in life.
If a heart valve develops a problem, it likely means its either leaking or narrowing . These issues also may develop as you age.
What To Expect With A Valve Replacement
Heart valve replacement involves either open-heart surgery or a minimally invasive procedure. It will depend on the particulars of your case. There are two categories of replacement valves: mechanical and biologic. Mechanical valves have excellent long-term durability, but require lifelong use of blood-thinning medication. Biologic valves dont require blood thinners long-term, but they are not as durable.
In most cases, youll need a new replacement every 10 to 15 years, Dr. Burns says.
Talk to your doctor if you have questions about whether valve repair or replacement is best for you.
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What Happens After Heart Valve Repair Or Replacement Surgery
In the hospitalAfter surgery the child will be taken to the cardiovascular intensive care unit to be closely monitored for several days. The child will be connected to monitors that will constantly display his or her electrocardiogram tracing, blood pressure, other pressure readings, breathing rate and oxygen level. Heart valve repair or replacement surgery generally requires an in-hospital stay of several days or longer.
The child will most likely have a tube in his or her throat so that breathing can be assisted with a ventilator until the child is stable enough to breathe on his or her own. As the child wakes up from the anesthesia more and starts to breathe independently, the breathing machine will be adjusted to allow the child to take over more of the breathing. When the child is awake enough to breathe completely by him or herself and is able to cough, the breathing tube will be removed. The stomach tube will also likely be removed at this time.
After the breathing tube is out, a nurse will assist the child to cough and take deep breaths every two hours. This will be uncomfortable due to soreness, but it is extremely important to do this in order to keep mucus from collecting in the lungs and possibly causing pneumonia.
Children experiencing pain are given pain medication. A nurse will show the child how to hug a pillow tightly against their chest while coughing to help ease the discomfort.
Notify the childs physician to report any of the following:
What Happens Before Heart Valve Repair Or Replacement Surgery
- The doctor will explain the procedure and offer the patient and family the opportunity to ask questions about the surgery and what to expect afterward.
- The childs primary caregiver will be asked to sign a consent form that gives permission for the procedure. It is important to read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, the doctor may perform a complete physical examination to ensure the child is in good health before undergoing the procedure. The child may also undergo blood tests or other diagnostic tests.
- The child will be asked to fast prior to the procedure. Please see the CHOC NPO guidelines for more information.
- Notify the doctor if the child is sensitive to or are allergic to any medications, iodine, latex, tape or anesthetic agents .
- Notify the doctor of all medications and herbal supplements the child is taking.
- Notify the doctor if the child has a history of bleeding disorders or if the child is taking any anticoagulant medications, aspirin or other medications that affect blood clotting. It may be necessary for the child to stop some of these medications prior to the procedure.
- The doctor may request a blood test prior to the procedure to determine how long it takes the childs blood to clot.
- Notify the doctor if the child has a pacemaker.
- Based on the childs medical condition, the doctor may request other specific preparation.
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Repair Procedure: Balloon Valvuloplasty
For many people, valve tightness can be relieved during a procedure called balloon valvuloplasty. It’s done as part of a cardiac catheterization, which is less invasive than general surgery or open heart surgery. Balloon valvuloplasty is more often performed for mitral stenosis and aortic stenosis.
In a balloon valvuloplasty, a small catheter holding an expandable balloon is threaded into the heart and placed into the tightened valve. Next, the balloon is expanded to stretch open the valve and separate the leaflets.
In some cases the valve cannot be successfully treated by balloon valvuloplasty, and a different surgical treatment is needed to open the valve and allow better blood flow.
Treatment results can vary depending on the experience and training of your medical care teams. Hospitals can become very proficient at managing care around certain conditions. When a valve problem is complex, it is very important to choose anexperienced team to do the repair.
Robotic And Minimally Invasive
Our cardiovascular surgeons specialize in robotic-assisted and minimally invasive cardiac surgeries to treat heart valve disease. We offer:
Transcatheter aortic valve replacement
Your physician places an expandable replacement valve into the heart via a catheter inserted through the femoral artery. AHN is a national leader in TAVR procedures.
MitraClipâ¢ mitral valve repair
This innovative device stops valve regurgitation by closing leaky valve leaflets. During minimally invasive heart surgery, your physician implants the device via a catheter inserted through the femoral artery in the groin.
Robotic-assisted mitral valve repair
Your physician repairs a leaky mitral valve using a small camera and instruments inserted through small incisions between the ribs. Learn more about robotic heart surgery for mitral valve repair.
During this minimally invasive procedure for valve stenosis , your physician inserts a catheter tipped with a balloon through a blood vessel in the leg or arm. After inflating and deflating the balloon to stretch the valve opening, your physician removes the catheter and balloon.
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Recovery: What To Expect
Things that can affect your surgery include your age, overall health, and the type of surgery. If you have a minimally invasive surgery you’ll be up and around in a few days.
If you have open heart surgery, your recovery will take longer. Your wound might be sore, swollen, and red. Youâll get tired easily. You might not feel like eating much, and you might find it hard to sleep. Thatâs all to be expected, and it gets better with time.
Your breastbone will take 6-8 weeks to heal, but it might be 3 months or so before you feel back to normal. Your doctor may suggest an exercise program or cardiac rehab to help.
As far as getting back to work, expect it to take 6-8 weeks for a desk job. If your work is more physical, it could take up to 3 months.
What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
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How Is A Heart Valve Replacement Surgery Performed
Heart valve replacement surgery can be performed via any of the two approaches:
- Open-heart surgery: Traditional method of heart surgery in which a large incision is made in the chest the heart is stopped for a time so that the surgeon can repair or replace the valve.
- Minimally invasive heart surgery: These are the newer techniques in which the doctors make smaller incisions over the chest to replace the heart valves.
The diseased valves may be replaced by any of the artificial valves that include:
- Manufactured mechanical valve: Made up of carbon-coated plastic, the mechanical valve is the most durable type of valve that will usually last for your entire lifetime.
- Donors valve: This is an actual human valve taken from a donor and implanted in your heart . It usually lasts for anywhere between 10 to 20 years.
- Tissue valve: Created from animal valves or tissues, this type of heart valve is expected to stay healthy for 10 to 20 years after the surgery.
Your doctor will discuss the benefits and risks of the available surgical options as well as of the types of valves.