Precautions: rest should be the main focus within 1 month after surgery, with appropriate activities; 2-3 months after surgery, appropriate rest should be taken, recovery activities can be carried out, do not weight-bearing activities; 3-6 months after surgery, work and daily life can be resumed according to the recovery and cardiac function; take anticoagulants and blood sampling to check prothrombin time regularly, within 1 month after discharge, blood sampling to check prothrombin time at least once a week, adjust to After adjustment to the standard level, check once a month for six months, and once every 2-3 months thereafter; application of cardiac and diuretic drugs: continue to take cardiac and diuretic drugs after discharge, and stop taking cardiac and diuretic drugs after 3-6 months. Follow-up review: 3-6 months after the operation, you should go to the hospital where the operation was performed or the nearest hospital for review, including chest X-ray, electrocardiogram and cardiac ultrasound. What should you do if you have arrhythmia? You should take a break and go to a nearby hospital for a checkup and ask your doctor for symptomatic treatment. Generally speaking, atrial premature beats have less impact on heart function and can be controlled by adequate rest and medications such as digitalis preparations; ventricular premature beats should be actively treated and controlled as soon as possible, and other arrhythmias should also be treated promptly. In patients with atrial fibrillation, atrial fibrillation is usually corrected 3 months after surgery when the heart function recovers better. If your atrial fibrillation is more stubborn, the heart function is poor or has been corrected fibrillation 1-2 times unsuccessfully, then do not barely fibrillate to avoid danger and poor results, but continue to take cardiac diuretic drugs and treat symptomatically. Second, the heart murmur. Sometimes after mitral valve replacement, a mild diastolic murmur can still be heard in the apical part of the heart; a mild systolic murmur can be heard in the aortic valve area. These murmurs are usually normal, mostly due to the narrow annulus of the prosthetic valve, and do not have any hemodynamic impact, so you do not need to worry about them. If you have a mechanical valve, you may sometimes hear a metallic clanging sound during the heartbeat, which is also normal and not a cause for concern. In addition, if you or your surgeon find other murmurs or no murmurs in the early postoperative period, but new murmurs are found later, further examination is needed to analyze the nature and cause of the murmur and to determine the course of treatment. What if the preoperative symptoms disappear unsatisfactorily or new symptoms appear after surgery? Valve replacement can generally improve symptoms more significantly after surgery, and its efficacy is certain. However, because valve disease is a complex pathological process, coupled with the trauma of the surgery itself, there are sometimes some symptoms in the early postoperative period. As long as you take care of yourself and treat the symptoms symptomatically, they will gradually decrease or even disappear. As for new symptoms that arise suddenly, you should go to the hospital in time to find the cause, distinguish whether it is a cardiac factor, and give symptomatic treatment. Valve failure is extremely rare, but it is important to be alert and to contact the hospital for symptomatic treatment as soon as it is confirmed. If you are suffering from other diseases requiring surgical treatment, such as tooth extraction, appendectomy, abortion, and other major and minor surgeries, you should pay attention to the following points: 1. determine the level of heart function before surgery, carefully maintain and improve heart function, and strive to deliver or perform surgery in pregnancy with good heart function, and not in pregnancy with poor heart function; 2. anesthesia methods should be appropriate, and strive for smooth anesthesia, and try to avoid affecting heart function; 3. Avoid affecting cardiac function as much as possible; 3. For patients on long-term anticoagulation therapy, suspend anticoagulation for 1 week before surgery, and add vitamin K intramuscularly 2 days before surgery, and take short-acting anticoagulant drugs such as heparin calcium during this period. If there is infection in any part of the body, if there is unexplained fever, if there is obvious shortness of breath and swelling, if there is foamy sputum, if there is jaundice in the sclera and skin, if there is subcutaneous bleeding, if there is hematuria, etc. When bleeding tendency such as subcutaneous bleeding, hematuria, etc.; 7. When new arrhythmia occurs; 8. When sudden syncope, hemiparesis or lower limb pain, chill and pallor occur. Sixth, drug interference with the anticoagulant effect of Warfarin 1, drugs that interfere: several common drugs that enhance or weaken the anticoagulant effect of coumarins. Enhancement: alcohol, allopurinol, cimetidine, steroids (steroids), anti-inflammatory pain, quinidine, salicylates, methotrexate, sulfonamide Reduction: vitamin K, sleeping pills, estrogen, oral contraceptives, rifampin 2, drug interference treatment: significant interference should be avoided, such as vitamin K; some alternative drugs are available, such as Valium instead of sleeping pills, propofol instead of Allopurinol; need for long-term use, such as female contraceptives, can be added at the beginning, several tests prothrombin time, to determine whether to increase the amount of coumarin, and then several tests prothrombin time after discontinuation, to determine whether the need to reduce the amount of coumarin, generally uncomplicated; short-term increase in a drug, such as cold medicine, temporary injection of broad-spectrum