1.What are the heart valves? There are four sets of valves in every human heart. These are the aortic valve that connects the left ventricle to the aorta, the pulmonary valve that connects the right ventricle to the pulmonary artery, the mitral valve that connects the left atrium to the left ventricle, and the tricuspid valve that connects the right atrium to the right ventricle. They all act as one-way valves so that blood can only flow from one direction to the other without backflow. Each valve consists of two to three leaflets, which are thin, smooth and flexible when normal. 2.What is heart valve disease? A congenital or acquired cause of valve malformation or deformation that causes impaired blood flow is called valvular disease. Acquired, especially rheumatic heart valve disease is very common, and the changes in the valve itself are more obvious. Valvular stenosis: poor blood flow due to valve deformity. Mitral stenosis, aortic stenosis, etc. Inadequate closure: regurgitation of blood flow due to poor closure of the valve. Simply put, the heart valve is the door, valve stenosis is equivalent to the door can not be opened, valve closure is equivalent to the door can not be closed. 3.Why do some patients need valve replacement? Valve stenosis or incomplete closure, loss of one-way valve function, and valve lesions can not be effectively treated with closed dilatation or shaping, then the original lesion must be surgically removed under extracorporeal circulation, replaced with an artificial heart valve to restore the physiological function of the one-way valve, to relieve or alleviate the symptoms. Thousands of patients worldwide are rehabilitated each year as a result of this procedure. It has been more than 30 years since the first valve replacement surgery was performed in our hospital. The clinical results are positive. 4.Does mitral valve insufficiency necessarily require valve replacement? What are the advantages and disadvantages of valvuloplasty? Mitral valve insufficiency does not always require valve replacement. The surgical approach depends on the degree and nature of the valve lesion. Congenital and degenerative mitral insufficiency, as well as some rheumatic mitral insufficiency, can be repaired with valvuloplasty. In contrast to valve replacement, valvuloplasty requires a higher level of surgical skill and must be performed by an experienced surgeon who decides on the type of valve to be repaired based on its pathology. Valvuloplasty has the advantage of preserving its own valve structure, eliminating the need for long-term anticoagulation therapy, and avoiding the dangers that may result from improper anticoagulation therapy. However, if the lesion continues to progress, reoperation may be required. 5.How many types of prosthetic valves are there? Which is the best valve to replace? There are two main types of prosthetic heart valves. One is the mechanical valve and the other is the biological valve. The former is made of high-tech synthetic material cracked charcoal, while the latter is made of both synthetic advanced material and complex chemically treated biological valve tissue. Each has its own characteristics and advantages and disadvantages. The advantage of mechanical valves is their durability; their disadvantage is the need for lifelong anticoagulation and the high rate of anticoagulated bleeding or thromboembolism. Biologic valves, however, do not require long-term anticoagulation after valve replacement, but their durability is limited. As to which valve you are suitable for replacement, your surgeon will make the appropriate choice based on your specific condition and requirements. Biologic mechanical valves 6.Why do patients with valve replacement need anticoagulation therapy? How long does anticoagulation therapy take? Because the artificial valve (biological valve or mechanical valve) is not the composition of the body itself, blood is easy to clot in and around the artificial valve, causing thrombosis and affecting the function of the artificial valve, and if the thrombus is dislodged, it can also cause vascular embolism (brain embolism, lower limb artery embolism, etc.), which is very harmful to people. Therefore, all valve replacement patients should undergo anticoagulation therapy to prevent thrombosis. Biological valve replacement patients generally only need anticoagulation for three months after surgery, and those with atrial fibrillation need anticoagulation for six months; while mechanical valve replacement patients need lifelong anticoagulation. 