Valvular Heart Disease is still very common in our country. Most of these are due to Rheumatic Heart Disease. Normally these start with recurrent throat infection and joint pains in childhood / teen age. These young adults develop valve problems.
There four valves in the human heart out of which single or two valves may be affected. The commonly affected valves are known as mitral and aortic. Sometimes tricuspid valve is also involved. Valve problems may be either narrowing (stenosis) or leaking (regurgitation) or a combination of both.
Valves once damaged require either a repair or a replacement. If it is not tackled in time it may cause heart to become enlarged and increased pressures in the lungs. This leads to permanent changes in the lungs.
Heart Valve Surgery can be done either by a conventional route or by a minimally invasive route. Dr S K Sinha, who is Director CTVS Cardiac Science, Max Healthcare, Saket, New Delhi , specializes in doing valve surgeries by minimally invasive route. Here instead of a mid line sternum splitting incision a small incision on the right chest beneath the breast is made and with the help of specialized instruments valve is repaired or replaced.
Minimally invasive cardiothoracic surgery has its advantage in the form of small incision, faster recovery less pain, minimal blood loss. As the scar is beneath the breast in females it is a widely accepted for its cosmetic value.
TYPES OF VALVES:
A frequently asked question which a patient asks is what type of valve will be good for me.
Prosthetic (Artificial) heart valves is broadly classified into two types:
- Mechanical
- Bioprosthetic
Mechanical Valve: Mechanical Valves are valves which are made of Pyrolite carbon(one of the strongest material known to mankind). It is used in younger patients, will last a lifetime. However it is important that patients take Warfarin or Acitrome lifelong. Below 50 years of age this is valve of choice. Exception being female patients who want to undergo pregnancy.
Bioprosthetics or biological valves are made up of biological tissue (Pericardium), best suited for patients above 50years of age. Warfarin/Acetrome is not needed. This valve is supposed to last 20-25 years hence not recommended in patients below 50 years of age.
Care after a Valve Replacement.
It is important that patients take care of themselves after a Valve Replacement. Most common problems to be prevented are:
Infection – The most dreaded complication. Infection occurring in the valve is dangerous. Any fever is a sign of infection. Toothache is dreaded as bacteria, circulates in the blood, hence oral hygiene is of utmost importance. Dr S K Sinha recommends morning evening brushing of teeth, Hot Saline Gargles and Listerine/betadine mouth wash before going to bed. Slightest toothache antibiotics are recommended.
Urinary tract infection, skin infection in the form of recurrent boils and abscess should be prevented and if it occurs early antibiotics therapy is a must.
Embolism/Haemorrahage _ Blood being too thick or too thin, both are bad. After valve replacement INR between 2.0 to 3.5 is recommended- a close contact with Dr Sinha’s team is important to maintain it in this range.
Pregnancy – It is important that if pregnancy occurs patients should be in close contact with doctors.