When people have serious heart valve disease, they often need valve replacement or plication surgery. Your doctor will explain the pros and cons of this type of surgery. You will need to make a decision about whether to undergo the surgery. The benefits, risks, and possible complications of surgery are described below. I. Anatomy 1. Everyone knows that the heart means life. It is like the engine of a car. A car can run because of its engine. The heart is like a human engine that drives blood throughout the body. The heart valve is similar to the valve of the engine, which is used to ensure the smooth transmission of blood. 2. The human heart is divided into two parts: the left heart and the right heart, and each side is composed of a small and thin atrium and a large and thick ventricle. The power of the heart mainly comes from the contraction and diastole of the ventricles. 3. Blood from the body enters the right atrium by two large veins and then passes through the tricuspid valve into the right ventricle. Contraction of the right ventricle pushes blood through the pulmonary valve into the lungs. The blood is oxygenated in the lungs and then returns to the left atrium. The blood then passes through the mitral valve into the left ventricle. The left ventricle contracts and pushes blood through the aortic valve to supply the whole body. The main function of the valve is to ensure that the blood flows smoothly in one direction and cannot regurgitate. The valve is a very delicate structure, and there are many reasons for valve damage. (1) congenital dysplasia; (2) rheumatic damage; (3) bacterial infection; (4) degenerative changes due to long-term strain. 2. These etiologies may result in two consequences. One is stenosis, which is a narrowing of the mitral valve opening, when the heart must exert itself very hard to get enough blood out of the heart. As the condition progresses, heart failure, lack of systemic blood supply and even death can occur. Another consequence is incomplete closure. This is when some of the blood expelled from the heart flows backwards into the heart. The heart can only do more work to meet the body’s needs, eventually causing heart failure. Symptoms Patients may experience panic, shortness of breath, swelling, dizziness, hemoptysis, purple lips, and inability to lie down equally while sleeping. IV. Treatment 1. Avoiding strenuous activities and emotional excitement is very important for heart patients because the sick and weak heart can hardly bear the extra burden. 2.Drugs can strengthen the heart or reduce the burden of the heart. But drugs often do not stop the progression of the disease. As valve disease progresses and severely affects heart function, surgery is needed. Your doctor will discuss with you when to choose which surgery to have. V. Surgical options 1. Valve plication. This is a good option if the lesion in the valve is suitable for repair. The risk of surgery is lower than valve replacement surgery and the quality of life is higher; however, there is a risk of recurrence of the condition with valve repair surgery. 2.Valve replacement surgery. The main prosthetic valves are mechanical valves and biological valves. The advantage of mechanical valves is that they can be used for life, but the disadvantage is that they must take anticoagulant medication for life and require regular blood checks. Overdosing on anticoagulants may cause bleeding, and underdosing may result in the formation of blood clots, which can lead to death if they occur in the brain. The advantage of bioprosthetic valves is that they do not require anticoagulants. The disadvantage is that the valve has to be replaced again after every 20 years or so. It is important to discuss with your surgeon which procedure to choose or which valve to select. 3. The surgery is done under general anesthesia and you are asleep during the entire procedure. After the chest is opened, the surgeon uses a special tube to connect to the large blood vessels going in and out of the heart, and then connects to an artificial heart-lung machine, which is also called an extracorporeal circulation machine. This way the blood does not pass through the heart, and the artificial lungs are used for oxygen exchange, and a mechanical pump is used instead of the heart to push the blood through the body. This is when the doctor uses drugs to stop the heart from beating, so that he or she can operate on a resting, bloodless heart. 4. The surgeon repairs and shapes the diseased valve or removes the diseased valve and replaces it with an artificial valve. After the heart surgery is completed, the surgeon allows blood to flow back to the heart, the heart beats again, its own heart starts to work, the artificial heart-lung machine gradually stops, and finally the wound is sutured. VI. Risks and Complications 1. Valve replacement surgery is safe enough, but serious complications can still occur, although the chances are small. Knowing the risks and complications of surgery helps you make the right choice and helps your doctor detect and treat them early. 2.There are three main types of complications: those related to anesthesia; those that can occur with various surgeries; and those specific to valve surgery. 3.The main complications related to anesthesia and extracorporeal circulation are cardiac arrhythmia, pneumonia, liver and kidney failure, cerebral hemorrhage, cerebral thrombosis and even death. The anesthesiologist will explain this in detail to you before the surgery. 4. Complications that can occur in various surgeries include: Infection: First, superficial incisional infection. The second is deep infection including infection of heart, mediastinum and sternum. Deep infection may require long term application of large amount of antibiotics and even re-operation. 