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Care of patients with heart valve disease and congenital heart diseases

What is heart valve disease?

Heart valve disease is a common cause of exertional dyspnoea and heart murmur. The valve may be congenitally defective or become defective over time. Aortic stenosis is caused by degradation and calcium build-up, which results in the valve not opening sufficiently, causing an obstruction. On the other hand, the valve may also leak, often due to a structural failure, causing blood to flow back from the leaking valve. The heart would then have to work harder to ensure the blood circulation. A serious persistent valvular defect overloads the heart and causes the atrium to enlarge, sometimes causing arrhythmia. The most common valvular diseases are aortic valve insufficiency and mitral valve disease.

When is surgery used to repair valve defects?

The aim of valve surgery is to stop overloading the heart. This will restore performance, increase functionality and improve the quality of life. A seriously ill patient is usually offered surgery. On the other hand, a symptom-free patient whose heart has reduced pumping power, or whose heart chamber is stretched, may be offered surgery preventively before symptoms emerge or the heart is damaged beyond repair. An ultrasound examination performed through the oesophagus is usually required before surgery. Coronary angiography is also often performed in older patients.

Heart valve surgery is usually performed through an incision down the middle of the breastbone with the aid of a heart-lung machine. There are also techniques which enable surgery to be performed partially through the breastbone and partially through an incision made through the side of the chest between the ribs. Particularly aortic stenosis can be treated with transcatheter aortic valve replacement through the blood vessels in joints. In this case, the patient’s own heart takes care of the blood circulation during the fitting. The doctor evaluates the patient for the safest and most appropriate surgical option and provides them the necessary information on the selected option.

Aortic stenosis and aortic regurgitation are most often treated by replacing the diseased valve with a new mechanical (artificial) valves or tissue (animal) valve. The tissue valve is made of a sac surrounding the heart of a cow (bovine) or a pig heart valve (porcine). After the administration of a tissue valve, a blood thinner is usually taken for 3 months, unless there are reasons for taking the drug for longer. A mechanical valve requires a permanent blood thinning medication. The choice of a valve is influenced by the age of the patient and their personal preference.

In mitral regurgitation, the surgery is usually intended to correct the existing valve. If the flap is replaced by a prosthesis, then the choice between tissue valve and mechanical valve must be made.

Does the surgery involve risks?

Like all surgery, there are some risks of complication associated with heart surgery. When planning surgical treatment, the patient’s age and underlying illnesses are considered. The risk of surgery is always discussed with the patient before the treatment decision is made. The starting point is that the benefit to the patient must exceed the potential risk of surgical treatment.

How does life continue after surgery?

Successfully timed treatment is the best guarantee of good quality of life after surgery. Following heart valve surgery, the care in Heart Hospital lasts for an average of 4-6 days and continues in the patient’s chosen follow-up hospital for the same number of days. Recovery and sick leave of patient in employment usually lasts for 2-3 months. The length of sick leave and the return to work depend on the strenuousness of the patient’s work and the progress of their rehabilitation. The patient’s ability to work is evaluated in a check-up at the end of their sick leave. Even after surgery, heart valve disease must be monitored with an echocardiogram at the start of the recuperation.