Q. I have a leaky heart valve that may need surgery down the road. Can you tell me about heart-valve surgery in one of your columns?
First, let’s explain briefly how the heart works.
There are four chambers in the heart—two atria on top and two ventricles below. There are four valves that open and shut with every heartbeat to control the circulation of the blood. These valves, which are made of tissue flaps, are called the tricuspid, pulmonary, mitral and aortic.
Blood flows in one direction through the heart to get a new supply of oxygen from the lungs. Here’s how it goes:
Used blood comes back to the heart from the body and goes into the right atrium. The right atrium pumps the blood downward through the tricuspid valve into the right ventricle. The right ventricle pumps the blood through the pulmonary valve to the lungs. The oxygenated blood returns from the lungs to the left atrium. The left atrium moves the blood down through the mitral valve into the left ventricle. The left ventricle pumps the blood out the aortic valve, which supplies the body.
Valves can malfunction and strain the heart. If a valve doesn’t close properly, blood will flow backward. This is called “regurgitation.” If valve flaps don’t open correctly, they prevent blood from flowing through them. This is called “stenosis.”
Advanced valve disease can cause blood clots, stroke or sudden death from cardiac arrest.
For seniors, there is a problem with the flaps of the aortic and mitral valves; they thicken and harden with age, making blood flow more difficult. These changes may lead to complications in people with heart disease.
Other common causes of valve disease are: birth defects that produce irregularly shaped aortic valves or narrowed mitral valves; infective endocarditis, a bacterial infection of the lining of the heart's walls and valves; coronary artery disease, and heart attack.
People with malfunctioning valves who don’t have serious symptoms may not need treatment. Medicines can help with symptoms but don’t fix a bad valve. Surgery or a less invasive procedure is often needed to correct valve disease.
There is a percutaneous (through-the-skin) procedure that may be used to open narrowed tricuspid, pulmonary and mitral valves. In rare cases, it is used on aortic valves. A balloon-tipped catheter is inserted into the narrowed valve and inflated. The balloon makes the central area of the valve larger. The balloon is then deflated and removed.
During surgery, valves may either be repaired or replaced. Repair may involve opening a narrowed valve or reinforcing a valve that doesn't close properly. Surgeons replace irreparable valves with prosthetic valves.
Prosthetic valves can be mechanical; they are made of plastic, carbon, or metal. Or, these replacement valves can be composed of human or animal tissue. There is an increased risk of blood clots forming with a mechanical valve, so patients who get them have to take blood-thinning medicines as long as they have this kind of valve.
Valve surgery is an open-heart operation that requires a heart-lung bypass machine. During the operation, the heart must stop beating. The machine keeps the blood circulating in the patient’s body.
If you would like to read more columns, you can order a copy of “How to be a Healthy Geezer” at www.healthygeezer.com.