Aortic Valve Disease

The heart has four valves. These are:

• Mitral valve. This is located between the upper left chamber or left auricle and the lower left chamber or left ventricle. It has two flaps or leaflets.
• Aortic valve. This is located between the lower left chamber or left ventricle and the aorta, which is the big blood vessel through which blood from the heart passes to other parts of the body. It has three flaps or leaflets.
• Tricuspid valve (also called the right atrioventricular valve). This is located between the right upper chamber and right lower chamber. It has three flaps.
• Pulmonary valve (also called pulmonic valve). This is located between the right lower chamber and the pulmonary artery. It has three flaps.

For efficient heart function, the valves must be able to open fully while the blood is passing through, then close tightly afterwards. Simply put, blood should flow only in one direction.

Abnormal or sick valves allow less blood to pass through and/or make it leak backwards. This may be due to:

• Weakened flaps
• Fusion of the flaps
• Holes or tears on the flaps
• Deformity on the valve due to scar tissue
• Hardening of the valve due to deposits that are either waxy or calcified (called plaques)

To resume efficient function, sick valves need to undergo a surgical procedure called valve repair or valve replacement.

Valve Repair

This is the preferred treatment because results have been proven good. The faulty valve is repaired by:

• Cutting through and separating fused flaps
• Patching holes and sewing tears on flaps
• Reshaping deformed valves by removing excess tissue, scars and plaque deposits

Valve Replacement

This is done only when repair is not possible. The diseased valve is removed and replaced with either a man-made metallic valve or a biological valve (from pig, cow or human tissue).

Conditions that may require aortic valve repair or replacement

Aortic insufficiency (also known as aortic regurgitation)

The aortic valve is unable to snugly close, allowing blood that has already flowed out to the aorta to flow back to the left ventricle of the heart. This might be due to softening or weakening, tear, or a disfigurement of the flaps.

Aortic stenosis

The aortic valve is unable to open fully, thereby allowing only a small amount of blood to pass through towards the aorta. This might be due to scarring, adhesion or sticking together (fusion) of the flaps of the valve, or the presence of waxy deposits or plaques in the valves.

Recovery Period

After heart surgery, the patient is made to recover for a few days in an intensive care unit where his vital signs are closely monitored. Once he awakens and is stronger, he is transferred to the post-surgery unit. Most often, pain medication, antibiotics and anti-coagulant are given. When the range and duration of movement and physical activity have increased (usually in 5-15 days), the patient is made to go home. In a month or two, the patient may feel stronger than he was before the operation.

At Home

Recuperating at home, the patient needs to consider certain things, such as:

• He may be made to continue certain medications for a lifetime (such as the anti-clotting medicine warfarin)
• Wound care
• Exercise and physiotherapy
• Complications to watch out for
• When to go back to work
• Diet
• Check ups
• Lifestyle modifications
• Cardiac rehab

It is best to have a detailed talk with your doctor regarding these before going home. So, make sure that all necessary contact numbers are listed down.