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made of human or animal tissue. The surgeon decides which type of replacement valve is appropriate. Mechanical replacement valves are efficient, but can cause blood clots to form that can break loose, travel through the bloodstream, and block an artery in the brain or elsewhere in the body. If you have a mechanical valve replacement, your doctor will prescribe an anticoagulant to help prevent the formation of blood clots. The opening and closing of a mechanical heart valve can also cause red blood cells to break down (hemolysis). Tissue valves are much less likely to cause clots to form, but they may be less durable than mechanical valves.

WARNING!

Heart Valve Replacement

If you have had heart valve replacement surgery and you suddenly become short of breath, dizzy, or faint; if your urine looks abnormally dark; or if your chest begins to ache, see your doctor right away. These symptoms may indicate that the replacement valve is not working.

Heart Valve Replacement Surgery

Doctors perform heart valve replacement surgery to replace damaged heart valves with either mechanical valves made of metal and plastic, or tissue valves made of human or animal tissue.

During Surgery

During the procedure, you are under general anesthesia, and a heart-lung machine takes over your circulation and breathing. An anesthesiologist monitors your breathing and vital signs. The surgeon makes an incision, either along your breastbone or along a lower rib on your left side. Your ribs are parted, your heart is opened, and the damaged valve is removed. The new valve is then stitched in place. The procedure takes from 2 to 4 hours.

After Surgery

You will spend the first few days after surgery in the hospital’s CCU (cardiac care unit) or ICU (intensive care unit). One or two drainage tubes will be placed in your chest and attached to suction bottles. You will breathe oxygen through a tube leading into your nose and you may need to use a ventilator (a device that assists with breathing). Your bladder will be drained with a catheter. You will receive fluid and blood through intravenous tubes, and your heart and vital signs will be monitored constantly.

Choice of Valves

The best type of valve for you depends on factors such as your age and general health. Mechanical valves last a long time, but you will need to take anticoagulant drugs to help prevent blood clot formation. Tissue valves made from animal or human tissue may need to be replaced after a period of years, but people who have tissue valves often do not need to take anticoagulants. The risk of complications is low with both types of valves.

Replacement heart valves

Replacement heart valves may be mechanical or made of tissue. Mechanical valves are made of metal and plastic; tissue valves are made from animal or human tissue. A mechanical heart valve allows blood to flow in one direction by forcing the metal valve flaps (leaflets) apart. If blood begins to flow in the opposite direction, it forces the leaflets together firmly against the ring, closing the valve. A tissue heart valve functions like a natural heart valve.

Mitral Valve Prolapse

Mitral valve prolapse is a deformity of the mitral valve that can sometimes produce mitral regurgitation (see page 589). Mitral valve prolapse produces a sound called a heart murmur that a doctor can hear through a stethoscope. This condition affects about 5 percent of Americans and is much more common in women than in men.

The cause of mitral valve prolapse is usually not known, but it may result from an inherited weakness in the connective tissue of the valve that allows the valve to bulge. Occasionally, mitral valve prolapse results from rheumatic fever (see page 432), heart disease (see page 558), or cardiomyopathy (a degenerative disease of the heart muscle).

Symptoms

Symptoms of mitral valve prolapse may include chest pain, arrhythmias (irregular heartbeats), shortness of breath, or fatigue. However, most people who have mitral valve prolapse have no symptoms.

Treatment

Treatment for mitral valve