1. What are the heart valves? There are four sets of valves in every human heart. These are the aortic valve, which connects the left ventricle to the aorta, the pulmonary valve, which connects the right ventricle to the pulmonary artery, the mitral valve, which connects the left atrium to the left ventricle, and the tricuspid valve, which connects the right atrium to the right ventricle. They all act as one-way valves, allowing blood to flow only from one direction to the other without backing up. Each valve consists of 2 to 3 valve leaflets, the leaflets are thin, smooth and elastic when normal. 2.What is heart valve disease? Valve malformation or deformation due to congenital or acquired causes of blood flow obstruction is called valve disease. Acquired, especially rheumatic heart valve disease is very common, and the changes in the valve itself are more obvious. Valve stenosis: The blood flow is impaired due to deformation of the valve orifice. Mitral stenosis, aortic stenosis, etc. Incomplete 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 incomplete door closed. 3. Why do some patients need valve replacement? Valve stenosis or insufficient closure, the loss of one-way valve role, and the valve lesions can not be closed expansion or molding surgery for effective treatment, then it is necessary in the extracorporeal circulation through the surgical method will be the original lesions of the valve excision, replacement of a man-made heart valves, in order to restore the physiological function of the one-way valve to lift or alleviate the symptoms. Every year, thousands of patients around the world receive a new lease on life 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 effect is certain. 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. Surgery depends on the degree and nature of the valve lesion. Congenital, degenerative, and some rheumatic mitral valve insufficiency can be repaired with valvuloplasty. Compared 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 plastic surgery to be performed based on the condition of the lesion. Plastic surgery has the advantage of preserving the structure of the valve, eliminating the need for long-term anticoagulation, and avoiding the hazards that can be associated with improper anticoagulation. However, if the lesion continues to develop, another surgery may be required. 5.How many types of prosthetic valves are there? Which type of valve is better? There are two main types of artificial heart valves. One is mechanical valves and the other is biological valves. The former is made of cracked charcoal using high-tech synthetic materials, while the latter is made of both synthetic high-level materials and biologic valve tissues after complex chemical treatment. Each has its own characteristics, advantages and disadvantages. Mechanical valves have the advantage of durability and the disadvantage of lifelong anticoagulation and a high rate of anticoagulation bleeding or thromboembolism. However, biologic valve replacements do not require long-term anticoagulation after surgery, but their durability is limited. As to which type of valve is suitable for you, your doctor will make an appropriate choice based on your specific condition and requirements. Biological Valve Mechanical Valve 6. Why do valve replacement patients need anticoagulation therapy? How long does anticoagulation therapy take? Because artificial valves (biological or mechanical valves) are not part of the human body itself, blood tends to coagulate in and around artificial valves, causing thrombus and affecting the function of artificial valves, and if the thrombus is dislodged, it can also cause vascular embolism (cerebral embolism, arterial embolism of the lower extremities, etc.), which is very harmful to people. Therefore, any patient who has a replacement valve should be treated with anticoagulation to prevent thrombosis. Biological valve replacements generally only need to anticoagulate three months after surgery, atrial fibrillation need to anticoagulate six months; and mechanical valve replacements need to anticoagulate lifelong. 7. How to anticoagulate in valve replacement patients? How is the standard of anticoagulation determined? The main method of anticoagulation is oral anticoagulation tablets. Commonly used anticoagulants include warfarin tablets, etc. Apivirine can also be used as an adjunctive anticoagulant. In special cases, anticoagulation can be maintained by subcutaneous injection of low molecular heparin. Oral anticoagulation tablets are usually started after removal of 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 the prothrombin time (PT) and international normalized ratio (INR). This test can reflect the strength of the anticoagulant 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. Anticoagulants must be taken regularly and recorded daily! 