Heart valve repair and replacement

Understanding heart valve disease

The heart has four valves — the mitral, aortic, tricuspid and pulmonary valves — that open and close with every heartbeat to keep blood flowing in one direction through the heart's chambers and out to the body and lungs. Valve disease means one or more of these valves is not working properly, in one of two broad ways: stenosis, where the valve becomes stiff or narrowed and does not open fully, making the heart work harder to push blood through it; or regurgitation (also called incompetence or leakage), where the valve does not close fully, allowing blood to flow backwards. Either problem, if severe, forces the heart to work harder over time, which can eventually weaken it.

Surgery is recommended once valve disease becomes severe and is causing symptoms, or is affecting the heart's function, even without symptoms in some situations. Depending on the valve and the disease, surgery may repair your own valve, or replace it with an artificial valve — either a mechanical valve, which is very durable but requires lifelong blood-thinning medicine, or a tissue valve, which does not usually require lifelong blood thinners but may wear over time. Your surgical team will discuss which option, and which valve, is right for you.

What you may notice

Symptoms depend on which valve is affected and how severe the problem is; some people have no symptoms for years even with significant valve disease, which is why regular follow-up matters once a valve problem is known:

• ●Breathlessness, especially on exertion or when lying flat
• ●Unusual fatigue or reduced ability to do activities that were previously easy
• ●Swelling of the ankles, feet or abdomen
• ●Palpitations, or an awareness of an irregular heartbeat
• ●Chest discomfort or tightness, particularly with exertion
• ●Light-headedness or fainting, particularly with narrowed (stenotic) valves

What causes valve disease

The cause shapes both the valve affected and the likely treatment path.

Rheumatic heart disease

A leading cause of valve disease in Nigeria and much of Africa. It follows an earlier, sometimes unrecognised, throat infection with a particular type of bacteria in childhood, which triggers an immune reaction that can scar and damage heart valves — often not becoming apparent until years later in adulthood. It most commonly affects the mitral valve.

Degenerative (age-related) valve disease

Valves, like other tissues, can stiffen, thicken or calcify (build up calcium deposits) with age, most commonly affecting the aortic valve.

Congenital valve problems

Some people are born with a valve that formed differently — such as an aortic valve with two leaflets instead of the usual three — which may not cause problems until later in life.

Infective endocarditis

An infection of the heart's inner lining and valves, which can damage a previously normal valve or worsen an already affected one; it needs urgent treatment and is a key reason good dental and skin hygiene matter for heart health.

Who is more likely to need valve surgery

• ●A history of rheumatic fever or frequent, untreated sore throats in childhood
• ●Increasing age, for degenerative valve disease
• ●A known congenital heart or valve condition
• ●A previous episode of infective endocarditis
• ●Poor dental health, which raises the risk of the infections that can lead to endocarditis
• ●Other structural heart disease

What happens on the day

Reaching the decision to operate, and the day of surgery itself, typically follows this pathway:

• 01
  Heart-team assessment. Cardiologists and cardiac surgeons review your imaging and overall health together to agree the best approach for you.
• 02
  Detailed imaging. A thorough echocardiogram, and where needed, catheter-based imaging or CT scanning, to define exactly which valve is affected and how severely.
• 03
  Anaesthetic and operative planning. Assessment by the anaesthetic team and discussion of the planned operation, including repair versus replacement and, where relevant, valve type.
• 04
  The operation. Performed under general anaesthetic, usually reaching the heart through an incision in the chest, with a heart-lung bypass machine temporarily taking over the work of the heart and lungs while the valve is repaired or replaced.
• 05
  Immediate ICU recovery. Close monitoring of heart rhythm, breathing and circulation in the hours after surgery.
• 06
  Ward recovery and rehabilitation. Progressive mobilisation, wound care and breathing exercises before discharge.
• 07
  Long-term follow-up. Regular review and echocardiography to check the valve continues to work well.

Living well with a new or repaired valve

Life after valve surgery usually returns to a full range of normal activities, with a few ongoing habits that protect the result:

• ✓Understand which valve type you have and your medicine plan, including whether you need lifelong blood thinners
• ✓Maintain good dental health, and tell your dentist you have had valve surgery before any dental treatment
• ✓Attend regular echocardiography as scheduled, even once you feel completely well
• ✓If you take a blood thinner such as warfarin, keep up with blood-level (INR) checks and be cautious with herbal remedies, which can interact with it
• ✓Ask about pregnancy planning in advance if relevant, as some valve types and blood thinners need special consideration
• ✓Report unexplained fever promptly rather than waiting, given the small risk of valve infection

Preparing for your appointment

What to bring

• ✓Any previous echocardiogram results or hospital letters
• ✓A list of all medicines you take, including herbal and over-the-counter products
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

Your symptoms and how they affect daily activities, any history of childhood sore throats or joint pains, other medical conditions, and all medicines you currently take.

Questions worth asking us

• ●How severe is my valve disease, and does it need surgery now or monitoring for now?
• ●Is repair possible, or is replacement more likely for me?
• ●If I need a replacement, which valve type would you recommend, and why?
• ●What will recovery involve, and when can I return to work and normal activity?