There are four valves in your heart: aortic, mitral, pulmonary, and tricuspid. These valves control the direction of blood flowing through the chambers of your heart. When closed, the valve prevents blood from flowing backwards to its previous location. When open the valve allows blood to flow to the next chamber. The opening and closing of the heart valves produce the sound of the heartbeat. Each valve either consists of two or three folds of thin tissue. Valve problems may be caused by infections such as rheumatic fever or endocarditis, congenital birth defects, acquired calcification, or certain medications. Symptoms of valve disease may include shortness of breath, wheezing, easy fatigue, palpitations in the chest, fainting spells, ankle swelling, chest pain, or murmur on exam.

Heart valve surgery is usually recommended for one of two conditions: stenosis or regurgitation. Stenosis is a narrowing of the heart valve, which limits the flow of blood forward to the next chamber. Regurgitation is a leaking of the heart valve, allowing blood to flow backwards into the previous chamber. In either case, the heart must pump harder to do the same work as someone with a normal valve. Over years, this will lead to heart failure. Recent evidence suggests that earlier surgical intervention may prevent this irreversible damage to the heart. The decision on when to proceed with surgery is usually made with your cardiologist and cardiac surgeon. These physicians are best able to discuss the risks and benefits of valvular heart surgery.

Heart valve surgery is open-heart surgery that is done while you are under general anesthesia. A cut is made through the sternum (median sternotomy). Like the CABG, the heart-lung bypass machine is used. This machine keeps the blood oxygenated and circulating while your heart is being operated on. Valves may be either repaired or replaced. Replacement heart valves are either mechanical (artificial) or made of tissue. Tissue valves may come from human or animal sources (commonly pig or cow). Tissue valves do not usually last as long as mechanical valves, and replacement surgery may be later necessary. However, mechanical valves require the chronic use of a blood thinner postoperatively to prevent blood clots. The use of chronic anticoagulants is associated with its own problems. Some valves (notably the mitral) can be repaired instead of replaced, lowering the risk of postoperative problems. If a valve needs replacement, it is removed and the new valve sewn into the fibrous tissue that held the old valve in place. Despite the complex surgery, the success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

You will stay in an intensive care unit for the first 1 to 3 days following the operation. Your heart functions will be monitored constantly. The average hospital stay is 1-2 weeks. Complete recovery will take a few weeks to several months, depending on your health before surgery. Most patients feel better after their operation because the symptoms of their heart valve disease have been relieved. The doctor will prescribe a program of recovery that includes diet, exercise, and medication. Special care must be taken to prevent bacteria from entering the blood stream and causing infective or bacterial endocarditis in the tissues around the valve. This is especially true for mechanical valves. After receiving a mechanical valve, antibiotics are necessary before any subsequent procedure, even dental appointments.