FREQUENTLY ASKED QUESTIONS
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- What is a heart valve?
Your heart has four valves: the mitral valve and the aortic valve on the left side of your heart and the tricuspid valve and the pulmonic valve on the right side of your heart. In order for blood to move properly through your heart, each of these valves must open and close properly as the heart beats. The valves are composed of tissue (usually referred to as leaflets or cusps). This tissue comes together to close the valve, preventing blood from improperly mixing in the heart’s four chambers (right and left atrium and right and left ventricle).
- When do the heart valves open and close?
You may notice that the beating of your heart makes a “lubb-dubb, lubbdubb” sound. This sound corresponds to the opening and closing of the valves in your heart. The first “lubb” sound is softer than the second; this is the sound of the mitral and tricuspid valves closing after the ventricles have filled with blood. As the mitral and tricuspid valves close, the aortic and pulmonic valves open to allow blood to flow from the contracting ventricles. Blood from the left ventricle is pumped through the aortic valve to the rest of the body, while blood from the right ventricle goes through the pulmonic valve and on to the lungs. The second “dubb,” which is much louder, is the sound of the aortic and pulmonary valves closing.
- How often do my heart valves open and close?
The average human heart beats 100,000 times per day. Over the life of an average 70-year-old, that means over 2.5 billion beats.
- How big are my heart valves?
Your heart is about the size of your two hands clasped together. The aortic and pulmonic valves are about the size of a quarter or half dollar, while the mitral and tricuspid valves are about the size of an old-fashioned silver dollar.
- What causes valvular heart disease?
There are several reasons that one or more of your heart valves may not work properly. The ultimate effect of a diseased heart valve is that it interrupts normal blood flow through the heart. Causes may include the following:
- Endocarditis — an infection of the valve tissue.
- Rheumatic fever — a specific type of infection more prevalent in developing countries where the valve tissue becomes inflamed and/or fused together.
- Calcification — over time, calcium in your body can build up on the tissue of your valve making it difficult for them to move properly.
- Congenital defects — a condition you are born with such as having only two leaflets on the aortic valve rather than three.
- Ischemia — also known as coronary artery disease when the heart’s own blood vessels become clogged and can no longer deliver the proper amount of blood.
- Degenerative disease — a progressive process that represents slow degeneration from mitral valve prolapse (improper leaflet movement). Over time, the attachments of the valve thin out or rupture and the leaflets become floppy and redundant.
- How is valvular heart disease treated?
There are different methods for treating valvular heart disease, and you should discuss your options with your physician. In some cases, no action may be needed and a “wait and see” approach may be used. Your doctor may also prescribe various medications that may improve your symptoms. If the disease has progressed, your doctor may recommend intervention. What procedure is appropriate is a decision that your doctor will make in consultation with you. This is dependent upon such things as which valve or valves need to be addressed, your specific medical conditions, and other factors. In general, there are two options to treat valvular heart disease: one is to repair your native valve, and the other is to replace your native valve with a prosthetic valve.
- What are my surgical options?
During typical “open-chest” surgery to repair or replace a heart valve, the surgeon makes one large main incision in the middle of the chest and breastbone to access the heart. A heart-lung machine takes over the job of circulating blood throughout the body during the procedure, because the heart must be still and quiet while the surgeon operates. Many surgeons are now able to offer their patients minimal incision valve surgery as an effective alternative to open-chest heart valve surgery. Smaller incisions may be on the side of the chest or in the center.
- How is minimal incision valve surgery performed?
Minimal incision valve surgery does not require a large incision or cutting through the entire breastbone. The surgeon gains access to the heart through smaller, less visible incisions (sometimes called “ports”) that are made between the ribs or a smaller breastbone incision. The diseased valve can be repaired or replaced with the surgeon looking at the heart directly or through a small, tube-shaped camera.
- How can my heart valve be repaired?
In some cases, it is possible to repair your valve. Repair is most commonly performed on the mitral and tricuspid valves. The goal of the repair procedure is to fix your native valve so that it can open and close properly, thereby restoring normal blood flow through the heart. An implantable device which is usually ring-shaped with a metal core may be placed directly above your valve and tied in place with sutures. This procedure is called ring annuloplasty. The ring helps your valve maintain its proper shape so that blood does not leak out as the heart contracts and relaxes. This surgery can be performed with a conventional, full sternotomy or through a less invasive or minimal incision approach as well.
- How can my heart valve be replaced?
If your heart valve cannot be repaired, your doctor may decide to replace your native valve with a prosthetic valve. The aortic valve is the most commonly replaced heart valve. The prosthetic valves are usually one of two types: a mechanical valve or a tissue valve. A mechanical valve is made from synthetic (manmade) materials, primarily carbon. A tissue valve is usually made from either the tissue from a pig’s aorta or the tissue from the pericardium (sac surrounding the heart) of a cow. The surgeon may remove part or all of the native valve in order to implant the new valve. Your new prosthetic heart valve is secured to the heart with strong, permanent sutures. This surgery can be performed with a conventional, full sternotomy or through a less invasive or minimal incision approach as well.
- Are there any complications or other risks with heart valve surgery that I should know about?
Serious complications, sometimes leading to re-operation or death, may be associated with heart valve surgery. It is important to discuss your particular situation with your doctor to understand the possible risks, benefits, and complications associated with the surgery.
- How long does an artificial heart valve last?
