Heart Valve surgery in India
Heart Valves and it Role
Blood is pumped through your heart in only one direction. Heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close tightly to prevent a backflow of blood. Heart valve disease occurs when a valve doesn't work right. A valve may not open all the way. Or a valve may have problems closing. If valve doesn't open all the way then less blood moves through to the next chamber or if a valve doesn't close tightly, blood may leak backward. These problems implies that the heart have to work harder to pump the same amount of blood. Or, blood may back up in the lungs or body because it's not moving through the heart as it should.
There are 4 valves in the heart:
- Tricuspid valve (located between the upper–right chamber (right atrium) and the lower–right chamber (right ventricle) of the
- Pulmonary valve (located between the right ventricle and the pulmonary artery, which is the main artery that carries the oxygen
–poor blood from the heart to the lungs for more oxygen).
- Mitral valve (is located between the left atrium and the left ventricle and is the most common valve to be repaired.)
- Aortic valve (between the left ventricle and the aorta, which is the main artery that carries the oxygen–rich blood from the heart to the rest of the body).
What is Heart valve surgery?
heart valve surgery is used to repair or replace diseased heart valves. Repair means that the valve is mended, while replacement means the diseased valve is removed and a new valve is inserted in its place.There are a number of approaches physicians can take to repair defective heart valves. The best approach depends on the nature of the valve problem, and the condition of the patient suffering with valve disease.If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed. In some cases, existing heart valves can be repaired, If they cannot be repaired then they are needed to be replaced.
At what condition of the Heart Valve surgery is recommended?
Heart valve surgery may be recommended for the following conditions:
A) Narrowing of the heart valve (stenosis)
B) Leaking of the heart valve (regurgitation)
What are the causes for Heart valve disease?
Valve disease may be caused from...
- Birth defects
- Calcium deposits (calcification)
- Infections such as rheumatic fever
- Defective valves may cause congestive heart failure and infections (infective endocarditis).
What is Heart valve repair and what are the procedures?
Valve repair can usually be done on congenital valve defects that is defects that the patients are born with and has a good success record with treating mitral valve defects.
Here are some procedures surgeons may use to repair a valve:
- Percutaneous balloon valvuloplasty : This is a nonsurgical procedure to treat stenosis. In this procedure, local anesthetic is used by the cardiologist to numb the area of the body generally the groin. From where catheter( a thin flexible tube) in inserted into the blood vessel and fed all the way up to the heart. Once the damaged valve is reached, a balloon at the tip of the catheter is inflated. The inflated balloon stretches, widens and separates the narrowed valve. This procedure is suggested for patients who cannot undergo open–heart surgery because of failing health or other reasons. However in some cases there is a risk that the repaired valve may re– narrow (restenosis) or that it may no longer be able to close properly, allowing blood to leak back in the wrong direction (regurgitation).
- Valvotomy : A valvotomy (also known as a valvulotomy) is a type of open–heart surgery in which the surgeon cuts into a valve to repair valvular damage. In this procedure narrowed valve leaflets are widened by carefully opening the fused leaflets or commissures with a scalpel.This is a procedure to strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
- Decalcification : In this process the calcium buildup is removed from the leaflets. Once the calcium is removed, the leaflets can close properly.
- Reshaping : Here the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
- Patching : In this process the surgeon covers holes or tears in the leaflets with a tissue patch.
- Repair of structural support : In this process the cardiologist replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.
What is Heart Valve replacement and what are it's type?
Severe valve disease means that the valve cannot be repaired, then it is need to be replaced. Valve replacement is an open-heart surgery and is mostly used to treat aortic valves and severely damaged mitral valves. It is also used to treat any valve disease that is life-threatening. . This type of procedure is typically used on heart valves that leak or on those that have thickened, hardened or stretched. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.
There are 2 kinds of artificial valves used for valve replacement:
- Mechanical valves : These are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong,
designed to last about 30 years, so they are often used if all other factors are equal. Because blood tends to stick to mechanical valves
and create blood clots, patients with these valves will need to take blood-thinning medicines (called anticoagulants) for the rest of their
- Biological valves : This type of valve may be an autograft (from the patient’s own tissue), a xenograft which are made from animal tissue (a pig or cow) or an allograft or homograft (taken from the human tissue of a donated heart ). Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.
What is the procedure of Heart Valve Replacement?
Before the procedure
Before surgery, the patient will undergo a number of tests like urine and blood tests, electrocardiogram (EKG), echocardiogram, chest x-ray, cardiac catheterization and angiogram. The a patient may also be advised to visit a dentist prior to the surgery to check for any infections. Smokers will have been advised to completely avoid smoking for at least two weeks before their surgery to prevent problems in breathing, reduce secretions and facilitate necessary coughing. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their cardiologist before surgery. As the date the surgery gets closer, the patient should inform the surgeon and cardiologist about any changes in his or her health. If also there is a cold or the flu, this can lead to infections that may affect the patient's recovery. He or she undergoing the surgery should be aware of fever, chills, coughing, or a runny nose in these days and inform the doctor if any of these symptoms are found.
