1.What are the heart valves? There are four groups of valves in the heart of an individual. 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 flow only 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 due to congenital or acquired causes of valve malformation or deformation caused by blood flow disorders, called valve 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 some patients need to replace the valve valve stenosis or incomplete closure, the loss of one-way valve role, and the valve lesion can not be effectively treated with closed dilatation or shaping, then the original lesion must be removed through surgical methods under extracorporeal circulation, replaced with an artificial heart valve, in order 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 at 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. Compared with 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? 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 carbon, while the latter is made of both synthetic advanced materials 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 doctor will make an appropriate choice based on your specific condition and requirements. 6.Why do valve replacement patients 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 prone to coagulation 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 be treated with anticoagulation 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? 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 in special cases to maintain anticoagulation therapy. 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 insufficient or excessive doses of anticoagulants Anticoagulation deficiency: caused by the insufficient amount of anticoagulants. Hazards: thrombosis can lead to valve activity disorder, 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. Anticoagulation overdose: caused by excessive use of anticoagulants. Hazards: It can lead to various bleeding and other complications: hematuria, mucosal bleeding such as nosebleeds, gum bleeds, 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.How to do about excessive menstruation in female patients with anticoagulation Generally speaking, anticoagulation therapy has little effect on menstruation, even if menstruation is slightly more or longer than before, as long as it is not serious, there is no need to deal with it. 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 postoperative period after valve 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 antiarrhythmic drugs. (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 antibacterial agents. 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 water intake, should not eat too salty food, and should not consume large amounts 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 you resume activities and work after valve surgery? After surgery, you should maintain an appropriate amount of activity in order to enhance your physical fitness and improve your 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, you can gradually resume labor and work, and the labor intensity should be appropriate without feeling tired and short of breath. 12.What to do if you need to extract teeth or do other surgery after valve replacement After valve replacement surgery, it is best to extract teeth or undergo other 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 to pay attention to when taking other drugs after flap replacement After flap replacement, patients sometimes need to take other drugs due to other diseases while taking anticoagulants, and patients should pay attention to whether the drug has an effect on anticoagulants, for example, some drugs can increase the anticoagulant effect of 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 – requiring a reduction in 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.