Heart Valve Replacement

Heart Valve Replacement is the cure for Heart valve disease which occurs if one or more of the four Heart valves (Tricuspid, Pulmonary, Mitral, and Aortic) cease to function.

Valves have tissue flaps- leaflets or cusps, which open and close with each heartbeat and ensure that blood flows in the right direction through the heart. Heart Valve disease occurs due to improper opening of the valves (Stenosis) or improper closing of the valves to prevent backflow of blood (Regurgitation). This adversely affects the flow of blood through the heart and hence, these valves have to be replaced or repaired. It may occur as a congenital defect, because of an infection or even due to aging.
 

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The symptoms observed vary with the degree of severity of the disease; however indicate the inadequate flow of blood throughout the body.

The signs and symptoms observed that highlight the requirement of a Heart Valve Replacement include- 

  • Chest Pain or Palpitations
  • Shortness of breath
  • Fatigue and Weakness
  • Dizziness 
  • Fainting and frequent loss of consciousness 
  • Swollen ankles, feet or abdomen caused by Water Retention

The improper functioning of a valve can be detected by listening to the Heart murmur, due to variation in the Lubb and Dupp sounds and Electrocardiograms which will show abnormality in the rhythm of the heart. Echocardoiograms are also used to determine the functioning of the valves as it uses sound waves to produce an image of the valves. The extent of severity of the disorder is observed by obtaining detailed images of the valves by inserting a catheter through a large artery in Cardiac Catherization or an ultrasound transducer is passed down to heart through the trachea as in Transesophageal Echocardiogram (TEE). The need for Heart Valve Replacement can also be assessed by several tests such as Chest X-Rays and Cardiac MRI.

The replaced heart valves can be biological or man-made. The former are made from pig, cow or human heart tissue and are treated with medicines to prevent rejection of the valve from the body. These valves have to be replaced after every 15 years, whereas the manmade ones last longer. However, the man-made valves have several complications such as the need to take anti-coagulant medicines for lifetime in order to prevent the formation of a blood clot on the valve and higher risks of infective endocarditis. The type of valve can be decided according to factors such as age, lifestyle, occupation and cost.     

For the surgery, it is essential to not consume any food or water at least 8 hours prior to it. The patient is connected to the ventilator, several catheters and a by-pass machine as the heart needs to be stopped for the treatment of valves. The valves are either replaced by biological or man-made ones or its openings are re-shaped.  

There are several risks involved in a Heart Valve Replacement surgery. There are possibilities of bleeding during or after the surgery, Heart Failure or Heart Attack, infections, Arrhythmia and rupture of the heart. There also may difficulties in healing of the Sternum or kidney failures, brain injury and post-pericardiotomy syndrome. However, the success rates of this surgery are very high and usually complications do not occur.

It is essential to take rest after a Heart Valve Replacement surgery. The patient must not engage in any sort of strenuous physical exercise for several weeks after the surgery. 

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Heart Valve Replacement

Heart Valve Replacement is the cure for Heart valve disease which occurs if one or more of the four Heart valves (Tricuspid, Pulmonary, Mitral, and Aortic) cease to function.

Valves have tissue flaps- leaflets or cusps, which open and close with each heartbeat and ensure that blood flows in the right direction through the heart. Heart Valve disease occurs due to improper opening of the valves (Stenosis) or improper closing of the valves to prevent backflow of blood (Regurgitation). This adversely affects the flow of blood through the heart and hence, these valves have to be replaced or repaired. It may occur as a congenital defect, because of an infection or even due to aging.
 

Symptoms

The symptoms observed vary with the degree of severity of the disease; however indicate the inadequate flow of blood throughout the body.

The signs and symptoms observed that highlight the requirement of a Heart Valve Replacement include- 

  • Chest Pain or Palpitations
  • Shortness of breath
  • Fatigue and Weakness
  • Dizziness 
  • Fainting and frequent loss of consciousness 
  • Swollen ankles, feet or abdomen caused by Water Retention

Diagnosis

The improper functioning of a valve can be detected by listening to the Heart murmur, due to variation in the Lubb and Dupp sounds and Electrocardiograms which will show abnormality in the rhythm of the heart. Echocardoiograms are also used to determine the functioning of the valves as it uses sound waves to produce an image of the valves. The extent of severity of the disorder is observed by obtaining detailed images of the valves by inserting a catheter through a large artery in Cardiac Catherization or an ultrasound transducer is passed down to heart through the trachea as in Transesophageal Echocardiogram (TEE). The need for Heart Valve Replacement can also be assessed by several tests such as Chest X-Rays and Cardiac MRI.

Treatment

The replaced heart valves can be biological or man-made. The former are made from pig, cow or human heart tissue and are treated with medicines to prevent rejection of the valve from the body. These valves have to be replaced after every 15 years, whereas the manmade ones last longer. However, the man-made valves have several complications such as the need to take anti-coagulant medicines for lifetime in order to prevent the formation of a blood clot on the valve and higher risks of infective endocarditis. The type of valve can be decided according to factors such as age, lifestyle, occupation and cost.     

For the surgery, it is essential to not consume any food or water at least 8 hours prior to it. The patient is connected to the ventilator, several catheters and a by-pass machine as the heart needs to be stopped for the treatment of valves. The valves are either replaced by biological or man-made ones or its openings are re-shaped.  