5. Bleeding during or after surgery. Blood transfusion is needed when there is excessive bleeding, and blood transfusion may cause allergic reaction or even spread the disease. Bleeding after surgery may cause pericardial tamponade, sometimes necessitating reoperation to stop the bleeding. 6. Complications specific to valve surgery. Although rare, it is important to understand them. Dysfunction of a repaired formed valve or a replaced valve sometimes requires emergency surgery and may sometimes result in death. Perivalvular leak: This is a blood leak between the suture ring of the prosthetic valve and the heart and may occur early or late after surgery, and in severe cases requires reoperation. Arrhythmias often occur after heart surgery and are mostly temporary and can be recovered quickly. Severe arrhythmias require long-term medication or even a pacemaker. VII. Post-surgery guidance 1. When you wake up, you will find a tube inserted in your mouth, so you can’t speak. You will feel thirsty, but you can’t drink. You should never try to remove the tube, you must relax yourself, it is an important tube connected to the ventilator. Usually the nurse will secure your hands with restraints to prevent you from removing the tube while you are unconscious. Your doctor will keep you comfortable with sedative medication. When you are fully awake, stable and off the ventilator, you can be transferred back to the general ward. 2. Your nose and throat may sometimes be sore and uncomfortable due to an oxygen tube, tracheal tube or gastric tube. Since a urinary catheter was inserted during the surgery, you may have a burning sensation in your urine at first, don’t be nervous, it is normal and will disappear in a few days. 3.In the general ward, the doctor will encourage you to get out of bed early, which is good for your recovery. As you move more, you may feel pain, especially when you turn over and cough. Please be careful not to use your arms as hard as possible, as it may affect the stability of the chest wound. Therefore, it is best to ask for help when turning and getting up. When coughing strongly, please ask the doctor to help cough up sputum and take appropriate cough suppressant and phlegm remover. 4. Slight redness, swelling, bruising, numbness and pain around the wound are all normal phenomena when the wound is healing. When the redness and swelling are serious, the pain is intense and even there is liquid flowing from the wound, notify the doctor to check the wound healing situation. 5. In some patients, there are two thin metal wires leading from the lower end of the incision, which are called temporary pacing wires, one of which is connected to the heart and the other to the pacemaker, and are used to regulate the heartbeat rhythm. It is usually removed before discharge from the hospital. 6. For the first one or two days after surgery, you should eat liquid food, such as thin gruel and milk, because the gastrointestinal function has not fully recovered. At three or four days, you can eat semi-liquid, such as noodles, chaos, etc. After five days, you can eat normally. If you always have no appetite after surgery, don’t worry, this is also normal, the doctor will give you gastrointestinal power medicine, and as your activity increases, your appetite will gradually improve. 7. When you leave the hospital, you should make a suitable step-by-step rehabilitation plan until you resume normal work and life. 8. In order to reduce the burden on your heart and improve its function. You should quit smoking, eat a healthy diet, control your weight, and exercise moderately under the guidance of your doctor. 9.You must tell your doctor that you have had valve replacement surgery when you are treated for dental disease or undergo other invasive examinations and treatments. 10.You must take antibiotics to prevent infection under the guidance of your doctor. When taking warfarin, you must have regular blood tests for PT and INR. their values should be kept within a specific range so that the blood, that is, cannot form clots or cause bleeding. In the early stages of taking warfarin it is often necessary to adjust the dose repeatedly until a suitable dose is found. When the correct dose is found, you still need to check your blood regularly, usually not more than three months. 11.Foods rich in vitamin K can reduce the effectiveness of warfarin. 12, The main risk of warfarin is life-threatening bleeding. Even minor trauma can cause fatal bleeding. If you have a severe headache it may be an intracerebral hemorrhage. Redness in the stools and urine must be reported to your doctor. Very dark stools mean bleeding in the gastrointestinal tract. If you have subcutaneous bruising, swollen joints, or excessive menstrual flow, please seek medical attention promptly. 13.While taking warfarin, certain tests have the risk of causing bleeding, such as gastroscopy and bronchoscopy. Stop warfarin in advance when doing these examinations. 14, to avoid intense impulsive physical activities to prevent bleeding after trauma. 15.Taking warfarin in early pregnancy may cause fetal malformation and may cause hemorrhage during delivery. Many drugs and warfarin have synergistic effects. 16, Remember! Consult your doctor before taking any new medication. VIII. Summary Heart valves are very important to the function of the heart, ensuring that blood flows smoothly and does not back up. If a valve stenosis prevents blood from flowing through it or if it does not close properly, blood can flow backwards, causing an increased burden on the heart, insufficient blood supply to the tissues, or even heart failure. The technology for valvuloplasty or valve replacement is well established and the procedure is relatively safe. Complications, although rare, can still occur, and knowing this knowledge can help you make the right judgment, reduce the risk of surgery, and detect and effectively prevent complications early.