Longevity of an artificial tissue valve depends on many patient variables and medical conditions. This makes it impossible to predict how long a valve or repair device will last in any one patient. However, symptoms indicating that a tissue valve may need replacement typically occur over time and allow the doctor to schedule elective surgery, if the need arises. All patients with prosthetic heart valves should have a yearly echocardiogram and check-up in order to assess heart valve function.
- Should I have a mechanical valve or a tissue valve?
You should discuss this question with your doctor as there are advantages and disadvantages to both. The key is to choose the valve that best fits your lifestyle and your goals. A mechanical valve may last longer than a tissue valve (which can wear out over time). However, patients with mechanical valves are required to be on anticoagulants (blood thinners) for life. Blood thinners are needed with mechanical valves to reduce the risk of clot formation. If these clots are big enough, they could cause adverse events like strokes. Being on blood thinners may require you to limit certain physical activities in order to reduce the risk of bleeding events. You may also need to modify your diet and make other lifestyle changes. It is important to discuss these issues with your doctor. Tissue valves do not require you to be on blood thinners for the rest of your life. However, they can wear out over time which may require a re-operation.
- Bovine or porcine tissue?
Artificial tissue heart valves are typically made from either bovine pericardium or porcine tissue. Bovine refers to cow or cattle, whose pericardial tissue is used to make the valve. Pericardium is a strong, fibrous membrane that surrounds the heart. Porcine refers to pig, from which aortic heart valve tissue is used to make the valve.
The Edwards porcine valve has been marketed since 1975. The Edwards bovine aortic valve was first used in clinical trials in humans in 1981 and was approved for sale in the USA in 1991. Your surgeon is the best resource to discuss treatment options for you.
- Should I expect an immediate improvement in my health following heart valve repair or replacement surgery?
The results of valve repair or replacement surgery vary for each individual. Most individuals feel relief from symptoms immediately, while other patients begin to notice an improvement in their symptoms in the weeks following surgery. Your doctor can help you to evaluate your progress and physical health following valve repair or replacement surgery.
- How long after heart valve repair or replacement surgery can I resume “normal” levels of activity?
If you have a valve replaced or repaired, the normal recovery period is four to eight weeks, although minimally invasive approaches are often associated with more rapid recovery. During this time, you will begin to notice restored muscle tone and return to normal energy and activity levels. Your ability to return to your normal daily activities depends on several factors, including the type of valve repair/replacement you’ve had, how you feel, how well your incision is healing, and the advice of your doctor. Regardless of the pace of your recovery, a supervised cardiac rehabilitation program is always helpful to regain energy and ensure overall good health.
- Will I need to take any medications following my heart valve repair or replacement surgery?
As with any surgical procedure, you may be required to take medications following surgery. Discuss with your doctor which (if any) medications you may need.
- What do I need to know if I am required to take blood thinners after my surgery?
Anticoagulants, or blood thinners, decrease the blood’s natural ability to clot. If you must take anticoagulant drugs, you will need a prothrombin time blood test (commonly called a pro-time test or INR) every two to four weeks. A pro-time test (INR) measures the level of certain clotting factors that indicate the blood’s ability to clot. This test result helps your doctor determine the amount of anticoagulant you need. The pro-time test should be done at the same lab every time because results may vary from one lab to another. It may take a while to establish the right dosage of this drug for you, but consistency and working with your doctor are important. Home testing may also be available, so check with your physician about this option.
While taking anticoagulants, you should avoid large amounts of foods high in vitamin K, such as leafy greens, since they may interfere with your anticoagulant. Excessive alcohol may also alter its effect. Even simple over-the-counter drugs such as aspirin, laxatives, vitamins, and cough medications can make your anticoagulant more or less active than usual. Consult your doctor before eating these foods or taking any of these drugs.
Notify your doctor IMMEDIATELY if you experience any of these symptoms, which can indicate that your anticoagulant dosage is too high:
- Bleeding from a cut that does not stop by itself
- Bleeding gums from brushing
- Red or black, tarry stools
- Any unusual symptoms such as pain, swelling, or discomfort
- How do I take care of my valve?
Be sure your dentist and doctors know that you have had heart valve surgery. Ask your dentist and doctor about taking antibiotics before dental or surgical procedures or endoscopy to help prevent valve infection. Always follow your doctor’s instructions carefully.
- Will my prosthetic heart valve or heart valve repair ring cause a metal detector at the airport to go off?
Although the amount of metal in these devices is very small, airport metal detectors can be very sensitive, so it is possible they could cause an airport metal detector to go off; however, this is very unlikely. Be sure to carry your patient identification card with you at all times.
- How can I get a patient identification card?
If you received an Edwards heart valve repair or replacement product, you may request a patient ID card by calling the Edwards Implant Patient Registry at 800-424-3278 (for calls placed from within the USA) or at 949-250-2500 (for calls placed from outside the USA).
You may also e-mail or write to us at:
Implant Patient Registry
Edwards Lifesciences LLC
PO Box 11150
Santa Ana, CA 92711-1150 USA
- Can I have an MRI with my heart valve or annuloplasty ring?
Most Edwards heart valves and annuloplasty rings are safe and compatible during magnetic resonance imaging (MRI) procedures. Information is not available on annuloplasty rings made of stainless steel before 1984. Please have your doctor or imaging center visit www.edwardsmri.com
or contact our Technical Services Department for details on specific product model numbers.
U.S. and Canada 800.822.9837
Outside the U.S. 1.949.250.2500 ext. 5030
Fax 1.949.250.2625 firstname.lastname@example.org
Edwards Lifesciences LLC
PO Box 11150
Santa Ana, CA 92711-1150 USA