17089 Heart Valve Surgery

Overview

Heart valve surgery is an operation to repair or replace one or more of the valves in your heart. Your heart has four valves. They work like one-way doors: they open to let blood through and close to stop it flowing backwards. When a valve becomes too narrow (doctors call this stenosis) or does not close properly (called regurgitation, or a 'leaky valve'), your heart has to work much harder to pump blood around your body. Surgery can mend the damaged valve or swap it for a new one, so your heart can pump properly again.

Yes. Valve surgery is one of the most common types of heart operation worldwide, and the numbers are growing as people live longer. It is a well-established procedure with a lot of evidence behind it.

It can affect people of any age. Most often it is older adults, because valves can become stiff and narrow as we age, especially after 65. Younger people may need surgery because of a valve problem they were born with (called congenital), or damage caused by rheumatic fever or an infection. Children born with narrow or leaky valves sometimes need surgery too.

Symptoms

Common symptoms

• Feeling short of breath when you are active, or when lying flat in bed
• Waking up at night feeling breathless or needing extra pillows to sleep
• Unusual tiredness, or tiring quickly with everyday tasks
• Dizziness or light-headedness, and sometimes fainting
• Chest pain or a tight feeling, often brought on by exercise
• Awareness of your heartbeat – a pounding, fluttering or irregular pulse
• Swelling in your ankles, feet or legs
• Putting on weight quickly because of extra fluid in the body

Symptoms in children

• Tiring quickly or sweating during feeds
• Poor feeding and slow weight gain
• Fast breathing, or breathlessness when playing
• Blue or grey tinge to the lips or skin
• Repeated chest infections
• In older children, getting out of breath more easily than friends during sport

Symptoms in older adults

• Breathlessness doing small tasks, such as dressing or walking to the kitchen
• New tiredness, or losing interest in usual activities
• Dizziness, unsteadiness or falls
• Confusion or memory changes, which can be caused by reduced blood flow
• Swollen legs and a bloated tummy
• Loss of appetite or feeling full quickly

Causes

Main causes

• Age-related wear and tear, where calcium builds up and makes the valve stiff and narrow
• Being born with an unusual valve, such as a valve with two flaps instead of three (bicuspid aortic valve)
• Rheumatic fever after an untreated strep throat infection, which can scar the valves
• Infection of the valve, called endocarditis
• Damage after a heart attack, or an enlarged heart that stretches the valve opening
• Radiotherapy to the chest, or connective tissue conditions that affect the valve tissue

Risk factors

• Getting older
• A family history of valve disease or heart problems at a young age
• A previous history of rheumatic fever, or strep throat that was not treated
• High blood pressure, high cholesterol, diabetes and smoking
• Kidney disease
• Previous radiation treatment to the chest
• Injecting drugs, which raises the risk of valve infection
• Poor dental hygiene – gum disease lets bacteria into the blood, which can settle on a valve

When to see a doctor

See a doctor urgently if:

• You feel breathless at rest, or you cannot lie flat because of breathing
• You have a fever with shivering and feel generally unwell
• Your ankles or legs have started swelling
• You have fainted, or come close to fainting
• You have a new irregular or racing heartbeat

Book a routine appointment if:

• You have been told you have a heart murmur
• You feel more tired or breathless than usual with exercise
• You have a family member with valve disease or a heart problem at a young age
• You have had rheumatic fever in the past
• You are due a check-up for a known valve problem

Diagnosis

Your doctor will start by asking about your symptoms and listening to your heart with a stethoscope. The sound of blood flowing through a narrowed or leaky valve creates a murmur, which is often the first clue. The main test is an echocardiogram – a painless ultrasound scan of the heart that shows how well each valve opens and closes and how strongly your heart is pumping.

Tests that may be done

• Echocardiogram (an ultrasound scan of the heart) – the key test
• Transoesophageal echocardiogram – a closer scan using a small probe passed gently down the throat, done with sedation
• Electrocardiogram (ECG) – sticky patches on the chest that record your heart rhythm
• Chest X-ray – to check the size of your heart and your lungs
• Blood tests – to check your general health and look for signs of strain or infection
• Exercise or stress test – to see how your heart copes with activity
• Cardiac catheterisation – a thin tube passed through a blood vessel to measure pressures inside the heart
• Cardiac CT or MRI scan – detailed pictures used to plan surgery or a catheter procedure

What to expect at your appointment

Most tests are quick and painless. For an echocardiogram you lie on a couch while gel and a small probe are moved over your chest; it takes about 30 to 45 minutes. You can usually go home straight afterwards. Results are explained to you by your cardiology team, and you will normally have time to ask questions before any decisions are made.

Treatment

Treatment depends on which valve is affected, how damaged it is, and how you feel. Options range from careful monitoring, to medicines that ease symptoms, to a procedure that repairs or replaces the valve. Your cardiology team will talk through the benefits and risks of each option with you, and your views matter.