Eight hours before surgery, all patients are placed on NPO (non per os; nothing by mouth) status. That means they are not permitted to eat, drink or take anything by mouth until after their surgery.Immediately before surgery, the patient is given a specific pre- operative medications and then prepared for surgery. First, the chest area is shaved. Next, a sterile environment is created by the surgical team by swabbing the patient’s chest with an antiseptic solution and covering the patient in sterile surgical drapes. An intravenous (I.V.) line is started, generally in the forearm or in the back of the hand. Then a sleep-inducing medication through the intravenous (I.V.) line is given to the patient. The patient will continue breadthing a mixture of oxygen and anesthetic gas (general anesthesia). This make sure that he or she remains asleep throughout the entire surgery.
During the procedure
After the patient is asleep, a device called the Swan-Ganz catheter is often inserted into the jugular vein in the neck and is threaded to the pulmonary artery (which goes from the heart to the lungs). The catheter can be used to give medication, measure the oxygen levels in the blood and measure pressures in the heart. A breathing tube also known as endotracheal tube will also be inserted into the mouth and guided down the windpipe (trachea) to maintain an airway. A urinary catheter is also inserted and connected to a collection bag to measure the patient’s urine output.
An incision is made through the chest and breastbone (sternum). A heart-lung machine is used for all valve repair or replacement surgeries. This will keep oxygen-rich blood flowing through out the body while your heart is stopped. The functions of the heart, including blood flow and oxygenation, are rerouted through a heart-lung machine via tubes (cannulas) that are placed in the body. While this machine takes care of the heart’s functions, the heart can be carefully stopped with a cardioplegic solution so the surgeon can perform the very delicate work. While stopped, some surgeons further protect the heart by decreasing its temperature (hypothermia). Before the patient is hooked up to this machine, a blood-thinning medicine called an anticoagulant will be given to prevent his or her blood from clotting. The heart will remain stopped for about 30 to 90 minutes during surgery.
Next, a cut is made into the heart or aorta, depending on which valve is being repaired or replaced. Once the surgeon has finished the repair or replacement, the heart is then started again. Once the surgical team is satisfied that the heart is beating strongly again, the patient is weaned from the heart-lung machine and the chest incisions are closed. The procedure may take up to five hours. Blood transfusion may be needed during any type of open-heart surgery, including a heart valve repair or replacement.
After the procedure
After the surgery, the patient is transferred to a cardiac intensive care unit, where he or she is monitored continually. The patient will be kept on respirator. Once the patient is completly awake and is able to breathe independently, the breathing tube and respirator will be taken away. The patient will be groggy and somewhat disoriented. The site of incision in the chest may be sore, so painkillers may be given to the patient. Blood samples will be collected and the electrical activity of the heart will be continuously recorded by electrocardiogram (EKG) monitors.
Patients generally need to stay in the hospital from five days to a week. In this time, stitches are removed from the chest and more tests are done to assess and monitor the patient’s condition. The cardiologist will inform the patient about further medical treatment, including the use of pain medications, antibiotics.
What are the do and the don't after the surgery?
After leaving the hospital, cardiologists usually encourage patients to better protect themselves from any types of complications by..
- Maintaining a balanced diet and Eating healthy foods.
- Avoiding smoking
- Losing any excess weight
- It is very important for the patients to do easy regular exercises under a physician's guidance.
What are the benifits of Heart Valve Replacement Surgery?
Most valve repair and replacement operations are successful. The after effect of the heart valve surgery is good, and most patients can expect to achive normal activities within a few months. Proper valve functions in the heart indicates the success of the surgery. Signs such as heart murmurs or enlarged heart chambers will be resolved, along with it any symptoms that the patient may have been experiencing such as fatigue will be resolved. However, the patient will resume his or her normal activities and energy levels on a time span of six months to a year in some cases.The doctors advice the patients to begin an exercise program or to join a cardiac rehabilitation program.
If the patient have an office job (desk work), then he or she can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.
What are the risks from the surgery?
There are a number of potential complications that could arise during or after the operation. They include:
- Excessive bleeding
- Infection at the incision site
- Circulation disorders, including fluid retention and swelling (edema)
- Kidney damage or failure
- Heart attack or heart failure
- Numbness in the face, arms or legs
- Breathing difficulties
- Cardiac arrest (in which the heart abruptly stops pumping)
- Deep vein thrombosis (the formation of an obstructing blood clot in a deep vein, usually in the leg)
For other problem in the heart go through.
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