7.How are patients with valve replacement anticoagulated? How is the standard of anticoagulation determined? The main method of anticoagulation is oral anticoagulation tablets. Commonly used anticoagulants include Warfarin tablets, and aspirin can also be used as an adjunctive anticoagulant. Subcutaneous injection of low-molecular heparin can be used to maintain anticoagulation therapy in special cases. Oral anticoagulation tablets are usually started after removal of the chest drain after surgery or 48 hours after surgery. In order not to overdose or underdose anticoagulants, blood is drawn periodically after surgery to check prothrombin time (PT) and international normalized ratio (INR). This test reflects the strength of anticoagulation therapy, and the INR should be maintained at about 2.0-2.5. The INR can be slightly lower for aortic valve replacement and slightly higher for mitral valve replacement. Anticoagulant drugs must be taken regularly and quantitatively every day and be recorded! 8.What are the side effects of underdose or overdose of anticoagulants? a Insufficient anticoagulation: caused by insufficient doses of anticoagulants. Hazards: thrombosis can lead to valve activity disorders, valve tone quality can be changed, and even heart failure and other manifestations; cerebrovascular embolism can appear neurological symptoms, similar to stroke; limb artery embolism can appear limb ischemia, pain and other symptoms. Treatment: The above conditions should be promptly sought medical attention. b Anticoagulation overdose: caused by excessive use of anticoagulants. Hazards: It can lead to various bleeding and other complications: hematuria, mucosal bleeding such as nasal bleeding, gum bleeding, bleeding from wounds or ulcers, with or without skin bleeding spots and bleeding purpura; uterine bleeding, showing increased or abnormal menstruation. Treatment: In case of the above, go to hospital for examination and adjust the dosage of anticoagulants. Even suspend the medication. 9.What about excessive anticoagulation menstruation in female patients? Generally speaking, anticoagulation therapy has little effect on menstruation. Even if menstruation is slightly more or longer than before, there is no need to deal with it as long as it is not serious. If the menstrual flow increases significantly, the dosage of anticoagulant can be reduced appropriately during menstruation and resumed after menstruation. If menstrual disorders and bleeding continue after anticoagulation therapy, you should visit a gynecologist and take menstrual regulating drugs. In addition, women of childbearing age should pay attention to contraception during anticoagulation therapy to avoid the risk of increased bleeding from abortion. 10.What are the precautions in the early post-valvular surgery? The first three months after surgery is an important stage to overcome the surgical trauma and recover the body, the following matters should be noted: (1) medication: take medication on time and in the right amount. Commonly used drugs include anticoagulants, cardiac diuretics, and antiarrhythmics. (2) Prevent infection: especially respiratory tract inflammation, periodontitis, skin boils, urinary tract infection, etc. They should be controlled as soon as they are detected. Intermittent or persistent fever of unknown origin should not be treated indiscriminately with antimicrobials. You should seek medical attention promptly. To avoid delaying treatment. (3) Diet: Pay attention to increasing nutrition and supplementing protein and vitamins. Do not consume too much or long-term foods rich in vitamin K: spinach, carrots, pork liver, tomatoes, cauliflower, fresh peas, etc. (4) Patients with poor heart function should limit the amount of water they drink, should not eat too salty food, and should not eat a lot of thin rice and soups. Drinking alcohol can affect the metabolism of warfarin, so during the anticoagulation period, then try not to drink alcohol, let alone alcohol. 11.When can I resume activities and work after valve surgery? An appropriate amount of activity should be maintained after surgery in order to enhance physical fitness and improve quality of life while recovering from cardiac function. The amount of activity should be measured and gradual, so as not to cause shortness of breath. Do not stay in bed all day. Some patients may feel tension in the neck, shoulders and chest muscles after surgery, so you can do light exercises to relax the muscles, such as slowly lifting your arms above your head, or shrugging your shoulders and then relaxing them. The sternal wound usually heals in six weeks, so you should not lift heavy things for six weeks. Arrange your early recuperation life, keep your mind happy, relaxed, optimistic and confident. Generally speaking, recuperation is the main focus for three months after surgery. After three months, go to the hospital for examination, and if the heart function recovers satisfactorily and the body is in good condition, then you can gradually resume labor and work, and the labor intensity should be appropriate without feeling tired and short of breath. 