Aortic Valve Surgery: Diagnosis and Methods of Treatment

Those with aortic valve disease need life saving treatment have to undergo aortic valve surgery. The aortic valve is the valve that connects your heart to your aorta. People that have a leaky valve condition can benefit from this surgery and have improved heart function. Surgeons may resort to an open-heart surgery or a minimally invasive surgery which has smaller incisions.

What is Aortic Valve Surgery?

There are four valves that control blood flow in the heart and the aortic valve is one of them. It is between the left heart chamber and the body’s main artery called the aorta.
The function of heart valves is to keep the blood flowing in the correct direction through the heart. When the heart contracts, the aortic valve opens and blood flows from the left heart chamber into the aorta. When the heart relaxes, the aortic valve closes. This prevents blood from flowing back into the heart. When the valve is diseased or damaged, the dynamics of the blood flow changes. This means that the heart has to work harder to send blood to the rest of the body.

Some people are born with congenital heart defects that affect valve function. These issues can be addressed with aortic valve surgery so that complications and risks of valve disease can be reduced. An aortic valve surgery can treat a leaky valve (aortic valve regurgitation) or a narrowed valve opening (aortic valve stenosis).

There are two types of aortic valve surgery:

• Aortic valve repair: the surgeon keeps as much natural tissue as possible and fixes damaged parts of the valve.
• Surgical aortic valve replacement(AVR): In this method, the surgeon removes your damaged valve and replaces it with a new one.

The surgeon will decide what type of surgery you need depending upon various factors like your age, results of your diagnostic tests, structure of your heart and other medical conditions. The surgeon will discuss the various options and recommend the most suitable treatment plan for you.

Diagnosis of Aortic Valve Disease

To diagnose aortic valve disease, your doctor will ask you questions about your medical history and symptoms. Your cardiologist may hear a whooshing sound called a heart murmur when listening to the heart with a stethoscope.

Test that may be done to diagnose aortic valve disease are:

Not all the tests required for diagnosis, may be few below tests, tailored for the fit .

• Echocardiogram: The echocardiogram uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and the valves. This can help assess the severity of the valve disease.
• Electrocardiogram (ECG or EKG): The ECG record the electrical activity of the heart. Through this we understand how the heart is beating. Sticky patches are placed on the chest and legs. A wire connects the patches to a computer that will print the results.
• Chest X-ray: A chest X-ray reveals the condition of the heart and lungs. It will show if the heart is enlarged which is a sign of aortic valve disease or heart failure.
• Cardiac MRI: The cardiac MRI uses magnetic fields and radio waves to create detailed pictures of the heart. This test can determine the severity of the aortic valve disease and measure the size of the aorta.
• Cardiac computerized tomography (CT) scan: A CT scan uses a series of X-rays to create detailed images of the heart and valves. The test can help measure the size of the aorta and look at the aortic valve more closely. A CT scan can determine the severity of the aortic valve stenosis.
• Exercise or stress tests: These tests involve walking on a treadmill or riding a stationary bike while an ECG is being done. This helps to see how the heart reacts to physical activity and whether you have valve disease symptoms during exercise.
• Cardiac catheterization: This test is used rarely to see how severe the aortic valve disease is and see what other tests could not diagnose. A thin, flexible tube is inserted into a blood vessel in the groin or arm and guided to the heart. This gives more details about blood flow and dynamics of the heart ,how well the heart is working.

Treatment Options

The treatment involves aortic valve surgery. Doctors will use an anaesthetic to put you in a sleep-like state before surgery. They will connect you to a heart-lung bypass machine. This machine will keep the blood pumping through your body during the aortic valve surgery. The surgery done could be either one of the following:

Open-heart surgery: a surgical cut called an incision will be made at the middle of the chest to reach the heart.
Minimally invasive heart surgery: Here smaller incisions are made. It uses a “J” incision. This type of surgery does not involve cutting any significant muscle or breaking any bone. Resultantly you may have a faster recovery.

If you have very mild symptoms, you may not need surgery, instead you may be prescribed medications to manage the symptoms. You may be prescribed blood thinners or blood pressure medications. Some people may be prescribed antiarrhythmics or medications that manage your heart’s rhythm.

Aortic Valve Surgery Procedure

• Aortic valve repair: This is done with an open heart surgery. The surgery may involve patching holes or tears in the aortic valve cusps, adding support to the roots of the valve, separate valve cusps that have connected together, remove tissue to allow the valve to close more tightly, and reinforce the annulus which is a ring around the valve.
• Transcatheter aortic valve implantation: This is also called balloon valvuloplasty and is done to repair the valve. A thin flexible tube called a catheter is inserted in the arm or groin. It is then guided to the diseased aortic valve. A balloon at the tip of the catheter is inflated which makes the valve opening larger.
• Aortic valve replacement: In this the surgeon removes the aortic valve and replaces it with a mechanical valve. Sometimes a valve made with cow, pig or human tissues are used.

Recovery and Outlook

Your recovery depends on your specific heart condition and the type of procedure you have had. You will be given fluid and medicines through IV. You may also be given oxygen through a mask. As you recover, the healthcare team looks for any signs of infection, checks your breathing, BP and heart rate. You will be asked to walk regularly. You may have to stay in hospital for five to seven days.

Post your discharge you will be told not to drive or lift anything very heavy for six weeks. You will also have to go for regular follow-up appointments with the doctor. Imaging tests will be done to ensure that the valve is working correctly. In case you have a mechanical valve, you may have to take blood thinners for life to prevent any clots. You will be recommended to eat a healthy diet, get regular exercise, manage stress, stop smoking or using tobacco.

Your body needs time to rest and heal.

Conclusion

Talk to your doctor about the risks and benefits of aortic valve surgery. Understand what is involved and what the outlook will be after the surgery. As the surgery is being planned, talk to friends and family. Seek help to prepare and recover. It is important to have a support system close by to help you recover physically and emotionally from a major life event.

Frequently Asked Questions

What happens during aortic valve surgery?

You will be given anaesthesia and a surgeon will either repair or replace your aortic valve. The surgery could take several hours during which you will be connected to a heart-lung machine.

What happens after the surgery?

You will recover in the ICU. Your hospital will monitor your vitals and they may encourage you to move around. You may have to stay for five to seven days in the hospital.

What are the risks of aortic valve surgery?

Risks could include wound infections, lung infections, bladder infections or heart valve infections. Sometimes excessive bleeding may occur which may need another surgery to stop it.

What medication do I need to take after surgery?

You will be prescribed medication depending on the type of surgery you have had. If you have a mechanical heart valve, you maybe prescribed blood thinners for life.

What should I do for a quick recovery after the surgery?

You must rest and eat well. Diet must include fruit, vegetables and whole grain. You cannot drive or lift anything heavy for many weeks after surgery. You must also get regular exercise.