In young patients with narrowing of the aortic valve a balloon dilatation can be done. However, this procedure does not give successful long lasting relief. Most patients with aortic valve problem will require open-heart surgery. Diseased aortic valve can be repaired or replaced.
AORTIC VALVE REPAIR
This operation can be performed only in some centres and by experienced surgeons. It is very difficult. However, it helps the patients to retain his own natural valve. It is also less expensive. However, the operation may fail to correct the abnormality permanently. This means that the patient may require a second operation if the valves are damaged again.
AORTIC VALVE REPLACEMENT
The major operation for aortic valve disease is aortic valve replacement.In this, Surgeon removes the aortic valve and replaces with an artificial valve prosthesis, bioprosthetic valve, homograft or autograft.In young patinets and in women and in elderly people it is better to have the valve replaced by human valve (homograft) or by the patients own pulmonary valve Autograft-Ross operation) Homograft/autograft is a natural valve and is expected to function normally.
OPERATIONS FOR TRICUSPID VALVE DISEASE
TRICUSPID VALVE REPAIR
The tricuspid valve is almost always repaired. It does not require replacement. However, minor degree of leakage may persist even after repair.
Prosthetic Valves (Metal)
There are many substitutes for the human heart valve. Among these the best is another human heart valve. In young children, women and adults the aortic valve can be replaced by the patients own pulmonary valve. This is the best option because this valve can function for rest of the patients life without any problem. The autograft is also likely to grow in children. However, this operation can not be done in all centres and by all surgeons. It is available only in very selected centres where homografts are also available. In older patients the best substitute for the aortic valve is a homograft valve or a bioprosthetic valve. In operation using autograft or homograft, the cost is nearly half that of valve replacement with an artificial valve. In addition the patient does not need to take medication for life or undergo sophisticated tests at frequent intervals. Therefore, in the long run this operation is not only better but more economical.
For the Mitral valve whenever possible it is better to have a repair. This leaves the patient with his own natural valve and may require no further treatment for long time. In addition this operation is also inexpensive and does not require costly medication or tests after operation. However, again this operation is not done at all centres or by all surgeons. It is available in a few selected centres.
Replacement of the aortic valve or the Mitral valve with a prosthetic valve is an operation that can be done in all major heart centres. However, the choice of prosthetic valve is usually best left to the surgeons. This operation is twice as expensive as repair or a homograft replacement and requires constant and regular check up with blood tests and x-ray examination at regular intervals. The medication can also produce excessive bleeding in women and if an injury occurs. Blood may also clot on this valve resulting in paralytic strokes even if the patient is taking medication properly. If the patient stops medication after a prosthetic valve replacement he may die suddenly by blockage of the valve from blood clots. It is therefore not the best suitable for a heart valve. However, sometimes it is the only choice in patients, and good number of patients do extremely well after operation.
Valve made from animal tissue (Bioprosthesis) are as expensive as prosthetic valves. However they do not last for a long time and are not recommended for young children and adolescents. These valves do not require life long medication but will require replacement by a second operation within 10 to 12 years after implantation.
In good centres generally there are no complications. However, because of the nature of the operation and because the heart has to be stopped for period of time there is a risk to life. This risk may be anywhere between 3 to 15% depending on the type of operation performed and condition of the patient before operation. For closed Mitral valvotomy the risk to life is less than one per cent.
For Mitral valve replacement risk to life is 6-8%. For Mitral valve repair it is 4-5%. For aortic valve replacement it is 3 to 5% and for double valve replacement (Aortic and Mitral Valve) it is 10-15%. In patients who require replacement of aortic and Mitral valve and repair of tricuspid valve risk to life is 15-20%.
Patients may also develop bleeding soon after surgery and may require to be returned to the operating room to control the bleeding. Rarely, damage to brain may cause prolonged unconsciousness and paralysis. Damage to the lungs, liver and kidneys are also possible in this operation. These complications are less in patients who come before heart failure has set in. It is therefore, better to get the operation done at the earliest opportunity after the diagnosis is made. However, discuss the risk with your doctor. The possibility of complications depends upon the age, general condition, other associated illness and condition of the heart.