Risks

There are several risks involved in a Heart Valve Replacement surgery. There are possibilities of bleeding during or after the surgery, Heart Failure or Heart Attack, infections, Arrhythmia and rupture of the heart. There also may difficulties in healing of the Sternum or kidney failures, brain injury and post-pericardiotomy syndrome. However, the success rates of this surgery are very high and usually complications do not occur.

After Procedure

It is essential to take rest after a Heart Valve Replacement surgery. The patient must not engage in any sort of strenuous physical exercise for several weeks after the surgery. 

FAQ Section

1) What are heart valves?

Heart valves are membranous structures separating the four chambers of the heart. Each chamber has a valve in order to facilitate the flow of blood in the right direction. The mitral and tricuspid valve separates the atria and the lower ventricles whereas the aortic valve and the pulmonic valve are situated between the ventricles and the major blood vessels of the heart. The mitral and tricuspid valve have two leaflets and the aortic and pulmonic valve have three leaflets, which along with the annulus play a significant role in maintaining the shape of the heart.

2) Why do you need to replace them?

When the valves, especially the aortic valve is not functioning properly, the blood flow through the body is obstructed, causing pressure on the heart to work harder in order to pump blood. This is quite dangerous and can lead to several conditions which can be fatal. It is often accompanied by symptoms like shortness of breath, fatigue, chest pain, loss of consciousness, irregular heartbeat (arrhythmia), heart failure and sudden cardiac death. In order to restore normalcy of the blood flow, tone down the symptoms and preserve the functioning of the heart, there may arise a need for the replacement of the heart valves.

 

3) What are the signs of heart valve problems?

A person suffering from heart valve problems need not necessarily show symptoms indicating its presence and may require treatment. The progress of this disease is usually very slow and the symptoms may appear at a later stage. Some of the symptoms associated with this condition are shortness of breath, fatigue, chest pain, loss of consciousness, irregular heartbeat (arrhythmia), heart failure and sudden cardiac death. It is also accompanied by several other symptoms such as dizziness, palpitations,  discomfort in the region of the chest, rapid weight gain and swelling of ankles, feet or abdomen.

4) Who is an ideal candidate for heart valve replacement?

A person with an aortic valve that is diseased leading to its non-functioning,  is an ideal candidate for a heart valve replacement. The necessity of a heart valve replacement is determined by the ability of the valve to open or close completely. The primary function of the heat valves is to regulate the flow of blood in the right direction facilitated by the opening and closing of the valves.If the valves do not open up properly, then sufficient amount of blood as required by the body is not pumped out of the body causing a strain of the heart. Similarly, if the valves do not close properly, then the blood may tend to leak backwards which again is an obstruction to the flow of blood. Another decisive factor for the need of a heart valve replacement is if the dysfunctionality hinders the normal or day-to-day activities of the person such as breathing, physical exercise etc.

5) What is the success rate of heart valve replacement surgery?

A significant number of studies over a period of time has estimated that 89.7% of the treated patients survive for at least two years following the surgery. About 78.4% survive for a period of five years and around 57.0% survive for around ten years. It has also been observed that the five-year survival rate declined by 31.2 % for the patients who are aged above 85 years.

6) How dangerous is heart valve replacement surgery?

The surgery performed for the replacement of the heart valve is usually considered to be safe. However, every surgical procedure is associated with a minimum number of risk factors or possible complications. Some of them include:

  • Bleeding during or after treatment due to damage of blood vessels
  • Blood clots leading to heart attack, stroke, or lung problems
  • Infection at the incision site
  • Infection in the new valve (endocarditis), which is more common with valve replacement
  • Pneumonia
  • Breathing problems
  • Arrhythmias (abnormal heart rhythms)
  • Valve failure
  • Bad reaction to anaesthetics

7) How long do new heart valves last?

It has been observed that when mechanical valves are used for the procedure, they may last for as long as twenty five years and when tissue valves are utilised, they may last for as long as fifteen years. Both these valves have not shown any signs of problems.

8) Can you die from a leaky heart valve?

A leaky heart valves usually tends to go unnoticed. However, it may sometimes result in death. This entirely depends upon the extent with which it interferes with the normal blood flow of the heart.

9) What is the life expectancy after aortic valve replacement?

A significant number of studies over a period of time has estimated that 89.7% of the treated patients survive for at least two years following the surgery. About 78.4% survive for a period of five years and around 57.0% survive for around ten years. It has also been observed that the five-year survival rate declined by 31.2 % for the patients who are aged above 85 years.

10) What is the most common heart valve replacement?

The most common type of heart valve replacement is the aortic valve replacement for aortic stenosis, or the narrowing of the aortic valve. Another common approach is for mitral stenosis, which requires the replacement of the mitral valve. The pulmonary and tricuspid valve replacement are usually not very common and may be recommended by your doctor in extreme cases.

 

11) What are the types of heart valves?

Heart valves are a membranous structure separating the four chambers of the heart. Each chamber has a valve in order to facilitate the flow of blood in the right direction. The mitral and tricuspid valve separates the atria and the lower ventricles whereas the aortic valve and the pulmonic valve are situated between the ventricles and the major blood vessels of the heart. The mitral and tricuspid valve have two leaflets and the aortic and pulmonic valve have three leaflets, which long with the annulus play a significant role in maintaining the shape of the heart.

12) Cost of heart valve replacement in India?

A valve replacement surgery in India may range in between 2.5 to 2.75 lakhs in the common private hospitals.