MENDING AND REPLACING DAMAGED HEART VALVES

Cardiac surgery for rheumatic valves has never been so good. Today, surgeons are using all kinds of sculpting techniques to mend damaged valves. Those which were once considered irretrievable pose no challenge either. It is possible to replace them. Narrowed valves can be treated without the scalpel too, by simply pushing balloon catheters. Even then, some problems do remain. People who have change of valves need life­long medication and have to be careful of their life styles.

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When does the need for surgery arise for damaged heart valves?

What is the usual age at which this stage is reached and surgery becomes necessary?

What investigations are necessary before taking up the patient for surgery?

What kinds of valve surgery are currently in vogue?

You just said that there are two kinds of valves in use to replace the diseased valve. One, an artificial one, the other, a pig valve. Which is better and why?

Are these valves easily available in India? Which kind is more expensive?

Are prosthetic valves prone to mechanical failure?

How long is the usual operating time when a valve has to be mended?

What if it has to be replaced?

How long is the usual post-operative stay in the hospital after valve surgery?

What is the operative risk during repair and replacement of valves?

What precautions are necessary after valvular surgery?

Can valve surgery be done on a pregnant patient if necessary?

Can a woman fitted with prosthetic valve afford a pregnancy?

When does the need for surgery arise for damaged heart valves?   Top  

This is governed by the extent of damage and or symp­toms of the patient.
When the heart is relaxed a normal mitral valve has an orifice of 5 cm2. If it gets narrowed to 1 cm2, or the patient begins to get breathless on climbing up stairs or gets unduly tired by the evening, corrective surgery needs to be done.
In a leaky mitral valve, surgery is delayed until the disease becomes so severe that the patient is unable to work or carry out normal household activities, despite optimal medical treatment.
In aortic stenosis, on the contrary, surgery is advocated early, even when a patient is asymptomatic, but the area of the valvular orifice has narrowed to less than 0.7 cm2.
In aortic regurgitation, the decision of surgery is made when the patient develops breathlesssness on exertion, or shows the earliest evidence of left ventricular dysfunction.

What is the usual age at which this stage is reached and surgery becomes necessary?   Top  

There is no definite relationship with age. Some patients deteriorate so fast that surgery may become necessary even in' late childhood, while others may enter into their 50s before they require surgery.
The golden rule in all circumstances is that once surgery becomes necessary, one must not delay it. Otherwise, the results would get adversely affected and complications may arise.

What investigations are necessary before taking up the patient for surgery?   Top  

Apart from the routine investigations called for at the time of any operative procedure, investigations are carried out for exact determination of the disease. Echocardiography is the best choice.

In men above 35, and women above 40, coronary angiography ard cardiac catheterization are recommended.

Some centres insist on cardiac catheterization even in younger patients.

What kinds of valve surgery are currently in vogue?   Top  

In mitral stenosis, a whole range of surgical techniques is currently being employed. What type of surgery suits which patient depends largely upon the extent of disease and the facilities available.

In early mitral stenosis, when the valve, though narrowed, is still supple, with no valvular or perivalvular calcification, a closed intracardiac operation without putting the patient on the heart-lung machine is in order. Called closed mitral val­vulotomy, this operation involves instrumental dilatation of the mitral valve through a ventricular access. Essentially, this is a blind procedure which can sometimes produce a leaky valve. It is the simplest of valve surgeries and the least expensive.

Most cardiac surgeons opt for open operation, where opera­tive manipulation can be done under direct vision on a silent heart with the patient hooked to a heart-lung machine. This technique is called open mitral valvulotomy.

More recently, at some advanced cardiac centres, interven­tional cardiologists are employing balloon catheters to serve a similar objective and doing away with conventional surgery. Using a catheter tipped with a deflated balloon, they guide it to the narrowed valve and under X-ray imaging dilate the balloon to open up the stenosed valve. In a leaky mitral valve, the ring and bands of the valve can be repaired under direct vision. This technique is called mitral I valvuloplasty. But when the valve is far too diseased, has large amounts of calcium deposited on it and is irretrievable, it is replaced by either a prosthetic (artificial) valve or a pig valve by an open operation.

