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Heart Valves: Keeping the Doorways Healthy

Dr Manoj Kumar Daga

Valve replacement surgery
When there is severe leakage in the valves or the valve is severely deformed due to calcification or other reasons, the viable option of treatment is a valve replacement. Artificial heart valves are of two types: mechanical or tissue.

Mechanical heart valves, as the name implies, are made of metals and are of various types: ball and cage, tilting disc and bileaflet. Depending on the designer, they are called Starr Edwards, Medtronic-Hall, St. Jude, ATS and so on. They last for a very long time (20-30 years) and allow the patients to lead a normal, active life. The only significant disadvantage of this type of valve is the tendency to form blood clots or thrombus around the metallic surfaces. To prevent this serious consequence, patients have to be on lifelong anticoagulation. Usually, the medication Warfarin (Coumarine group) is given, which reduces the clotting tendency and keeps the valves working smoothly. Patients have to undergo a monthly blood test to check their INR (International Normalised Ratio), which is an index of the clotting ability. The medication is thus adjusted to the minimum safe dosage so as to reduce the risk of serious internal or external haemorrhage.

Biological heart valves are principally harvested from animals. The pig’s (porcine) heart valve is frequently used since it is anatomically very similar to the human heart valve. This type of surgery is called xenotransplantation. The other type of biological valve is made out of the pericardial sac of cows or horses. These valves also work very well. But these valves do not grow with the patient and may need a replacement in future.

Ross procedure is a surgery where the severely diseased aortic valve is replaced by the patient’s own pulmonic valve, and the pulmonic valve is replaced by a cadaveric valve. The pulmonic valve, working under low pressure, is slow to develop any dysfunction. These types of valves grow with the patient and thus give freedom from the prospect of re-operation. Anticoagulation is also not required for this type of replacement since no metallic surface is present. This is the procedure of choice, particularly for children, with severe aortic valve disease. Some hospitals today offer the facility of valve banks, where cadaveric valves are harvested and preserved.

Life after valve replacement
The principal purpose of any therapy is to give back a normal active and good quality of life to the patients. Thus after a successful valve replacement surgery, patients are to be able to pursue their education, job, active social life and would be in no way different from their heart-healthy counterparts. But they need to be under regular medical checkup, as advised by their cardiologists. Those on anticoagulation therapy should have their blood tests done as scheduled and take the medicines without fail. Rough contact sports like rugby should be avoided to minimize the risk of injury and bleeding. Periodic tests like echocardiogram may be needed to assess the functioning of the valves.

There is no restriction in marriage and having a family. But women who look forward to be mothers, should discuss with their cardiologist before planning for conception and keep in constant touch with him throughout the pregnancy and childbirth, so that medications can be properly adjusted for the safety of both the mother and the child.
Development of any symptoms like shortness of breath, unexplained exhaustion, swelling of ankles, fever and severe cough should never be ignored and promptly reported to the cardiologist to rule out any valve dysfunction.

As mentioned earlier, valve surgery has come a long way since its introduction in the fifties. It is important to perform the surgery at the opportune moment to prevent irreversible damage and to allow the patients to enjoy the maximum benefit of this life-saving procedure.

Dr Manoj Kumar Daga is Senior Consultant Cardiothoracic and Vascular Surgeon at Apollo Hospitals, Kolkata.
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