antibiotics or chloramphenicol for a few days, it is not necessary to adjust the coumarin type dosage, generally not to interfere greatly. Seven, food interference with the anticoagulant effect of Warfarin influence: the patient’s postoperative diet can interfere with the anticoagulant effect of coumarin drugs, but not directly, generally very little interference. Often eat spinach, bok choy, tomatoes, cauliflower, fresh peas and other vegetables in larger amounts, or often eat more meat such as pork liver, or fruit, because these side dishes contain more vitamin K in the crystal, can make the prothrombin time is reduced. However, the effect of diet on anticoagulation is not important in normal diet and lifestyle habits after the stage of anticoagulant dose adjustment. Treatment: It is not necessary to change the habits of the diet after discharge. The diet is usually not restricted, and meals can be improved and the variety of food changed, but a phase of prolonged alcohol consumption or abuse, or a monotonous diet of a vitamin K-rich vegetable, unchanged for several days or weeks, should be avoided. If care can be taken to avoid the effects that generally do not occur, it is not necessary to test the prothrombin time or adjust the amount of coumarin-based medication due to diet. VIII. Special problems of anticoagulation in women of childbearing age and its treatment Menstruation In women with normal menstruation before surgery and taking anticoagulants after flap replacement, most patients have some changes in menstrual period and volume, and the period is basically similar to that before surgery, and the volume of menstruation may increase compared with that before surgery. In order to reduce bleeding, in recent years it has been taken to stop warfarin from the day before the onset of menstruation until the day before the basic cleansing of menstruation; or to reduce the amount of warfarin taken during menstruation by half compared to the usual amount. In patients with regular functional uterine bleeding before surgery, the menstrual period can be prolonged in postoperative anticoagulation, and the menstrual volume can be increased, but the cycle can be basically unchanged. If the bleeding is heavy, vitamin K1 can be injected to stop the bleeding. If repeated heavy bleeding is required to stop the bleeding with drugs each time, microwave therapy or hysterectomy can be used. Patients with IUDs are similar to normal women with IUDs, and the menstrual flow is usually increased. Oral contraceptives Oral contraceptives can reduce the effect of oral anticoagulants. Therefore, pay attention to check the prothrombin time and adjust the dose of medication in time. After the application of both types of drugs has formed a regular pattern, there is no need to increase the number of additional laboratory tests. Pregnancy and Childbirth 1. Continued Pregnancy After valve replacement, the hemodynamics and cardiac function improve significantly, and for married women who are pregnant or wish to have children, pregnancy can be allowed 2-3 years after valve replacement. Patients with mechanical valve replacement are anticoagulated by coumarin-like drugs. Coumarins can cross the placental barrier into the fetus and are at risk of causing malformations in the first 3 months of pregnancy, especially from 6 to 13 weeks. Therefore, heparin can be used as anticoagulation in the first 3 months of pregnancy and in the last 2 weeks of the first 3 months. Because of its large molecular size, heparin does not cross the placenta. However, the application of heparin requires hospitalization, which is inconvenient for long-term use and cannot be promoted. During pregnancy, the fetus can be premature, stillborn or die after birth. The causes of death are placental abruption, internal bleeding or cerebral hemorrhage. During pregnancy, the mother’s body may be in a hypercoagulable state, which may lead to thromboembolism. Therefore, the prothrombin time should be checked regularly and the dosage of medication should be increased according to the value of the test. Proper adjustment can reduce the risk to the mother and fetus to a very low level. The increased burden on the mother’s heart can be improved with cardiac stimulation and diuretic therapy. In patients with long-term anticoagulation therapy after valve replacement, if the recovery of cardiac function is poor and hemodynamic improvement is delayed, such as preoperative cardiac function class IV, postoperative improvement to class III or still class IV, the physiological changes after pregnancy can increase the burden on the heart, and patients are often threatened by the coagulation mechanism in a hypercoagulable state and circulatory overload after pregnancy, pregnancy should be aborted, and preferably before the third month after pregnancy. The procedure should be completed before the third month of pregnancy. The procedure is simpler and less harmful to the patient. The anticoagulation treatment for termination of pregnancy is to stop taking anticoagulants for 2-3 days before surgery, operate after checking the normal prothrombin time, and resume anticoagulation 48h after surgery. 3. Anticoagulation treatment in the perinatal period Patients can be hospitalized 1 to 3 weeks before the expected delivery date, and anticoagulation with heparin is stopped during the hospitalization period instead. If preterm labor occurs, the mother and fetus are safer. If oral anticoagulants are not discontinued, cesarean section is preferred. The newborn should be given vitamin K15mg via umbilical vein. breastfeeding should be abandoned because breast milk contains anticoagulants. Restart anticoagulation therapy 48 to 72 h after surgery. Individual women who still deliver spontaneously after valve replacement should be very cautious.