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What is a surgery of the heart valves?

Valvular surgery or surgery of the heart valve is performed by replacement or reconstruction of the heart valve that does not “function” properly. Most valve replacements include the aortic and the mitral valves. The aortic valve divides the left ventricle (your main pump of the heart) and the aorta (the largest arterial blood vessel that carries blood to your body). The mitral valve divides the left atrium and the left ventricle.

• The four valves in your heart ensure blood flow in the correct direction through your heart.
• In case of valve disease or damage, a replacement may be required with artificial, mechanical valve as shown.

What do heart valves do?

The four valves in your heart are made of a thin (but strong) layer of tissue which open and close when your heart pumps. They ensure blood flow in the correct direction through your heart. Your valves “work” hard because they open and close with each beat of your heart.

What types of valvular problems are there?

Heart problems force the heart to function with a difficulty. This may lead to heart failure. In some cases, valves:

• Do not open sufficiently (stenosis)
• Do not allow sufficient blood flow through them (also called stenosis)
• Do not close properly and allow flow when there should not be flow. This is called insufficiency or regurgitation
• Prolapse – the leaflets of the mitral valve do not close properly (mostly in women). As pressure is created inside the left ventricle, it presses the leaflets of the mitral valve back to the left atrium, which may lead to a slight permeability of flow.

What may cause valve problems?

• Small congenital heart defects that have not been corrected and could worsen later in life and may cause problems.
• Aging can weaken or strengthen the valves.
• Certain diseases can damage or destroy the valves.

What can be done?

• Regular annual examinations by your doctor, healthy lifestyle or drug therapy may be sufficient.
• In some cases, surgery may be required in order to correct the damaged valve.
• Sometimes the valve can be removed and replaced with a new artificial valve. Ask your doctor about the use of the various types.

What does a valve surgery look like?

A surgery is the best treatment for some problems of heart valves. Your doctor will explain more, however these are some of the things you can expect:

• You will sleep during the surgery that will last 3-5 hours.
• After the surgery you will be accommodated in the intensive care unit.
• Your family can visit you briefly in the intensive care unit.

• After the intensive care, you will be accommodated in a department room.
• You will feel exhausted, with pain due to the incision.
• You will need to breathe deeply and cough hard in order to clean your lungs from liquids.
• You will be given medications.
• For day/two you would be able to sit and to start walking around.
• You can eat normally, however there may be restrictions for the intake of salt.
• You will feel slightly better and stronger every day.

What should I do?

Treatment options. Work with your doctor in order to understand the goals of the treatment and the key facts for your conditions.

Mitral valve stenosis

Mitral valve – or mitral stenosis is a reduction of the mitral valve of the heart. This is an abnormal condition of the valve that does not allow proper opening, thereby blocking the blood flow to the main pumping ventricle of the heart (the left ventricle).

Mitral valve stenosis can be the cause of your fatigue and shortness of breath, among other problems.

The failure to treat these conditions of the mitral valve may lead to serious heart complications.

Regurgitation of the mitral valve

Mitral regurgitation is more common than aortic regurgitation. When the valve permeates, the heart should work much more in order to pump enough blood in the appropriate direction. Since the heart is a muscle like any muscle in your body, it is able to conduct more work than usual. However, in order to have the appropriate amount of blood to your brain and the rest of your body, your heart has to pump harder to move blood forwards and to make room for the blood that returns back to the ventricles.

Mitral valve prolapse

In USA, the leading cause of mitral regurgitation is prolapse of the mitral valve. Mitral prolapse is created due to an extra tissue in the valve which retains it from appropriate tightened closure. Approximately 4-5% of the population has extra tissue on the mitral valve.

Over time, a tightened valve may remain unchanged or the condition may worsen and a treatment may be required. All people experiencing problems with the valves should constantly and timely have checkups in order to monitor the size and the function of the heart and any symptoms that may be related.

Report any of the observable symptoms that include weakness, lack of breath, chest discomfort, dizziness, and even palpation.

It is also important to know that some people never develop noticeable symptoms. Although it is important to monitor the symptoms, still they are not the only important factor. A problematic valve may need to be treated regardless of whether there are or there are no noticeable symptoms.

Valvular surgery: Replacement or reconstruction?

Over time, the valve complication may create problems or it may progress and become more difficult. Unfortunately, there are no drugs that can improve the performance of the valve.

Therefore when the valves become too tight or release too much blood and begin to create problems with the heart function or emergence of symptoms, the valve must be repaired. Whether the valve can be reconstructed or it has to be replaced, is an issue you should discuss with the operator.

Mitral valve usually can be reconstructed in order to work better. Sometimes reconstruction of the valve can be performed with less invasive surgery.

Non-surgical balloon procedure for excessively tight valves

Balloon procedures can be recommended for mitral stenosis, however usually they are not taken into consideration in aortic valves.

