Surgical Valvuloplasty

What is surgical valvuloplasty?

Surgical valvuloplasty is surgery to repair 1 or more valves in your heart.

When is it used?

You may have this procedure if 1 or more valves in your heart don’t work well. They may be scarred, they may leak, or they may not close or open all the way. The defective valves may disrupt the flow of blood to your lungs or body.

Before this surgery, your healthcare provider may recommend that you have a heart catheterization. For this procedure, a thin tube (catheter) is passed into one of your blood vessels and into your heart to learn more about your heart.

Surgical valvuloplasty is used when:

• Medicines are not helping your heart valve problem.
• You don’t need to have a valve replaced with an artificial valve.
• A different procedure called balloon valvuloplasty is not an option. (This is a procedure in which a balloon on the tip of a catheter is used to make the valve open wider.)

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Do not eat or drink anything after midnight and the morning before the procedure. Shower and wash your hair with a special anti-infective soap the night before the procedure.

Follow any other instructions your healthcare provider gives you.

What happens during the procedure?

You will be given a general anesthetic. The drug will relax your muscles and put you in a deep sleep, and keep you from feeling pain during the operation.

Your surgeon will make a cut (incision) in your chest and divide your sternum (the flat bone in the center of the chest). You will be connected to a heart-lung machine, which will take over the work of your heart and lungs during the operation. The surgeon will then stop your heart, make a cut in your heart to reach the valve and repair it.

The surgeon will then close the cut in your heart and restart your heart. You will be taken off the heart-lung machine. The surgeon will then close the cut in your chest by wiring together your sternum (breastbone) and then close the skin with stitches. Some tubes may be left in your chest cut to drain any blood or fluid.

What happens after the procedure?

You may stay in the hospital for 3 to 10 days, depending on your condition. You will be in an intensive care unit (ICU) or intermediate care unit for several days for observation and monitoring. An electrocardiogram (ECG) will record the rhythm of your heart.

You will have respiratory therapy to prevent any complications in your lungs, such as a collapsed lung, infection, or pneumonia. A nurse or therapist will give the therapy every few hours. It is very important to cooperate and ask for pain medicine if you need it. Therapy may include:

• deep breathing exercises
• coughing while holding a pillow against your chest to protect your breastbone
• chest percussion, which is a gentle slapping on the back to help loosen lung secretions that may have collected your lungs after surgery
• moving your legs to lower the chance of blood clots.

While in the ICU, you may have the following tubes in your body to help in recovery:

• a breathing tube connected to a ventilator to help you breathe
• a tube through your nose down to your stomach to drain out natural fluids that may cause discomfort when you are not eating
• a bladder catheter to empty your bladder
• intravenous (IV) tubes in your arms or possibly near your collarbone for fluids, nutrition, and medicines
• chest tubes to drain blood from your chest cavity and to help detect any excessive bleeding in your chest
• an arterial line in your forearm to measure the pressure of the blood flowing through the arteries.

When you have recovered enough, your tubes will be removed and you will go to an intermediate care unit until you are ready to leave the hospital. You will have physical therapy that includes walking around the hospital and other activities. You will be taught how to move your upper arms without hurting your breastbone, and you will keep having respiratory therapy. Occupational therapy will help you learn how to take it easy when you do your daily activities.

Ask your healthcare provider if you should take antibiotics before you have dental work or procedures that involve the rectum, bladder, or vagina. Damaged valves are more likely to become infected by bacteria. Infection of the valve can damage it more and may destroy it. Antibiotics can prevent this.

Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Your heart may work better and let you live a more normal life.

What are the risks associated with this procedure?

• Depending on your age and the condition of your heart and valve, there is about a 2% to 10% risk of death from this operation.
• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• The repaired valve may not work as well as planned, or the repair may not last.
• This operation may need to be repeated or you may need to have the valve replaced.

There is risk with every treatment or procedure. Talk to your healthcare provider for complete information about how the risks apply to you.

When should I call my healthcare provider?

Call 911 right away if:

• You have a lot of chest pain.
• You have problems speaking or with your vision.
• Your arms or legs feel numb or you cannot move them.

Call your healthcare provider right away if:

• You have a fever over 101.5°F (38.6°C).
• You get short of breath.
• You have redness, swelling, pain, or drainage from your incision.
• You notice swelling in your legs or ankles.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.