Heart Valve Replacement

Physical examEchocardiogram 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 In the days leading up to your procedure: Do not take aspirin or other anti-inflammatory drugs for two weeks before surgery, unless told otherwise by your doctor.Stop all blood thinners a week before surgery.See a dentist and get your 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 your doctor. During ProcedureIV fluids, oxygen, anesthesia, and diversion of blood circulation through a heart-lung machine

AnesthesiaGeneral Description of the ProcedureThe surgeon cuts through the skin and breastbone, opens the chest, and connects your 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, you will be removed from the heart-lung machine and your chest will be closed with wires. The skin will be closed with absorbable sutures. After Procedure You'll be closely monitored in the intensive care unit with the help of the following devices: Heart monitorBreathing tube until you can breathe independently, then an oxygen maskChest tubes to drain accumulated fluids from the chestA line into an artery in your arm to measure pressureA tube through your nose and into the stomach (a nasogastric tube) to keep the stomach drained of accumulated fluids and gasBladder catheter How Long Will It Take?3-5 hours, depending on how many valves are being replaced Will It Hurt?Anesthesia prevents pain during surgery. You may experience some pain during recovery, but will be given pain medication to relieve the discomfort.

Possible ComplicationsInfection Blood clots around the valve, which can cause a stroke , kidney damage, or damage to the extremities New valve does not work properlySac around the heart may become inflamed and painfulExcessive bleedingPneumoniaPhlebitis (blood clots of a vein) Anesthesia-related problemsInfection of breast boneDeath Average Hospital Stay2-5 daysThe first day is usually spent in an intensive care unit. Over the next few days, all the lines and tubes are removed. As you start to walk and eat a regular diet, you may be sent for rehabilitation therapy Postoperative CareBreathe deeply and cough 10-20 times every hour.Two to three days after surgery, you may be able to walk with help.You may be started on anticoagulant medications (blood thinners) to prevent blood clots from forming around the valve. If you have a tissue valve, you will not require a blood thinner after surgery. But, if you have a mechanical valve, you will be placed on a blood thinner for the rest of your life.Only take medications approved by your doctor. OutcomeThe surgical site in your breastbone heals in 4-6 weeks. Once recovery from the surgery is complete, you should be able to return to your normal activities.

Depending on the type of valve you receive, you may need to take anticoagulant medication for the rest of your life. You will need to take antibiotics before some dental and surgical procedures to decrease the risk of infection. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteCough, shortness of breath, chest pain, or severe nausea or vomitingCoughing up bloodRapid heart rateSudden headache or feeling faintProblems with vision or speakingNumbness or weakness on one sideInability to urinatePain, burning, urgency, frequency of urination, or persistent bleeding in the urinePain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain RESOURCES American Heart Associationhttp://www.americanheart.org/presenter.jhtml?identifier=1200000 National Library of Medicinehttp://www.nlm.nih.gov/ CANADIAN RESOURCES Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/Page.asp?PageID=24 University of Ottawa Heart Institutehttp://www.ottawaheart.ca/UOHI/Welcome.do References: Cecil Textbook of Medicine . 21st ed. WB Saunders Co, 2000. Society of Thoracic Surgeons website. Available at: http://www.sts.org/ .

Last reviewed November 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.