Factors Your Doctor May Consider - Heart Valve Repair Surgery

There are several ways to treat a problem heart valve. One of them is through surgery to repair it.

While heart valve repair is generally the preferred method for treating a diseased heart valve, some patients are not candidates for heart valve repair surgery. This is because their valves are too badly damaged. Every patient's condition is unique, and each doctor has a unique approach to treatment. Your doctor will determine if heart valve repair surgery is the best treatment for your particular condition.

Your doctor will get information about your heart valve condition by performing tests that may include any or all of these:

• Listening to your heart to hear the valves opening and closing and the rush of blood through them.
• Conducting an echocardiogram (ultrasound), which uses sound waves to produce detailed images of your heart. This is the most common test used to find out if a heart valve can be repaired. But often, direct inspection during surgery is the only way to find out.
• Performing a magnetic resonance imaging (MRI) study, which uses a magnetic field and radio waves to get detailed images of the inside of your heart.
• Taking an x-ray image of your chest to check your heart, its major vessels, and your lungs for abnormalities.
• Ordering an electrocardiogram (ECG) to measure the electrical impulses given off by your heart. An ECG gives your doctor important information about your heart's rhythm and its size.
• The procedure used to repair your heart valve depends on which valve is damaged. Tricuspid and mitral valves are the most likely to be repaired. A large percentage of patients with mitral valve damage have successful repair procedures.

If damaged, the aortic valve is usually replaced. These are some of the procedures used to repair damaged heart valves:

• Balloon valvotomy – If possible, your surgeon may recommend this procedure as it does not require open heart surgery. A thin, flexible tube (catheter) with a small deflated balloon at its tip is inserted into an artery in your arm or groin and guided into your narrowed valve. The balloon is quickly inflated, stretching the valve opening and allowing more blood to flow through it.
• Commissurotomy – If the valve is narrowed because of thickened leaflets or leaflets that are stuck together, your surgeon opens the valve by cutting the places where the leaflets join.
• Ring annuloplasty – When a valve loses its shape and strength, it's unable to close tightly. An annuloplasty gives the leaflets support through ring-like devices that your surgeon attaches around the outside of the valve opening.
• Reshaping – If a valve has lost its shape and cannot close completely, your surgeon may cut out a piece of a leaflet so the valve can close properly again.
• Decalcification – Over time, calcium deposits keep heart valves from closing properly. If this happens, your surgeon will remove the calcium buildup from the leaflets so that they can function normally.
• Repair – Heart valves are supported by chords (chordae tendineae and the papillary muscles). These can weaken and stretch so the valve cannot function properly. Repair shortens or replaces these chords so that the valve can close normally.
• Patching – If one of your valve leaflets has a hole or tear, your surgeon may repair it with a tissue patch.

Besides heart valve repair, other treatment options include medication and heart valve replacement.

Make sure you get answers to all your questions and that you understand completely why a particular method of treatment was chosen for you.

Next: Your Healthcare Team

Your Healthcare Team

Heart valve surgery is a delicate operation that takes a team of experienced and dedicated healthcare professionals. Depending on your condition, your team may include the following people:

• Heart (cardiac) surgeon – This is the person who opens the heart, does the heart valve repair or replacement and closes the heart when the surgery is finished. The cardiac surgeon is the professional your cardiologist or other doctor referred you to once he or she suspected that you had heart valve disease.
• Surgical assistant – While the cardiac surgeon concentrates on repairing or replacing your heart valve, the surgical assistant manages other medical or surgical needs that may arise away from the heart. The surgical assistant may be another surgeon, a surgical resident, a physician's assistant, or a specially trained health professional.
• Interventional cardiologist – Some heart valve procedures can be done without opening the chest. In such cases, an interventional cardiologist may work with the surgeon to pass a narrow tube (catheter) through an artery to repair or replace the defective valve.
• Anaesthetist – During surgery, you have to be placed in an unconscious state. The anaesthetist uses a variety of drugs to make sure you stay asleep during the operation. Then, when the surgery is completed, the anaesthetist gently brings you back to consciousness.
• Perfusionist – Some heart valve operations require that the heart be stopped. The perfusionist is in charge of the heart/lung machine that keeps blood flowing through your body while your heart is at rest. When your surgery is complete, the perfusionist and the surgeon work together to restart your heart.
•  Nurses – The cardiac surgeon is assisted by a team of nurses who are very familiar with heart valve operations.

Next: Surgery: What to Expect – Heart Valve Repair

Surgery: What to Expect – Heart Valve Repair

In most cases, heart valve repair is an open heart operation. This means that the surgeon opens your chest and heart to repair the defective heart valve.

During the Procedure

During the operation, the surgeon opens your chest to get to your heart and the problem valve. You will be asleep during the operation and will feel no pain.

During the majority of procedures, your heart will be temporarily stopped, and you'll be put on a heart/lung machine that takes over your breathing and blood circulation. Alternatively, there are procedures that may be performed on a beating heart. Your surgeon will decide which type of procedure is best for your particular needs.

