Heart valve replacement surgery is available for patients who have been suffering from symptoms that are not attributable to other heart issues. Once a medical history has been done and a number of medical tests that will pinpoint the exact cause of the issues have been conducted, if the problem has been deemed a cardiac valve problem, surgery can repair the malfunction. The symptoms that may have caused a person to seek medical attention initially would often be problems breathing when lying down, wheezing or coughing during exertion, waking up at night short of breath, tiredness, dizzy spells, swollen feet or ankles, pounding heart and chest pain. Cardiac valves can be damaged by a number of sources. Congenital issues can occur before birth while rheumatic fever produces a bacteria that produces protein antibodies that can damage cardiac valves. And of course, aging can cause valves to calcify or harden bringing on an onset of dysfunction. In some cases medication can help the valves begin functioning again properly and in other cases, cardiac surgery is required.
Cardiac valves are flap-like leafs that swing open to allow blood to pass and then close to insure that blood is flowing in only one direction. There are four different valves: aortic that separates the left ventricle from the aorta, the mitral, that separates the left ventricle from the left atrium, and the tricuspid separates the right atrium from the right ventricle and the pulmonary which separates the right ventricle from the pulmonary artery. The heart valve replacement physician will need to determine where the problem is and a number of tests will be conducted to determine which valve is damaged. A simple chest X-ray will help show heart abnormalities, while blood tests will uncover infections, anemia and other blood anomalies. An electrocardiogram will help to gauge the heart’s rhythm and a Holter monitor will be worn by the patient for twenty four hours to continuously create an electrocardiogram record to determine any cardiac irregularities not caught by the ECG in the office. Additionally, a cardiac stress test on a treadmill may be ordered as well as a catherization of the cardio muscle. Heart valve replacement surgery requires extensive testing in order to decide just exactly which surgical procedures are needed.
In addition to the X-ray as a visual scan, the cardiologist may also order a CAT scan, which is a series of X-rays that form a detailed image. The typical magnetic resonance imaging (MRI) may be employed to create a very detailed image of the heart as well as a PET scan. The positron emission tomography test has the patient injected with a small amount of radioactive substance which can be then tracked by a camera. This imaging procedure can give a very good idea of what is happening with the cardiac valves under suspicion of being damaged or not performing. It is important that the surgeon know whether or not the heart valve replacement surgery be a replacement or just a repair of the poorly functioning valve. In some cases, it may not be clear as to whether it will be replaced or repaired until the cardio muscle is opened for visual inspection.
When it is determined that the valve needs replaced, the surgeon has two choices: the replacement can either be mechanical or biological. Man-made mechanical valves are ones that may require a life time use of blood thinner that the patient may or may not be able to tolerate. The biological valves come from the hearts of pigs, cows or a human donor. These valves do not usually require long term use of blood thinners but do not have the long lasting track record of the mechanical valves. These decisions on kinds of valves to use will be made ahead of the surgery, with all decisions made with the approval of the patient. Issues such as the occupation of the patient, age and what kind of physical shape he or she is in may all be part of the decision as to what kind of cardiac valves are used in the heart valve replacement surgery.
While typically heart valve replacement surgery is done by splitting open the breast bone and exposing the cardiac muscle, a number of cutting edge medical centers are now doing the surgery using robotics and thorascopic approaches. These state of the art approaches allow surgeons to enter the patient from the side instead of breaking open the breast bone (sternum). One surgeon guides cameras and surgical tools into the patient while another surgeon views the cardiac muscle and makes the repair through specially designed monitors and hand guided surgery tools. The cardiac muscle must still be stopped and blood must be bypassed from the heart during the surgery. But this approach to heart valve replacement surgery certainly does drastically reduce the recuperative time for cardiac surgery from the traditional open chest procedure that has been practiced for decades.
Once the heart valve replacement surgery has taken place, the patient will go to intensive care for a day or two while the medical staff can monitor the patient’s recovery closely. A breathing tube used during surgery will have to be removed, usually after waking from the anesthesia. A catheter will also be in place which can be removed once ambulatory ability is achieved. While the physical heart can cause all of us some problems during our lifetimes, the Bible declares the heart to be the center of all man’s problems with God. “Create in me a clean heart, O God and renew a right spirit within me.” (Psalm 51:10)