What Happens During Traditional Heart Valve Surgery?

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. Often, the surgeon and cardiologist (heart doctor) will use a probe that is passed down the esophagus to help determine the functioning of the valve before and after surgery. If your valve can be repaired, your surgeon will perform any of the following types of valve repair procedures.

• Commissurotomy. Fused valve leaflets are separated to widen the valve opening.
• Decalcification. Calcium deposits are removed to allow the leaflets to be more flexible and close properly.
• Reshape leaflets. If one of the leaflets is floppy, and bows back into the left atrium, a segment may be cut out and the leaflet sewed back together, allowing the valve to close more tightly.
• Repair of chordae or papillary muscles. If the chordae or papillary muscles are torn or stretched out, they will not give the valve leaflets support. The surgeon may transfer or shorten the chordae to the correct length to provide support for the leaflet, allowing the valve to seal tightly.
• Annulus support. If the valve annulus (the ring of tissue supporting the valve) is too wide, it may be reshaped or tightened by stitches or sewing a ring structure to the annulus. The ring may be made of tissue or synthetic material.
• Patched leaflets. The surgeon may patch any leaflets with tears or holes with tissue patches.

What If My Valves Cannot Be Repaired?

If your valves cannot be repaired, your doctor will replace the valve.

During the surgery, the old valve is removed and a new valve is sewn to the annulus of your old valve. The new valve can be a:

• Mechanical valve. It is made totally of mechanical parts that are tolerated well by the body. The bi-leaflet valve is used most often. It consists of two carbon leaflets in a ring covered with polyester knit fabric.
• Biological valve. Also called a tissue or bioprosthetic valve, it is made of tissue taken from pigs or cows. It may also have some artificial parts to help give the valve support and sew it in place.
• Homograft valve. This type of valve may be used to replace a diseased aortic or pulmonic valve. A homograft is an aortic or pulmonic valve that has been removed from a donated human heart, preserved and frozen under sterile conditions

What Are the Advantages and Disadvantages of Each Type of Valve?

• Mechanical valves. The advantage to mechanical valves is their sturdiness. They are designed to last for many years. There are also drawbacks. Due to the artificial material involved, people who receive these valves will need to be on life-long blood-thinners to prevent clots from forming in the mechanical valve. These clots can cause strokes. Also, some people report a valve ticking sound that is usually not bothersome. It is the sound of the valve leaflets opening and closing.
• Biological valves. The advantage of biological valves is that most people do not need to be on lifelong blood-thinner medication, unless they have other conditions (such as Atrial fibrillation that warrant it. The drawback is that biological valves are not as durable as mechanical valves, especially in younger people. They may need to be replaced at about 10 years. In older people (greater than age 60), these valves last longer, often 15 years or more.
• Homograft valves. These valves have been used for only about 15 years, but they are expected to last much longer and may not need to be replaced.

Are There Non-Surgical Options for Valve Disease?

Yes. Balloon valvuloplasty is used to increase the opening of a narrowed (stenotic) valve. It is used for select patients who have mitral valve stenosis (narrowing of the mitral valve) with symptoms, older people who have aortic stenosis (narrowing of the aortic valve), but are not able to undergo surgery, and some patients with pulmonic stenosis (narrowing of the pulmonic valve).

What Happens During Balloon Valvuloplasty?

A specially designed catheter is inserted into the blood vessels in the groin and guided to the heart. The tip is directed inside the narrowed valve. Once there, a tiny balloon is inflated and deflated several times to widen the valve opening. Once the cardiologist is satisfied the valve has been widened enough, the balloon is removed.

During the procedure, the cardiologist may perform an echocardiogram (ultrasound of the heart) to get a better picture of the valve.

The procedure takes about one hour, but the preparation and recovery adds more time. Plan on staying overnight.

What Happens After the Procedure?

After the procedure, you will need to continue seeing your doctor regularly to make sure your heart valves are working properly. Lifestyle factors that can worsen valve disease may also need to be modified. An exercise program may be prescribed to improve your cardiac health.

Are There Side Effects Associated With Balloon Valvuloplasty?

Once you go home after the procedure, call your doctor or nurse immediately if you have:

• Fever of 100 degrees F (38 degrees C) or higher
• Chest pain
• Shortness of breath
• Unusual swelling or weight gain
• Bleeding, swelling, pain or discoloration at your groin site
• A return of previous symptoms (before the procedure was performed)

Does Balloon Valvuloplasty Cure Valve Disease?

Balloon valvuloplasty may relieve many of the symptoms of valve disease, but it will not cure valve disease. Some people may continue to need medications, even after a successful procedure.

To protect your heart valves from further damage, tell your doctors, dentist and other health care providers that you have valve disease so antibiotics can be prescribed before you undergo any procedure that may cause bleeding. Also, it is important to take good care of your teeth and gums to prevent valve infection.

Reviewed by the doctors at The Cleveland Clinic Pain Management Department.

Edited by Charlotte E. Grayson, MD, June 2004.

Portions of this page © The Cleveland Clinic 2000-2003

sourceLast Editorial Review: 1/31/2005 10:49:42 AM

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