Dr. Kenneth Liao, chief of the division of cardiothoracic transplantation and circulatory support in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, tells you what you need to know about heart valve surgery and recovery.
Liao also serves as chief of the section of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke’s Medical Center.
What is a heart valve?
The valves are very important structures in the heart that control the direction of blood circulating through the heart. The valves are considered the gates to control the blood flow in one direction.
The heart has two ventricles and two atriums – the left ventricle and atrium and the right ventricle and atrium.
The mitral valve controls the blood flow from the left atrium to the left ventricle.
The tricuspid valve controls the blood flow from the right atrium to the right ventricle.
The aortic valve controls the blood flow from the left ventricle to the aorta, which provides blood to the rest of the body.
The pulmonary artery valve controls the blood flow from the right ventricle to the lungs.
The valves open to allow blood to flow through and then close to prevent blood from flowing back into the heart and lungs.
What are the symptoms of valve disease?
Patients with valve disease can be without any symptoms for a long time, especially with normal activities. The common symptoms are shortness of breath, heart palpitations, irregular heartbeats, dizziness or lightheadedness, leg edema, and chest pressure or pain. These symptoms typically get worse with exertion and can affect day-to-day activity. If ignored for a long period of time, patients can develop atrial fibrillation or heart failure symptoms, which is why it’s important to treat the problem as soon as it is diagnosed.
What is the treatment and what is the recovery?
A valve needs to be repaired if it is not closing properly or leaking, allowing blood to flow back to the heart or lungs, or not opening properly, blocking blood from leaving the heart or lungs. Valves can be weakened or damaged due to congenital anomalies, degenerative changes or secondary disease, such as infection. The valves of the left hear are more commonly affected than those of the right heart. The two most common valve diseases are mitral valve prolapse and aortic valve stenosis.
If the valve cannot be repaired, it can be replaced using the same minimally invasive technique.
Treatment for valve disease has generated excellent results over the years. Most mitral valve prolapses can be successfully repaired by preserving a patient’s native valve structure. Studies have shown that the success rate of repair is directly correlated to the surgeon’s experience in a high-volume cardiac surgery center. Almost all aortic valve stenosis cases need to be replaced with artificial valves. Both repair and replacements of the valves can be done using a minimally invasive technique. The minimally invasive approach is typically through a two-inch incision between the ribs to access the valves. The traditional procedure is a sternotomy, where the chest is opened to access the valves.
The surgery has advanced and current technologies have allowed surgeons to perform this procedure in a much safer and less traumatic way. Minimally invasive procedures have a 2 to 3 week recovery time, less blood loss and a smaller scar compared to the traditional method, which requires about 8 weeks of recuperation and physical rehabilitation.
What is the risk of waiting to repair or replace a valve?
Once a diagnosis is established, surgery should not be delayed. Delaying the procedure could result in permanent damage of the heart or permanent or difficult-to-treat arrhythmia. The surgery risk is higher once the patient is in the stages of heart failure.