8.What are the side effects of under or over dosage of anticoagulants? (1) Insufficient anticoagulation: caused by insufficient dosage of anticoagulants. Harms: thrombosis can lead to valve activity disorder, valve tone 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 situations should seek medical treatment in time. (2) Overdose of anticoagulation: caused by overdose of anticoagulants. Harm: It can lead to various bleeding and other complications: hematuria, mucous membrane bleeding such as nosebleed, gum bleeding, bleeding from wounds or ulcers, with or without skin bleeding spots and hemorrhagic purpura, etc.; uterine bleeding, manifested by increased or abnormal menstruation. Treatment: the occurrence of the above conditions, should be promptly examined in the hospital, adjust the anticoagulant dosage. Even suspend the use of drugs. 9. What should be done if a female patient has excessive menstruation with anticoagulation? Generally speaking, anticoagulant therapy has little effect on menstruation. Even if menstruation is slightly heavier or longer than before, there is no need to deal with it as long as it is not serious. If there is a significant increase in the amount of menstruation, the amount of anticoagulant can be appropriately reduced during menstruation and resumed after menstruation. If the menstrual disorder after anticoagulation therapy, bleeding continuously should go to the gynecology department, taking menstrual regulating drugs. In addition, women of childbearing age should pay attention to contraception in anticoagulation therapy, so as not to increase the risk of bleeding by abortion. 10.What are the precautions in the early period after valve surgery? The first three months after the operation is an important stage to overcome the trauma of the operation and to recover the physique, and the following matters should be noted: (1) medication: take the medication on time and according to the dosage. Commonly used drugs include anticoagulants, cardiotonic diuretics, anti-arrhythmic drugs, etc. (2) Prevention of infections: especially inflammation of the rostrum, periodontitis, skin boils, urinary tract infections and so on. Once discovered, they should be controlled promptly. For unexplained intermittent or persistent fever, do not seek medical advice and use antimicrobials indiscriminately. You should consult a doctor in time. To avoid delayed treatment. (3) Diet: pay attention to increasing nutrition and supplementing protein and vitamins. Do not overdo or long-term consumption of vitamin K-rich foods: spinach, carrots, pig liver, tomatoes, cauliflower, fresh peas and so on. (4) Patients with poor cardiac 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 soup. Drinking alcohol can affect the metabolism of Hua decree, so during the anticoagulation period, just try not to drink alcohol, not to mention alcoholism. 11.When can I resume activities and work after valve surgery? Appropriate activity level should be maintained after surgery in order to enhance physical fitness and improve the quality of life while cardiac function recovers. The amount of activity should be measured and gradual, so as not to cause panic and shortness of breath. Do not stay in bed all day. Some patients may feel tension in the neck, shoulder and chest muscles after surgery. At this time, you can do light exercise to relax the muscles, such as slowly lifting your arms above your head, or shrugging your shoulders and then relaxing them, and this repeated exercise will improve. Sternal wounds usually heal in six weeks, so you should not lift heavy objects for six weeks or less. Arrange your early recuperation life, keep your spirit 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, if the heart function is recovered satisfactorily, good health, can gradually resume labor and work, as for the intensity of labor in order not to feel tired and shortness of breath and panic as appropriate. 12.What should I do if I need to have my teeth extracted or undergo other surgeries after the valve replacement surgery? If you need to have your teeth extracted or undergo other surgeries after the valve replacement surgery, it is best to do so when your heart function is in good condition. If you have been anticoagulated for a long time, you should suspend warfarin and change to heparin therapy before surgery. If the surgery is an emergency, special treatment is needed to stop and prevent bleeding. The doctor will carefully stop the bleeding for you during the operation, and you can continue the anticoagulation treatment with warfarin after 24～48 hours after the operation without blood seepage. 