Self-care at home

• Take any medicines exactly as prescribed, and ask your pharmacist if you are unsure
• Weigh yourself daily at the same time and write it down – a fast rise can be an early sign of fluid build-up
• Cut down on salt, as it makes your body hold on to fluid
• Stay active within what feels comfortable, and build up slowly
• Look after your teeth and gums, and have regular dental check-ups
• If you smoke, ask for help to stop – this is one of the best things you can do for your heart
• Keep all follow-up appointments, even when you feel well

Medical treatments

Medicines cannot repair a damaged valve, but they can ease symptoms and protect your heart. Doctors may prescribe medicines to lower blood pressure, to help your body get rid of extra fluid, to slow a fast heartbeat, or to reduce the risk of blood clots. For some people with an artificial valve, a blood-thinning medicine is needed long term, with regular blood tests to keep the dose safe. When a valve is badly narrowed or leaking, the main treatment is a procedure. This may be valve repair, valve replacement (with a mechanical valve or one made from animal or donated human tissue), or a catheter-based procedure where a new valve is placed through a blood vessel without opening the chest. Your team will recommend what suits your age, health and valve problem.

When is surgery considered?

A procedure is usually recommended when you have symptoms, when tests show the valve is severely narrowed or leaking, or when your heart is starting to enlarge or weaken even if you feel fine. Waiting until the heart is damaged can make recovery harder, so doctors sometimes advise surgery before symptoms become serious. Repair is often preferred because it keeps your own valve, but not every valve can be repaired. Your cardiologist and surgeon will explain the choices in your case.

Living with this condition

If you have surgery, expect to feel tired for a few weeks. Your breastbone (sternum) takes about 6 to 12 weeks to heal, so you will be asked to avoid heavy lifting, and to be careful with pushing and pulling movements. Many people feel a big improvement in breathing and energy within a few weeks, but full recovery can take 2 to 3 months. You will be given a card describing your valve or procedure – keep it with you, as it matters if you ever need medical or dental treatment. Regular check-ups will continue, usually with repeat echocardiograms.

Lifestyle tips

• Quit smoking, and avoid second-hand smoke
• Keep alcohol within recommended limits
• Keep to a healthy weight, and check your weight daily if fluid build-up is a concern
• Brush your teeth twice a day and see a dentist regularly
• Get plenty of sleep and pace yourself during recovery
• Ask your team before starting vigorous exercise or heavy lifting

Diet and exercise

A heart-friendly way of eating – plenty of vegetables, fruit, whole grains, beans, fish and healthy oils, with less salt, processed food and sugary drinks – helps your heart and blood pressure. Salt is especially worth watching, because it makes your body hold on to fluid. If you have had surgery, cardiac rehabilitation is a supervised programme of gentle exercise and advice that most people find very helpful, and it is usually offered to you. Walking is a great way to build fitness; start short and build up gradually, and stop if you feel chest pain, dizziness or unusual breathlessness.

Mental health and emotional wellbeing

It is very normal to feel worried, low or overwhelmed before or after heart surgery. Some people feel anxious about their heartbeat, have trouble sleeping, or feel frustrated at how slow recovery can be. These feelings usually ease, but they deserve attention. Tell your GP or cardiac team if you feel persistently low, panicky, or unable to cope – talking therapies and support are available. If you ever have thoughts of harming yourself, contact your local crisis line or emergency services straight away.

Prevention

Not all valve disease can be prevented – some causes, like being born with an unusual valve or simple ageing, are outside your control. But you can lower your risk in several ways: get strep throat properly treated, keep blood pressure and cholesterol in a healthy range, avoid smoking, stay active, eat well, and look after your teeth and gums. Good dental care matters because gum disease lets bacteria into the bloodstream, where they can settle on a valve.

Vaccines

Vaccination against flu is recommended each year for people with heart conditions, and your GP or pharmacist can advise on other vaccines that may suit you, such as pneumococcal vaccination. Staying up to date helps prevent infections that can be harder on a heart with valve disease.

Screening programmes

There is no routine national screening programme for valve disease in most countries. However, if you have a heart murmur, a family history of early valve problems, or previous rheumatic fever, your doctor may suggest an echocardiogram. If you have a known valve problem, regular scans let your team act at the right time rather than waiting for symptoms to worsen.

Complications

If left untreated

• Heart failure – the heart becomes too weak or stiff to pump efficiently, causing breathlessness and swelling
• Irregular heart rhythms, such as atrial fibrillation, which raise the risk of stroke
• Blood clots and stroke
• Infection of the valve (endocarditis), which can be serious
• Permanent damage to the heart muscle, which may not fully recover even after surgery
• In rare cases, sudden serious heart problems

Long-term outlook

The outlook is generally good. Valve surgery is a well-established operation, and most people notice real improvements in breathing, energy and quality of life. Recovery takes weeks rather than days, and it is common to have good days and tired days at first. Many people return to work, driving, hobbies and travel within a few months. Your team will monitor you over the years, because repair or replacement valves need checking, but most people go on to live full, active lives.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.