In very early cases of aortic stenosis too, repair of the valve can be undertaken. But such cases are few. Most require a valve replacement.

In aortic regurgitation, the only option is to replace the valve.

You just said that there are two kinds of valves in use to replace the diseased valve. One, an artificial one, the other, a pig valve. Which is better and why?   Top  

Yes, valves are broadly of two kinds. One, made of artificial material, is called a prosthetic valve. The other, the pig valve, is procured from a pig's heart.
The prosthetic ones come in various shapes and designs. The two main varieties are ball valves and disc valves. Each has its good points and its shortcomings.
With pig valves, the biggest advantage is that the patient does not need anti-coagulant medication, which is mandatory for the lifetime with prosthetic valves. But pig valves have a life of usually about ten years. They begin to deteriorate after this. As such, they are favoured only in patients who require valve replacement surgery at a late age.
On the other hand, prosthetic valves, which usually last a lifetime, are the choice for young patients. Ball type valves are used to replace mitral valves, and disc type valves for aortic valves.

Are these valves easily available in India? Which kind is more expensive?   Top  

Yes, both kinds of valves are easily available in the country. They are imported from the developed countries.

Pig valves and ball valves cost the same. Disc valves how-ever cost twice as much and more.

Are prosthetic valves prone to mechanical failure?   Top  

The risk is very small, almost negligible. If this does happen, a repeat surgery can be done.

How long is the usual operating time when a valve has to be mended?

Anything between two and four hours.

What if it has to be replaced?

That usually takes four to five hours operating time.

How long is the usual post-operative stay in the hospital after valve surgery?   Top  

Commonly, a patient is discharged from the hospital ten to twelve days after the day of surgery.

How much longer does it take for the patient to recu­perate and go back to normal life?

Often, in about a month or a month-and-a-half the patient can get back to work and resume normal physical activity.

What is the operative risk during repair and replacement of valves?   Top  

Mending operations have a mortality of less than 2%. But valve replacement surgery has a higher risk of up to 7%. The risk is higher in patients with frank heart failure.

What precautions are necessary after valvular surgery?   Top  

Patients must strictly comply with the doctor's advice. Shots of penicillin for prophylaxis against recurrence of rheumatic fever are recommended.

In patients who are fitted with prosthetic valves, continuous regular anti-coagulant medication, which helps prevent for­mation of blood clots, is necessary for lifetime. They require to undergo blood tests every month. All sports and activities where they are likely to injure themselves such as hockey, football, and boxing are best avoided. If injury does occur, they must take medical advice. Whenever they require any kind of surgery, howsoever trivial it may be, they must inform the anaesthesiologist and the surgeon that they are on anti-coagulants, as this may require a readjustment of the dosage of medication.

Precautions are also necessary to prevent bacterial infection: of the valves. Good dental hygiene, and antibiotic cover before any dental manipulation, any instrumentation, and surgery are mandatory.

Can valve surgery be done on a pregnant patient if necessary?   Top  

Yes, if the patient cannot be managed even with inten­sive medical treatment, surgery may be done.

Can a woman fitted with prosthetic valve afford a pregnancy?

Yes, but prior advice from the treating doctor must be taken. Such patients need to be admitted to the hospital at least eight weeks before the expected date of labour and their oral anti-coagulant medication dosage needs to be readjusted.

Herbal Cure for Heart - Complete Pack
Total Heart Support	Arjuna	Arjun Tea	Arjun Saar	Kumari Saar	Total Price
					Free Shipping and Handling Worldwide! No Side Effects!
2 Bottles	1 Bottle	1 Pack	4 Bottles	4 Bottles
$47.90	$ 31.00	$ 14.95	$ 75.80	$ 75.80	$ 274.55
Price after Discount 20%					$ 220.00
Buy This Pack for Just $ 220.00
Free Shipping and Handling Worldwide! No Side Effects!

Click here to buy Individual herbal products for heart care, heart herbal cure, herbs for heart