Valvular Heart Diseases

Heart Valve Disease: After Your Visit

Your Care Instructions

Your heart is a muscular pump that has four chambers and four valves. The four valves are the mitral, aortic, tricuspid, and pulmonary valves. The valves open and close to keep blood flowing in the proper direction through your heart. When something is wrong with one of the valves, the blood cannot flow in and out of the heart properly. Problems with the heart valves can cause leaks (valve regurgitation) and blockages (valve stenosis). You can be born with heart valve disease, or it can develop over a number of years.

Mild cases of heart valve disease may not cause problems, but more serious cases will weaken the heart and can lead to heart failure. Treatment with medicine can help relieve symptoms, but it will not fix the valve. You may need to have surgery to replace or repair the valve.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
Eat a heart-healthy diet. For example, eat more fruits, vegetables, whole grains, and other high-fiber foods.
If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for 30 minutes on most days of the week. You also may want to swim, bike, or do other activities.
Do not smoke. Smoking can cause more heart problems. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You have severe trouble breathing.
You cough up pink, foamy mucus and you have trouble breathing.
You have symptoms of a heart attack. These may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

You have signs of a stroke. These may include:

Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
New problems with walking or balance.
Sudden vision changes.
Drooling or slurred speech.
New problems speaking or understanding simple statements, or feeling confused.
A sudden, severe headache that is different from past headaches.

You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You gain 2 to 3 pounds or more over 2 days.
You have increased swelling in your legs, ankles, or feet.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

Aortic Valve Stenosis: After Your Visit

Your Care Instructions

Having aortic valve stenosis means that the valve between your heart and the large blood vessel that carries blood to the body (aorta) has narrowed. That forces the heart to pump harder to get enough blood through the valve. Many people do not have symptoms until they are in their 50s or later. Some people never have symptoms.

Treatment with medicine can help relieve symptoms, but it will not fix the valve. Your doctor may want to delay surgery to replace or repair the valve until you begin to have symptoms of severe narrowing. These include chest pain, dizziness, fainting, or shortness of breath.

How can you care for yourself at home?

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
Plan your meals so that you are eating heart-healthy foods.

Eat a variety of foods daily. Fresh fruits and vegetables and whole grains are good choices.
Limit your fat intake, especially saturated and trans fat.
Limit salt (sodium).
Increase fiber in your diet.
Limit alcohol.

If your doctor recommends it, get some exercise. Walking is a good choice. Talk with your doctor about what kind of exercise is safe for you. Your doctor may suggest that you join a cardiac rehabilitation program so that you can have help increasing your physical activity safely.
Do not smoke. Smoking can make aortic valve stenosis worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).
You have symptoms of a heart attack. These may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Call your doctor now or seek immediate medical care if:

You develop new symptoms of aortic valve stenosis, such as chest pain, dizziness, or shortness of breath.
You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You have sudden weight gain, such as 3 pounds or more in 2 to 3 days.
You have increased swelling in your legs, ankles, or feet.

Watch closely for changes in your health, and be sure to contact your doctor if:

You have trouble making healthy lifestyle changes.
You want more information about healthy lifestyle changes.

Mitral Valve Regurgitation: After Your Visit

Your Care Instructions

The mitral valve lets blood flow from the upper to lower areas of the heart. Mitral valve regurgitation occurs when the valve cannot close all the way and blood backs up (regurgitates) into the upper area of the heart. This causes the heart to work harder to pump the extra blood.

Mild regurgitation causes few problems. Many people have it for many years without having problems. But if the regurgitation is severe, it can weaken the heart and lead to heart failure.

The causes of mitral valve regurgitation include a heart attack, heart infection (endocarditis), mitral valve prolapse, cardiomyopathy, calcium buildup in the heart, the weight-loss medicine Fen-Phen, and diseases such as lupus and rheumatoid arthritis. Some people are born with the valve problem.

Your doctor may just want to watch your health closely if you have mild mitral valve regurgitation. For more severe disease, you may need medicine or surgery to fix the valve.

How can you care for yourself at home?

If you feel lightheaded or very short of breath, sit or lie down so you do not get hurt if you faint and fall.
If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
Avoid eating foods with a lot of salt. These include potato chips, salted nuts, pizza, canned soups, canned vegetables, olives, and fast food.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You have severe trouble breathing.
You cough up pink, foamy mucus.
You have symptoms of a heart attack, such as:

Chest pain or pressure.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms.
Dizziness or lightheadedness.
A fast or uneven pulse.

After calling 911, chew 1 adult-strength aspirin. Wait for an ambulance. Do not try to drive yourself.

Call your doctor now or seek immediate medical care if:

You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You have sudden weight gain, such as 3 pounds or more in 2 to 3 days.
You have increased swelling in your legs, ankles, or feet.
You are suddenly so tired or weak that you cannot do your usual activities.

