Cardiac Valve Replacement: Symptoms, Classification, Diagnosis & Recovery

Cardiac Valve replacement is performed to replace or repair a valve in the heart that stops working properly due to Valvular Heart Disease, also called Heart Valve Disease.

Heart valve replacement surgery involves a significant procedure that is performed through an open-heart approach, accessing the chest via the breastbone. This major operation, lasting two hours or more, requires a substantial recovery period, often extending over several weeks. While advancements have introduced less invasive alternatives for specific cases of valvular heart disease, these procedures are currently limited to select hospitals.

The main types of cardiac valve impairment include:

Valvular Stenosis: Narrowing of the valve opening, restricting the flow of blood through the valve. Common valves affected include the aortic and mitral valves.
Valvular Regurgitation (Insufficiency or Incompetence): Leakage or backward flow of blood through a valve that does not close properly, leading to inefficient pumping. The aortic and mitral valves are commonly affected.
Valvular Prolapse: This occurs when the valve leaflets bulge or collapse backward into the atrium during the heart's contraction. Mitral valve prolapse is a well-known example.
Valvular Atresia: Complete blockage or absence of a heart valve, hindering blood flow. This condition is often congenital and may require surgical intervention.
Infective Endocarditis: Inflammation of the heart valve, typically caused by an infection. It can lead to valve damage and impairment.
Rheumatic Heart Disease: A condition resulting from untreated streptococcal infections that can cause inflammation and scarring of the heart valves, affecting their functionality.
Bicuspid Aortic Valve: A congenital condition where the aortic valve has only two leaflets instead of the usual three, potentially leading to stenosis or regurgitation over time.
Calcific Aortic Stenosis: A gradual accumulation of calcium deposits on the aortic valve, causing it to become stiff and narrow over time.
Degenerative Valve Disease: Age-related wear and tear on the heart valves, leading to conditions such as calcification, stenosis, or regurgitation.
Traumatic Valve Injury: Damage to heart valves due to injury or trauma, which can affect their structure and function.

Valve replacement includes four procedures:

Aortic valve replacement (AVR)
Mitral valve replacement (MVR)
Tricuspid valve replacement (TVR)
Pulmonary valve replacement (PVR)

The aortic valve and the mitral valve replacements are the most common. Pulmonary and tricuspid valve replacements are uncommon in adults.

It's crucial to note that the specific symptoms can vary depending on which valve is affected (aortic, mitral, pulmonary, or tricuspid) and the nature of the impairment (stenosis or regurgitation). The following are the symptoms:

Chest Pain or Discomfort: Individuals with valve impairment may experience chest pain or discomfort, often associated with exertion or physical activity.
Shortness of Breath: Difficulty breathing or shortness of breath, especially during exertion or when lying down, can be a common symptom of valve problems.
Fatigue and Weakness: Persistent fatigue and weakness, unrelated to physical activity, may indicate insufficient blood flow due to valve dysfunction.
Irregular Heartbeat (Arrhythmia): Valve issues can disrupt the normal heart rhythm, leading to palpitations or irregular heartbeats.
Swelling (Edema): Fluid retention may cause swelling in the extremities, such as the ankles, feet, or abdomen.
Lightheadedness or Dizziness: Impaired blood flow through the heart can lead to decreased oxygen delivery to the brain, resulting in lightheadedness or dizziness.
Fainting (Syncope): Severe valve impairment may cause a drop in blood pressure, leading to fainting episodes.
Chronic cough: sometimes accompanied by pink or blood-tinged sputum, may be a sign of heart failure resulting from valve problems.

Before undergoing cardiac valve replacement, individuals typically undergo a series of diagnostic tests to assess the condition of the heart and determine the need for surgery. These may include:

Echocardiogram: An ultrasound of the heart that provides detailed images of the heart's structure and function, helping evaluate the condition of the heart valves.
Electrocardiogram (ECG or EKG): Records the heart's electrical activity, detecting irregularities in rhythm or conduction that may indicate valve problems.
Chest X-ray: Provides images of the heart, lungs, and blood vessels, helping assess the size and shape of the heart.
Cardiac Catheterization (Angiogram): Involves injecting contrast dye into the coronary arteries to visualize blood flow and identify any blockages or abnormalities.
Cardiac MRI (Magnetic Resonance Imaging): It offers detailed images of the heart's structure and blood vessels, providing additional information about valve function.
CT Scan (Computed Tomography): It Produces detailed cross-sectional images of the heart and surrounding structures, aiding in the evaluation of valve anatomy.
Blood Tests: Assess overall health, check for infection, and evaluate factors such as blood clotting and kidney function.
Pulmonary Function Tests: Measure lung function to ensure optimal respiratory capacity before surgery.

Valve replacement or repair can be done in several ways, depending on the problem. The most common valve replacements are:

Aortic Valve Replacement (AVR)

Surgical procedure- In Aortic valve replacement the incision is made by cutting through the sternum. After the pericardium is opened, the patient is put on a cardiopulmonary bypass machine, which is also known as the heart-lung machine. This machine performs the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.

The surgeon makes a cut in the aorta when the patient is on bypass and applies a crossclamp. The patient's diseased aortic valve is removed and is replaced by a mechanical or tissue valve. After the placement of the artificial valve and closing the aorta, the heart-lung machine is taken off from the patient. A transesophageal echocardiogram helps to confirm whether the new valve is functioning properly.

Mitral Valve Replacement (MVR)

Surgical procedure- General anesthesia is given to the patient before mitral valve replacement. An incision is made horizontally under the left breast, or vertically through the sternum. After exposing the heart, a cannula is placed and blood is directed to the heart-lung machine for cardiopulmonary bypass. The mitral valve is exposed by creating an incision in the left atrium. Then the valve is replaced. The left atrium is closed and the cardiopulmonary bypass is removed. The patient is taken to an intensive care unit after the surgery.

Post cardiac valve replacement, patients typically undergo a recovery period that involves monitoring for signs of infection, managing pain, and gradually resume normal activities. Short-term restrictions on strenuous activities may be advised, and a cardiac rehabilitation program could be recommended to enhance overall recovery.

Regular follow-up appointments with healthcare professionals help track progress and address any concerns, ensuring a smooth transition back to daily life while promoting optimal heart health.

Rod Schaubroeck

United States

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