Our Summary

This research paper discusses the challenges of treating heart valve disease in newborns and infants. Sometimes, the only option left is to replace the damaged valve, but this should only be done as a last resort because it often leads to other health problems and even death. When a replacement is necessary, the type of valve chosen depends on the size of the opening where the valve sits. If this opening (or ‘annulus’) is 15-16 mm or larger, surgeons should try to use the smallest available mechanical valve. If the annulus is smaller, a different type of valve (a ‘stented valved conduit’) may be safer. Another technique, placing the valve above the annulus (‘supra-annular implantation’), is risky and should only be used in special cases by surgeons experienced with the method.

FAQs

  1. What are the challenges of treating heart valve disease in newborns and infants?
  2. What factors influence the type of valve chosen for replacement in infants?
  3. What is a ‘supra-annular implantation’ and when should it be used?

Doctor’s Tip

A doctor might tell a patient undergoing valve replacement surgery to follow all post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation programs to ensure a successful recovery. It is important to monitor for any signs of infection, blood clots, or other complications and to seek medical attention if any concerning symptoms arise. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and avoiding tobacco and excessive alcohol can help support the function of the new valve and overall heart health.

Suitable For

Patients who are typically recommended valve replacement include:

  1. Patients with severe symptomatic heart valve disease, such as aortic stenosis or mitral regurgitation, where medical management is no longer effective in controlling symptoms.

  2. Patients with congenital heart defects that affect the heart valves and cannot be repaired through other means.

  3. Patients with valve degeneration or damage due to infection, rheumatic heart disease, or other underlying conditions.

  4. Patients who have undergone previous valve repair surgeries that have failed or are no longer effective.

  5. Patients who are at high risk for complications from valve repair procedures and would benefit more from a valve replacement.

  6. Patients who are in good overall health and are likely to tolerate the surgical procedure and recovery process well.

It is important for patients to discuss their individual case with their healthcare provider to determine the best treatment option for their specific condition.

Timeline

Before valve replacement:

  • Patient may experience symptoms such as shortness of breath, chest pain, fatigue, dizziness, and swelling in the legs and abdomen
  • Diagnosis of heart valve disease through physical examination, imaging tests (echocardiogram, MRI, CT scan), and cardiac catheterization
  • Treatment with medications to manage symptoms and slow the progression of the disease
  • Consultation with a cardiac surgeon to discuss the possibility of valve replacement

After valve replacement:

  • Preoperative preparation including blood tests, imaging tests, and consultation with an anesthesiologist
  • Surgery to remove the damaged valve and replace it with a mechanical or biological valve
  • Recovery in the hospital, with monitoring of vital signs and potential complications such as infection, blood clots, or bleeding
  • Rehabilitation and physical therapy to regain strength and mobility
  • Follow-up appointments with the cardiologist to monitor the function of the new valve and adjust medications as needed

Overall, the timeline of a patient before and after valve replacement can vary depending on the individual’s health status, the type of valve used, and any potential complications that may arise during or after the surgery. It is important for patients to work closely with their healthcare team to ensure a successful outcome and optimal recovery.

What to Ask Your Doctor

  1. What are the different types of valve replacement options available for me?

  2. What are the risks and potential complications associated with valve replacement surgery?

  3. How long is the recovery period after valve replacement surgery?

  4. What lifestyle changes will I need to make after valve replacement surgery?

  5. How often will I need to follow-up with my doctor after valve replacement surgery?

  6. What are the signs and symptoms of complications that I should watch out for after valve replacement surgery?

  7. Are there any restrictions on physical activities or medications I should be aware of after valve replacement surgery?

  8. How long can I expect the replacement valve to last before needing another replacement?

  9. Are there any alternative treatments or therapies to consider before opting for valve replacement surgery?

  10. How experienced is the surgical team in performing valve replacement surgeries, especially in cases like mine?

Reference

Authors: Caldaroni F, Brizard CP, d’Udekem Y. Journal: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2021;24:57-61. doi: 10.1053/j.pcsu.2021.03.006. PMID: 34116783