Watch closely for changes in your health, and be sure to contact your doctor if you develop new symptoms.

Learning About Heart Valve Surgery

What is heart valve surgery?

Heart valve surgery fixes or replaces a damaged heart valve. There are four valves in your heart. They are the mitral, aortic, tricuspid, and pulmonic valves. These valves open and close to keep blood flowing in the proper direction through your heart. When you have a problem with a heart valve, blood does not flow through the heart the right way.

During the surgery, the doctor may fix your heart valve or replace it with an artificial valve. The artificial valve may be made of plastic, metal, or animal tissue. Or your heart valve may be replaced with a donor heart valve that comes from a person who has died. Whether your heart valve is repaired or replaced depends on the type of heart valve problem you have.

How is heart valve surgery done?

The most common way to do heart valve surgery is through a large cut, called an incision, in the chest. This is called open-chest surgery. During open-chest surgery a heart-lung bypass machine is used to add oxygen to the blood and move the blood through the body. This machine will allow the doctor to stop your heartbeat while he or she works on your heart.

In some cases, other types of heart valve surgery may be an option. These include surgery that is done without stopping the heart and surgery that is done through smaller incisions in the chest.

What can you expect after heart valve surgery?

You will stay in the hospital for 4 to 7 days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. For at least 6 weeks, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.

You will probably need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel.

You will probably feel better than you did before you had the surgery. For example, you may no longer have shortness of breath and fatigue. But you may continue to have some heart problems.

After surgery, you may need to take anticoagulants to prevent blood clots. Be sure to tell all your doctors and your dentist that you have had heart valve surgery. This is important, because you may need to take antibiotics before certain procedures to prevent infection.

Heart Valve Surgery: Before Your Surgery

What is heart valve surgery?

Heart valve surgery repairs or replaces a damaged heart valve. There are four valves in your heart. They are the mitral, aortic, tricuspid, and pulmonic valves. These valves open and close to keep blood flowing in the proper direction through your heart. When the heart valves do not close properly or are very tight and narrow, blood does not flow through the heart the right way.

The doctor will make a cut (incision) in the skin over your breastbone (sternum). Then the doctor will cut through your sternum to reach your heart. The doctor will connect you to a heart-lung bypass machine, which is used to add oxygen to the blood and move the blood through the body. This machine will allow the doctor to stop your heartbeat while he or she works on your heart. While your heartbeat is stopped, the doctor will repair your heart valve. If the heart valve is badly damaged, it may be necessary to replace your heart valve with an artificial valve. The artificial valve may be made of plastic, metal, human, or animal tissue. Your doctor will talk with you before surgery about which type of valve is best for you.

After the doctor has repaired or replaced your heart valve, he or she will restart your heartbeat. Then the doctor will use wire to put your sternum back together, and stitches or staples to close the incision. The wire will stay in your chest. The incision will leave a scar that may become less noticeable with time.

You will stay in the hospital for 3 to 8 days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for 2 to 3 months you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles.

You will probably feel better than you did before you had the surgery. For example, you may no longer have shortness of breath and fatigue. But you may continue to have heart problems.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Having surgery can be stressful. This information will help you understand what you can expect and how to safely prepare for surgery.

Preparing for surgery

Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
Tell your doctors ALL the medicines, vitamins, supplements, and herbal remedies you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your surgery.
If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
You may need to stop taking certain medicines a week or more before surgery, so talk to your doctor as soon as you can.
Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

Taking care of yourself before surgery

Build healthy habits into your life. Changes are best made several weeks before surgery, since your body may react to sudden changes in your habits.

Stay as active as you can.
Eat a healthy diet.
Cut back or quit alcohol and tobacco.

If you have an advance directive—which may include a living will and a durable power of attorney for health care—let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before surgery, regardless of the type of surgery or condition.

What happens on the day of surgery?

Follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
Do NOT shave the surgical site yourself.
Remove all jewelry, piercings, and contact lenses.
Leave your valuables at home.

At the hospital or surgery center

Bring a picture ID.
Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery may be marked.
A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
The surgery will take about 3 to 5 hours.
You will go to the intensive care unit (ICU) right after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
As you wake up in the ICU, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.
You will have a thin plastic tube, called a catheter, in a vein in your neck. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal and usually last for only a few days. The chest tubes are usually removed in 1 or 2 days.
You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.

Going home

Be sure you have someone to drive you home.
For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
You will be given more specific instructions about recovering from your surgery, including activity and when you may return to work.

When should you call your doctor?

You have questions or concerns.
You don’t understand how to prepare for your surgery.
You become ill before the surgery (such as fever, flu, or a cold).
You need to reschedule or have changed your mind about having the surgery.