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School of Medicine
Aortic Valve Replacement
On this page:
- Why doesn't my heart valve work properly?
- Surgical Valve Repair and Replacement
- Transcatheter Aortic Valve Replacement (TAVR)
- Preventing Valve Infection
- Valve Identification
- Valve Clicking
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The valves in your heart may be damaged due to infection, rheumatic heart disease or birth (congenital) defects. The affected valve leaflets (cusps) may grow thick and brittle from scar tissue or calcium deposits, or they may become thin and weak, resulting in an inefficient valve.
Valve conditions are described as follows:
- Stenosis - the opening of the valve becomes smaller, thus allowing less blood to flow through.
- Regurgitation/Insufficiency (leaky valve) - the valve does not close properly and allows blood to flow backward as well as forward in the heart.
Due to the damaged valve, your heart must work harder to pump blood throughout the body. You may tire easily and feel short of breath with less activity or exercise. You may experience an irregular heartbeat due to over-stretching of the heart muscle as in mitral stenosis, or dizziness and near fainting due to decreased blood flow to the brain as in aortic stenosis.
Depending on the extent of your valve disease, you may need to have the valve repaired or replaced. To repair the valve, your surgeon may perform a commissurotomy or implant a valve ring. A commissurotomy is performed for a tight valve (aortic stenosis). The valve leaflets are cut to loosen the valve slightly, allowing blood to pass easily.
Another type of valve repair is a valve ring annuloplasty, which is sewn in place when the valve is leaking (regurgitant or insufficient). The valve leaflets are tucked in place with the ring. Because platelets tend to stick to the articficial material of the ring, someone with an annuloplasty ring will go on lifelong anticoagulation therapy to prevent blood clots.
Often, however, the valve cannot be repaired and must be replaced. The surgeon may replace the damaged valve with a tissue (bioprosthetic) valve or with a mechanical valve.
Tissue valve are valves from animals (e.g., cow, pig). They generally do not require long-term anticoagulation therapy, but are not as durable as mechanical valves.
Mechanical valves are made from materials such as plastic or metal. They are considered extremely durable, lasting longer than tissue valves. But as with the annuloplasty ring, mechanical valves require long-term anticoagulation medication.
Your surgeon will discuss the need for repair or replacement of the valve with you prior to surgery as well as the type of valve (tissue or mechanical) should replacement be necessary.
Transcatheter aortic valve replacement is an alternative option for patients who may be at high risk or extreme risk for open heart surgery. This is a much less invasive procedure than open heart-valve surgery. Learn more about TAVR at Johns Hopkins.
To prevent an infection (endocarditis) from occurring around the new heart valve or ring, you should receive antibiotics before having any procedures that could permit bacteria to enter your body. Among these procedures are:
- All dental procedures (cleaning, filling, removing teeth, root canals, gum or ulcer treatment). You may use dental floss, In fact, we encourage you to reduce tartar with any approved method.
- Surgical procedures such as colonoscopy, cystoscopy, or other surgical procedures.
Discuss with your dentist or doctor whether the dosage of Coumain (warfarin) needs to be decreased or stopped before any of the above procedures.
Symptoms of Common Infections
Notify your family doctor if you have any of the following symptoms:
- Respiratory: Fever higher than 101oF, or coughing up white, yellow or green tinged mucus.
- Urinary: Fever higher than 101°F, or burning, frequency, urgency or difficulty urinating.
- Blood: Any fever that last longer than two days and is accompanied by chills, weakness, general feeling of ill health.
You will receive a valve identification card from the valve manufacturer that contains information about the type and size of your heart valve. Carry this with you at all times. Remember, you must tell any doctor or dentist caring for you about your valve and the need for antibiotics.
A mechanical heart valve (such as a St. Jude or Carbomedics) may produce a clicking sound as it closes. Some patients are more aware of this sound than others. It can be louder with activity or more noticeable when you are resting. As you adjust to the sound, it will become less distracting.