1.How do you anticoagulate patients with heart valve disease after surgery and what are the criteria? The main method of anticoagulation is to take oral anticoagulation tablets. Commonly used anticoagulants include Warfarin tablets, etc. 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! 2.What are the side effects of underdose or overdose of anticoagulants? a) Insufficient anticoagulation: caused by insufficient amount of anticoagulants. Hazards: thrombosis can lead to valve activity disorder, valve tone quality can be changed, and even heart failure and other performance; 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 treated promptly by a doctor. 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. 3.Is it possible for women to get pregnant and have children after valve replacement? a) Women with replacement bioprosthetic flap can get pregnant and give birth normally. However, it is important to note that (1) pregnancy should be considered only after anticoagulants have been stopped for at least six months after valve replacement and cardiac function has recovered well. (2) Prevent perinatal cardiac insufficiency in particular by providing good health care during pregnancy. b) Women with mechanical valve replacement should be carefully considered 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 of course 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. 4.What do I need to pay attention to when taking other medications after valve replacement? After valve replacement, patients taking anticoagulant drugs may sometimes need to take other drugs due to other diseases at the same time. 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. 5.When should I return to work or related activities after flap replacement? After the surgery, you should maintain an appropriate amount of activity in order to enhance your physical fitness and improve your quality of life while recovering your 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, such as heart function recovery is satisfactory, good health, then you can gradually resume labor and work, as for the intensity of labor is not to feel tired and shortness of breath is appropriate. 6.What is heart valve disease? There are four groups of valves in each person’s heart. That is, the aortic valve connecting the left ventricle and the aorta, the pulmonary valve connecting the right ventricle and the pulmonary artery, the mitral valve connecting the left atrium and the left ventricle and the tricuspid valve connecting the right atrium and 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 is composed of two to three leaflets, which are thin, smooth, and flexible when normal. 7.What is heart valve disease? A congenital or acquired cause of valve malformation or deformation that results in impaired blood flow is called valvular disease. Acquired, especially rheumatic heart valve disease is 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. In simple terms, 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 close. 8.Why do some people need valve replacement? If the valve is stenosed or insufficiently closed and loses its one-way valve function, and the valve lesion cannot be effectively treated by closed dilatation or shaping, the original diseased valve must be surgically removed and replaced with an artificial heart valve under extracorporeal circulation to restore the physiological function of the one-way valve and 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. 9.Does all mitral valve insufficiency require valve replacement? What is the current technology of valvuloplasty? Mitral valve insufficiency does not always require valve replacement. The surgical approach depends on the extent 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. 10.Why do patients with valve replacement need to take anticoagulants and when should they start taking them? 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. Biologic valve replacements generally require anticoagulation for only three months after surgery, while those with atrial fibrillation require anticoagulation for six months; mechanical valve replacements require lifelong anticoagulation. 11.What are the prosthetic valves? What is the performance? Artificial heart valves are divided into two main categories. 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 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 doctor will make an appropriate choice based on your specific condition and requirements. 12.Is it normal to have a heart murmur after valve replacement? Sometimes a metallic sound like a clock can be heard after mechanical valve replacement, which is normal and need not be minded. Since the caliber of the prosthetic valve is smaller than that of a normal human valve, a mild systolic or diastolic murmur can sometimes be heard in the precordial region after valve replacement (especially after aortic valve replacement), and 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. 13.Is it normal to have an irregular heart rhythm after valve replacement? When you feel that your heartbeat is not in order, you should visit the hospital to find out the type of arrhythmia. Atrial premature beats – can be corrected by 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 after the heart rate has increased (>70 beats/min). If the heart rate is still slow after stopping digoxin and there is dizziness, palpitations and other discomfort, promptly seek medical advice. Heart valve disease is often associated with atrial fibrillation. Anticoagulation therapy can be administered along with digitalis preparations to control the heart rate from being too fast or not too slow. 14.What do I need to pay attention to when I need to have my teeth or other surgery after heart valve replacement? The best time to have a tooth extraction or other surgery after valve replacement is 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. Your surgeon will carefully stop the bleeding during the procedure, and you can continue warfarin anticoagulation therapy 24 to 48 hours after the procedure when there is no blood leakage. 15.What are the early considerations after valve surgery? The first three months after surgery is an important stage for overcoming the surgical trauma and recovering the body, the following should be noted: (1) Medication: Take medication on time and in the right amount. Commonly used drugs include anticoagulants, cardiac diuretics, anti-arrhythmic drugs, etc. (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 water intake, 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.