Procedures that let the surgeon get to the damaged valve through a small incision in the "breastbone" (sternum) or under the right pectoral muscle in your chest are called minimally invasive procedures.

With recent advances in technologies and procedural techniques, more cardiac surgeons are using minimally invasive procedures to repair heart valves. These procedures may potentially reduce pain, scarring, and your recovery time. You and your doctor will decide if this is a practical procedure for your condition.

Factors Your Doctor May Consider - Heart Valve Replacement Surgery

There are several ways to treat a diseased heart valve – with medication, by repairing it, or by replacing it.

Every patient's condition is unique and each doctor has a unique approach to treatment. Together, you and your doctor will determine if heart valve replacement surgery is the best treatment for your particular condition.

Surgical heart valve replacement is one method used to treat problem valves. This procedure has been performed for several years. Two types of prosthetic (artificial) replacement valves are available for implantation. One is a mechanical valve that is made of durable materials; the other is made of tissue. Tissue valves can be donated human heart valves or they can be made from animal tissue.

Your condition is unique, so the kind of prosthetic valve used will be a decision you and your doctor make together.

Your doctor will get information about your heart valve condition by performing tests which may include any or all of these:

• Listening to your heart to hear the valves opening and closing and the rush of blood through them.
• Performing an echocardiogram, which uses sound waves to produce detailed images of your heart. This is the most common test used to find out if a heart valve can be repaired. But often, direct inspection during surgery is the only way to find out.
• Conducting a magnetic resonance imaging (MRI) study, which uses a magnetic field and radio waves to get detailed images of the inside of your heart.
• Taking an x-ray image of your chest to check your heart, its major vessels, and your lungs for abnormalities.
• Using an echocardiogram (ECG) to measure the electrical impulses given off by your heart. An ECG gives your doctor important information about your heart's rhythm and its size.

Make sure you get answers to all your questions and that you understand completely why a particular valve was chosen for you.

Next: Your Healthcare Team

Your Healthcare Team

Heart valve surgery is a delicate operation that takes a team of experienced and dedicated healthcare professionals. Depending on your condition, your team may include the following people:

• Heart (cardiac) surgeon – This is the person who opens the heart, does the heart valve repair or replacement, and closes the heart when the surgery is finished. The cardiac surgeon is the professional your cardiologist or other doctor referred you to once he or she suspected that you had heart valve disease.
• Surgical assistant – While the cardiac surgeon concentrates on repairing or replacing your heart valve, the surgical assistant manages other medical or surgical needs that may arise away from the heart. The surgical assistant may be another surgeon, a surgical resident, a physician's assistant, or a specially trained health professional.
• Interventional cardiologist – Some heart valve procedures can be done without opening the chest. In such cases, an interventional cardiologist may work with the surgeon to pass a narrow tube (catheter) through an artery to repair or replace the defective valve.
• Anaesthetist – During surgery, you have to be placed in an unconscious state. The anaesthetist uses a variety of drugs to make sure you stay asleep during the operation. Then, when the surgery is completed, the anaesthesiologist gently brings you back to consciousness.
• Perfusionist – Some heart valve operations require that the heart be stopped. The perfusionist is in charge of the heart/lung machine that keeps blood flowing through your body while your heart is at rest. When your surgery is complete, the perfusionist and the surgeon work together to restart your heart.
• Theatre nurses – The cardiac surgeon is assisted by a team of nurses who are very familiar with heart valve operations.

Next: Surgery: What to Expect – Heart Valve Replacement

Surgery: What to Expect – Heart Valve Replacement

In most cases, heart valve replacement is an open heart operation. This means that the surgeon opens your chest and heart to remove the damaged valve. The new artificial (prosthetic) valve is then sewn into place. In some cases, the valve can be replaced without opening the chest. Called minimally invasive surgery, the damaged valve is replaced through a small incision near the "breastbone" under your right chest muscle.

Before the Procedure

How long the operation takes depends on how much heart disease is present. Your surgeon will discuss this with you before the operation.

During the Procedure

To help you learn about the procedure, your doctor may suggest a number of actions, including:

• Talking with different members of the surgical team, such as the anaesthetist, surgeon, cardiologist, respiratory therapist, and nurses
• Discussing with family members the details of the operation
• Visiting the intensive care unit (ICU) where you may be sent for postoperative recovery

During the operation, the surgeon opens your chest to get to your heart and the problem valve. You will be asleep during the operation and will feel no pain.

During the majority of procedures, the heart will be temporarily stopped and you'll be put on a heart/lung machine that takes over your breathing and blood circulation. Alternatively, there are some procedures that may be performed on a beating heart. Your surgeon will decide which type of procedure is best for your particular needs.

A minimally invasive technique may also be an option for you. With recent advances in technologies and procedural techniques, more cardiac surgeons are using minimally invasive procedures to replace heart valves.

These procedures may potentially reduce pain, scarring, and your recovery time. You and your doctor will determine which method will best treat your condition.