12.What should I do if I need to extract teeth or do other surgery after valve replacement? It is best to have your teeth extracted or undergo other surgery after valve replacement surgery when your heart function is in good condition. If you are on long-term anticoagulation, you should suspend warfarin and switch to heparin therapy before surgery. If the procedure is an emergency, special treatment is needed to stop and prevent bleeding. The surgeon will carefully stop the bleeding during the procedure, and you can continue the warfarin anticoagulation treatment 24 to 48 hours after the procedure without any blood leakage. 13.What should I pay attention to when taking other medications after valve replacement? After valve replacement, patients may need to take other medications for other diseases while taking anticoagulants. This is known as a “synergistic effect” in medical terms. Other drugs can reduce the effect of anticoagulants, called “antagonism”. “Synergism” increases the anticoagulant effect by reducing the amount of anticoagulant used: aspirin, heparin, steroids, fenpropathrin, anti-inflammatory pain, quinidine, salicylates, protamine, etc. “Antagonism” weakens the anticoagulant effect – need to increase the amount of anticoagulants: vitamin K, sleeping pills, estrogen, oral contraceptives, rifampin, barbiturates, certain cold medicines, etc. 14.Can women get pregnant and have children after flap replacement? aWomen who have replaced biological flaps can have normal pregnancy and childbirth. However, it is important to note that: (1) Pregnancy should be considered at least six months after valve replacement when anticoagulants have been stopped and cardiac function has recovered well. (2) Prevent perinatal cardiac insufficiency, especially during pregnancy. bWomen with mechanical valve replacement should be considered carefully because of the need for lifelong anticoagulation. This is because: (1) There is a reported risk of fetal malformation with warfarin during the first trimester. (2) There is an increased risk of bleeding during anticoagulation for pregnancy and delivery. There are certainly reports of successful pregnancy and delivery after mechanical flap exchange. If you decide to have a child, you should consult more cardiologists and obstetricians and gynecologists for special anticoagulation treatment and health care in the perinatal period. 15.What should I do if my heart rhythm is irregular after valve replacement? You should visit the hospital when you feel an irregular heartbeat to find out the type of arrhythmia. Atrial premature beats – can be corrected with adequate rest and digitalis preparations. Ventricular premature beats – control them as soon as possible. Measures include rest, potassium supplementation, injection of lidocaine, and administration of medications such as betalactone, but always under the supervision of a doctor. Temporary discontinuation of digoxin and ? receptor blockers, and then gradually resume digoxin application after the heart rate has accelerated (>70 beats/min). If the heart rate is still slow after stopping digoxin and there is dizziness, palpitations and other discomfort, promptly seek medical attention. Heart valve disease is often associated with atrial fibrillation. This can be controlled by taking digitalis preparations along with anticoagulation therapy to keep the heart rate from becoming too fast or too slow. 16.Is it normal to have a heart murmur after valve replacement? Sometimes a metallic sound like clockwork can be heard after mechanical valve replacement, which is a normal phenomenon and should not be minded. Since the caliber of the prosthetic valve is smaller than the caliber of normal human valves, a mild systolic or diastolic murmur can sometimes be heard in the precordial region after valve replacement (especially after aortic valve replacement), if the echocardiogram shows no perivalvular leakage, good valve activity, and good recovery of cardiac function, this murmur has no effect on hemodynamics and is not a cause for concern. If the murmur changes or a new murmur appears with palpitations, shortness of breath, and other symptoms, prompt medical attention should be sought to analyze the cause. 17.When should I go to the hospital for a review after valve surgery? Early review after valve replacement or valvuloplasty is more frequent, and 2-3 weeks is needed to review anticoagulation therapy and recovery of cardiac function in the hospital. Please go to the hospital if you experience: ① Chest pain instead of wound pain. ②Sudden change or disappearance of heart valve opening and closing sound and arrhythmia, i.e. irregular heartbeat. ③Heart rate lower than 60 beats/minute or higher than 120 beats/minute. ④If fever persists for more than three days and there is infection in any part of the body. ⑤ When there is swelling and sudden weight gain of more than 2 kg. (6) When there is shortness of breath, panic, or foamy blood sputum. (7) Nausea, vomiting without any reason, jaundice on the sclera and skin of the body. (8) When there are bleeding spots under the skin, darkening of the stool, red urine, etc. (9) Sudden fainting, coma, hemiplegia or pain in the lower limbs, coldness and pallor.