In cases of mitral stenosis, where the mitral valve is tight, a treatment procedure called balloon procedure sometimes is an effective way to open the valve.

When the balloon procedure is successful, major surgery to reconstruct or replace the tight mitral valve is not required.

Valve replacement

For some patients, valve surgery is recommended. It is most important to consider the availability of the best care, the right time for surgery, as well as the symptoms or the weaknesses that are likely to improve with a surgery.

With an experienced surgical team and institution, the risk of a valve surgery is very small and the likelihood of success is great. In ideal circumstances, a medical center with many years of experience in valvular surgery should be considered.

The appropriate time also plays an important role in the successfulness of the valve sugery. Monitor your medical condition for timely detection and recognition of a valve problem and its resolution before long-term damage is caused.

The symptoms should not be ignored. Ignoring symptoms for a long time can weaken your heart. The heart damage may increase the risks of a surgery, which are very low in other cases. Most people who have had a valve surgery, have a normal life after rehabilitation. By taking care of yourself, you give yourself and those you love best prospects for a long and healthy life.

What is the problem?

Examine your valve, if you have a heart murmur or possible problems with the valve, your doctor should check how well your valve “functions”.

Aortic valve regurgitation

Aortic regurgitation is an expression that implies leakage of the aortic valve each time the left ventricle relaxes. The leakage of the aortic valve allows blood flow in both directions.

Certain amount of blood moves in the right direction, and oxygen enriched blood moves through the aorta to the rest of the body, as it should.

However certain amount of blood moves in the opposite direction, from the aorta back to the left ventricle when the heart relaxes between two beats.

What is happening during aortic regurgitation?

The volume and pressure in the heart ventricles increase. As a result, the heart may have to work harder in order to compensate. The ventricle stretches out/increases and its walls sometimes thicken (hypertrophy), and a thickened heart muscle is less effective. Eventually the heart may not be able to meet the needs of blood in the heart, leading to heart failure. Aortic regurgitation can also lead to a bulge of the aorta or to weakened spots that are susceptible to aortic aneurysm.

Stenosis of the aortic valve

Aortic valve – or aortic stenosis – represents a narrowing of the aortic valve of the heart. This narrowing of the valve prevents it from its full opening, which contributes for obstruction of blood flow from the heart to the aorta and further to the entire body.

When there is an obstruction of the aortic valve, the heart has to “work” harder in order to pump blood in the body. Unfortunately this extra operation of the heart limits the amount of blood that can be pumped, which may cause weakening of the heart muscle.

If these conditions of the aortic valve remain untreated, they may lead to serious heart complications.

Over time, a tightened valve may remain unchanged or the condition may worsen and a treatment may be required. All people experiencing problems with the valves should constantly and timely have checkups in order to monitor the size and the function of the heart and any symptoms that may be related.

Report any of the observable symptoms that include weakness, lack of breath, chest discomfort, dizziness, and even palpation.

It is also important to know that some people never develop noticeable symptoms. Although it is important to monitor the symptoms, still they are not the only important factor. A problematic valve may need to be treated regardless of whether there are or there are no noticeable symptoms.

Aortic surgery: Replacement or reconstruction?

Over time, the valve complication may create problems or it may progress and become more difficult. Unfortunately, there are no drugs that can improve the performance of the valve.

Therefore when the valves become too tight or release too much blood and begin to create problems with the heart function or emergence of symptoms, the valve must be repaired. Whether the valve can be reconstructed or it has to be replaced, is an issue you should discuss with the operator.

Aortic valves usually should be replaced by mechanical or biological valves. Sometimes reconstruction of the valve can be performed with a less invasive surgery.

Transcatheter valve replacement: in some cases replacement of the aortic valve is possible with a much smaller surgical procedure called TAVR (transcatheter aortic valve replacement). Although many of these surgeries are successfully performed, currently they are approved only for the patients who cannot sustain i.e. tolerate open-heart surgery.

For some patients, valve surgery is recommended. It is most important to consider the availability of the best care, the right time for surgery, as well as the symptoms or the weaknesses that are likely to improve with a surgery.

With an experienced surgical team and institution, the risk of a valve surgery is very small and the likelihood of success is great. In ideal circumstances, a medical center with many years of experience in valvular surgery should be considered.

The appropriate time also plays an important role in the successfulness of the valve sugery. Monitor your medical condition for timely detection and recognition of a valve problem and its resolution before long-term damage is caused.

The symptoms should not be ignored. Ignoring symptoms for a long time can weaken your heart. The heart damage may increase the risks of a surgery, which are very low in other cases. Most people who have had valve surgery, have a normal life after rehabilitation. By taking care of yourself, you give yourself and those you love best prospects for a long and healthy life.