Heart Valve Disease
Symptoms of heart dysfunction may be helped by following a diet for weight reduction and reducing salt intake to help control fluid accumulation. Diuretics help eliminate excess fluids that accumulate in the body.
Tests for Heart Valve Disease
Cardiac Assessment - is a way to assess the state, function, and defects of the heart and blood flow.
Cardiac Catheterization - is a non-surgical test to diagnose coronary artery disease within the blood vessels. It is done by inserting a catheter in the blood vessel and injecting a radiographic contrast material, or dye.
Echocardiogram - An echocardiogram is done to check valve function and heart size using ultrasound (sound waves).
EKG - An EKG is ordered to assess the electrical activity of the heart and to diagnose abnormalities, such as a previous heart attack.
Transesophageal Echo (TEE)
Treatment for Heart Valve Disease
Medication - Vasodilator medications, such as nitroglycerin, reduce the workload of the heart, while heart stimulants, such as digoxin, cause the heart to pump more efficiently. In some cases, medications for heart rhythm disturbances and anticoagulants (blood thinners) may be prescribed.
Valve defects increase the workload of the heart muscle and may cause the heart to become abnormally large. The heart my tolerate this excessive workload for a few months or for many years. When it is unable to handle the extra work, valve surgery may be recommended.
Valvuloplasty is a technique aimed at making sure the flaps of the valves (or leaflets)close properly, preventing blood from backing up into the atrium. In the healthy heart, blood flows from the upper chamber (atrium) to the lower chamber (ventricle), and from the ventricle to the body. Commissurotomy is a special form of valvuloplasty. Commissurotomy is used when the leaflets of the valve become stiff and actually fuse together at the base, which is the ring portion (or annulus) of the valve. Sometimes a scalpel is used to cut the fused leaflets (commissures) near the ring, which may help them open and close better. In other cases, a balloon catheter, similar to a catheter used during angioplasty, is inserted into the valve. The balloon is inflated, splitting the commissures and freeing the leaflets to open and shut fully. Unlike other valvuloplasty procedures, this procedure can be done in the cardiac catheterization lab, and the chest does not have to be opened.
Annuloplasty is a technique aimed at repairing the fibrous tissue at the base of the heart valve (the annulus). Sometimes, the annulus becomes enlarged, which enables blood to back up into the atrium. To repair this, sutures are sewn around the ring to make the opening smaller. This creates a purse string effect around the base of the valve and helps the leaflets meet again when the valve closes.
Sometimes when repairing the annulus, it is necessary for the surgeon to implant an annuloplasty ring. A ring is used to correct a problem, provide support for the valve, and reinforce other repair techniques or any combination of these.
Heart valves that are seriously deformed or degenerated cannot be repaired. The old valve is removed and replaced with a new valve mechanism. The new valve is attached by sewing it to a rim of tissue kept from the original valve. There are different types of valve mechanisms in two categories tissue valves and mechanical valves.
A mechanical valve is carefully designed to mimic the native heart valve. It has a ring, like your own natural heart valve, to support the leaflets. Like your own heart valve, the mechanical valve opens and closes with each heartbeat, permitting proper blood flow through the heart. To prevent any blood clots from developing on the valve, which can cause complications, a mechanical valve replacement requires you to take anticoagulation medicine (blood thinners) daily. The dosage of this medication is different for each person, so you will be closely monitored to make sure you are on the correct dosage for you. Regular blood tests will be performed at the physician's office, an anticoagulation clinic, or at home with a specialized testing kit.
The tissue valve is a native valve taken from an animal. Once the tissue is explanted (removed), it is chemically treated and prepared for human use. Some tissue valves have a frame, or stent, that supports the valve, and some valves are stentless (no framework). A very thin polyester mesh cuff is sewn around the outside of the valve for easier implantation. Eliminating the stent makes it possible for the surgeon to implant a larger valve. Larger valves generally provide more surface area for blood flow; this allows more blood to flow through the valve to accommodate the body's needs.
Minimally Invasive Valve Surgery
Minimally invasive valve surgery is a new technique that uses a smaller incision than the ones typically used to repair or treat heart valves. Rather than completely divide and retract the breastbone (sternum) to access the heart, surgeons use a variety of smaller incisions. This method requires complex equipment and highly skilled cardiac surgeons. Genesis cardiac surgeons are among the select few who perform minimally invasive valve surgery. The benefits to minimally invasive valve surgery include:
- Shorter recovery and a quicker return to everyday activities
- Shorter stay in the hospital
- Since the breastbone is not dissected there are fewer complications such as blood loss and infections
- Less pain
Not all patients are candidates for minimally invasive valve surgery. Your surgeon will review your condition and determine if you are a candidate.
How do I prepare for heart valve surgery?
Feeling anxious is very natural when considering any type of operation. You may reduce your anxiety by resting, eating well, limiting exercise, and talking to the health care professionals who are handling your case. Having the procedure explained to you, voicing your concerns, and getting your questions answered will help put you at ease. Being well informed will help you feel more relaxed as the procedure draws near. We have videos that explain the procedure in detail. It is best to get specific information about your own case from your doctor.
What happens after surgery?
After you are discharged from the hospital, you will have regular visits with your surgeon and cardiologist.
Eating nutritious meals is very important to your healing. Limiting how much salt you eat is often advised after heart valve surgery.
If you smoke, you are strongly urged to give up tobacco products.
Follow a gradual exercise program may help you have a quicker recovery. Ask your doctor about cardiac rehabilitation.
You will discuss with your surgeon when you can resume driving, return to work, and with what limitations. Your doctor will also discuss your medications. Even over-the-counter medications will need your doctor's approval.
Your successful recovery depends on how well you follow medical advice, exercise, and follow healthy living suggestions.
What are the risks?
As in all major surgery, there are risks. Heart valve surgery has an excellent success rate. There is a small risk of:
After careful review of your medical history and a physical exam, your surgeon will identify your risks.
It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your cardiac specialist. Early detection of heart disease is important for effective treatment.