Heart valve surgery is a procedure for treatment of heart valve disease. This takes place when one of the four heart halves that are responsible for pumping blood in the right direction are not functioning properly.
Basically, our heart is a pump that comprises muscle tissue. It consists of four chambers responsible for the pumping. The upper chambers are known as atria and the lower ones are referred to as ventricles. In between each of these chambers are valves which ensure the blood is flowing through the heart and into the right directions
Pulmonary valve – This is present between right ventricle and pulmonary artery
Tricuspid valve – Present between right atrium and right ventricle
Mitral valve – This one can be found between left ventricle and left atrium
Aortic valve – This one is located between aorta and left ventricle
Each valve consists of flaps that are known as leaflets for tricuspid and mitral valves, and cusps in the case of pulmonary and aorta valves. These valves close and open with every heartbeat. At times the valves are not able to close and open properly which in turn affects the blood flow from your heart to the body.
In cases where any of the valves are diseased or damaged, they demand medical intervention. A heart valve surgery therefore includes a surgeon repairing or replacing the affected heart valves. In fact, mitral valve and aortic valve are the two most commonly replaced valves. There are fairly uncommon cases of tricuspid and pulmonary valve replacement. This comprises many surgical procedures to repair the heart and include minimally invasive heart surgery and open heart surgery.
In many cases it can develop before your birth or be acquired during the span of your life. Further in many cases the causes remain unknown. There are some of the common causes –
Congenital valve disease – This particular form impacts the pulmonic or aortic valve. They include valves of the wrong size or malformed leaflets. In many cases the leaflets are not attached correctly.
Bicuspid aortic valve disease – This one affects the aortic valve. Unlike a normal valve with three cusps or leaflets, this one only has two. With the absence of the third leaflet, the valve becomes stiff and finds it difficult to close and open properly. It can also become leafy and creates resistance in closely tightly.
Acquired valve disease – This one involves problems that were acquired over one’s life. It includes changes in the valve structure due to some kind of infection or disease like rheumatic fever or endocarditis.
Rheumatic fever – This is a result of bacterial infection which is left untreated. This was more prevalent earlier before antibiotics came into the scene to treat it during 1950s. The infection initiates at a younger age and leads to inflammation of the valves. However one is not able to see the symptoms until 20-40 years later.
Endocarditis – This is caused when bacteria enter the bloodstream and start attacking the valves. As a result, holes and growths begin to occur in the valve and also lead to scarring. This causes leaky in the valves. The germs that are the major cause of Endocarditis can enter the bloodstream during surgery, dental procedures, severe infections and other IV drug usage.
There are many other conditions that can affect the valves. They have papillary muscles or chordae tendinea that can tear or simply stretch. Another case can be the dilating of annulus of the valve. Then there are also chances of stiffness of the leaflets and they an also calcify.
There is another condition called Mitral valve prolapse that can lead to flopping back of the mitral valve leaflets to the heart’s contraction. This also impacts the tissues and they become abnormal thereby causing a leakage.
Further other causes include heart attack, coronary artery disease, syphilis, coronary artery disease, connective tissue diseases and high blood pressure. Other lesser reasons include radiation, tumour or some type of drug abuse.
Some of the symptoms include –
Shortness of breath – This is most noticeable when you are engrossed in daily activities or lie down on the bed. You are required to keep a few pillows under your head to breathe easier.
Dizziness or weakness – You feel dizzy in carrying out every day activities and a general low in energy all the time. There can also be cases when you pass out suddenly.
Discomfort in chest – You may feel a certain discomfort or pressure on your chest. It can worsen when you are out in the cold or a breezy environment.
Constant palpitations – It is a red sign if you have constant episodes of palpitations which include an increased heart rate and irregular heartbeat, flip flop feeling in the chest or skipped beats.
Swollen ankles, abdomen or feet – This condition is often referred to as Edema. You can experience swelling in your belly which causes you to feel bloated
Sudden weight gain – A sudden increase in your weight without any possible indulgences or change in diet.
Your doctor will have a thorough discussion, perform a physical examination and carry out certain tests before recommending a replacement surgery.
The physical examination involves listening to the sound that your heart makes as the valves open and close. A murmur is the kind of swishing sound made by the bloodstream as it passes through a leaky valve or stenotic. Similarly, an irregular rhythm signifies an enlarged heart. In fact, if your heart is retaining fluid and not able to pump the way it should, the doctor can figure that out by listening to the lungs. This is followed by a thorough examination of the body that helps assess the circulation and functioning of other organs.
Some of the tests conducted by the doctor include –
Cardiac catherization also known as angiogram
Basis this test the progress of the valve disease is diagnosed and further treatment method is recommended.
During the procedure
You will be under anaesthesia and connected to a heart-lung bypass machine that allows constant movement of the blood throughout the procedure. This surgery can be performed during open-heart surgery that includes a cut or incision in the heart. In many cases surgeons also perform a minimally invasive surgery that includes smaller incisions. This involves using long instruments that are inserted through small incisions in the chest or using robotic arms. This surgery usually comes with a shorter stay and quicker recovery.
In cases wherever possible, the doctor suggests heart valve repair as it allows the preservation of the valve and proper heart function. It includes –
Surgeon patching a hole in the diseased valve
Followed by reconnecting the valve cusps
Removal of any excess oil between the valves so they can close tightly
Replacing the cords to support valve repair for structural support
Separation of the fused valves
Tightening of ring around the valve also known as annulus
In cases where repairing of the valve is not possible at all, doctors recommend replacement. It involves removing the valve and replacing it with a mechanical one or one made from the tissue of human, pig or cow’s heart. These biological tissue valves also require to be eventually replaced because they tend to degenerate over the years. On the other hand, a mechanical valve requires blood-thinning medicines for all your life to avoid blood clots. The pros and cons of each type of valve replacement is discussed with the patient before making a decision. A minimal invasion is carried out during this surgery using a catheter process.
With a diseased valve condition, every step needs to be carefully planned. That is why we at Max Healthcare make it easier for the patients to take the decision. The exceptional row of doctors takes each case differently and provides treatment methods after thoroughly studying the history and the present condition of the patient. This ensures that the surgery is not the only focus but a comfortable post-treatment plan as well.
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