13.What should I pay attention to when taking other medications after valve replacement? After valve replacement, patients may need to take other medications due to other diseases while taking anticoagulant drugs. At this time, patients should pay attention to whether the drug has an effect on anticoagulant drugs, for example, some drugs will increase the anticoagulant effect of anticoagulant drugs. For example, some drugs increase the anticoagulant effect of anticoagulants, which is called “synergism” in medicine. Other drugs may reduce the effect of an anticoagulant, known as “antagonism”. “Synergism” increases the anticoagulant effect – the amount of anticoagulant used needs to be reduced: aspirin, heparin, steroids, fen-phen, anti-inflammatory pain, quinidine, salicylates, prednisone, etc. “Antagonism” weakens the anticoagulant effect – need to increase the amount of anticoagulants: vitamin K, sleeping pills, estrogen, oral contraceptives, rifampicin, barbiturates, some cold medicines. 14.Can women get pregnant and have children after valve replacement? Women who have replaced the biological valve can have normal pregnancy and childbirth. However, it should be noted that: (1) At least half a year after the valve replacement surgery, after stopping the use of anticoagulants, cardiac function has recovered well before pregnancy can be considered. (2) Good health care should be provided during pregnancy, especially to prevent perinatal cardiac insufficiency. Women with mechanical valves should be carefully considered because of the need for lifelong anticoagulation. (1) Warfarin in the first trimester of pregnancy has been reported to pose a risk of fetal malformation. (2) Anticoagulation during pregnancy and labor increases the risk of bleeding. There are certainly reports of successful pregnancy and delivery after mechanical flap replacement. If you decide to have a child, you should consult your cardiologist and obstetrician/gynecologist for special anticoagulation treatment and health care during the perinatal period. 15.What about arrhythmia after valve replacement? When you feel that your heartbeat is irregular you should go to the hospital 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 early as possible. Measures include rest, potassium supplementation, injection of lidocaine, and taking drugs such as betalactam, but always under the supervision of a doctor. In bradycardia (heart rate less than 60 beats/minute) temporarily discontinue digoxin and ? receptor blockers, and then gradually resume the use of digoxin when the heart rate increases (greater than 70 beats/minute). If the heart rate is still slow even after stopping digoxin, and there is dizziness, palpitations and other discomforts, one should consult a doctor promptly. Heart valve disease is often accompanied by atrial fibrillation. The heart rate can be controlled by taking digitalis preparations along with anticoagulant therapy without being too fast or slow. 16.Is it normal to have a heart murmur after valve replacement? After the replacement of mechanical valves, you can sometimes hear a metallic sound similar to that of a clock, which is a normal phenomenon, and you do not have to mind it. Because the caliber of the artificial valve is relatively small compared to the caliber of the normal human valve, after valve replacement, sometimes a mild systolic or diastolic murmur can be heard in the precordial area (especially after aortic valve replacement), if the echocardiogram shows no perivalvular leakage, good valve activity, good recovery of cardiac function, this murmur has no effect on hemodynamics, no need to worry. If the murmur changes or a new murmur appears with symptoms such as palpitations and shortness of breath, you should seek medical attention and analyze the cause. 17.When should I go to the hospital for review after valve surgery? After valve replacement or valvuloplasty, early rechecking is more frequent, 2-3 weeks need to go to the hospital to recheck the anticoagulation treatment and the recovery of heart function. If you experience any of the following conditions, please go to the hospital for examination: ① Chest pain instead of wound pain. ② Sudden change or disappearance of the sound of heart valve opening and closing, arrhythmia, i.e. irregular heartbeat. ③ Heart rate below 60 beats/minute or above 120 beats/minute. ④ Persistent fever for three days or more, when there is infection in any part of the body. ⑤ When there is swelling and sudden weight gain of more than 2 kilograms. (6) Shortness of breath, panic attacks, and frothy bloody sputum. (7) Unexplained nausea, vomiting, and jaundice in the sclera and skin. (8) When there are bleeding spots under the skin, darkening of stool color, reddening of urine color and other bleeding phenomena. Sudden fainting, coma, hemiplegia or lower limb pain, coldness and pallor.