Prosthetic Valves

What is a prosthetic valve?

A prosthetic valve is a valve that a surgeon puts in the heart to replace a damaged heart valve (figure 1). Prosthetic valves are used when a valve condition is severe. These conditions includes:

  • Stenosis – This is when a valve doesn’t open fully. Examples – aortic stenosis (figure 2) and mitral stenosis.
  • Regurgitation – This is when a valve leaks, so blood flows in the wrong direction. Examples – aortic regurgitation and mitral regurgitation.

There are 2 main types of prosthetic heart valves:

  • Mechanical – These valves are made from man-made materials. They can last 20-25 years or longer.
  • Bioprosthetic – These are made from valve tissue from a pig, cow, or horse. In some cases, they come from another person. These valves usually last 8 to 10 years.

In some patients they also can lasts for >10 years.

What problems can happen with prosthetic valves?

The problems that can happen depend on the type of valve and where it is in the heart.

Problems that can happen with prosthetic valves include the following:

  • Blood clots can form on the valve. This is a problem because clots can break off and travel through the blood vessels to other parts of the body.

The clots can then block off small blood vessels. This can cause organ damage and symptoms. Sometimes, a blood clot can also block the valve. Blood clots are more common with mechanical valves than bioprosthetic valves.

There are medicines that can help prevent blood clots. These are called “anticoagulants.”

  • People can have side effects from treatments they take. For example, people who take anticoagulant medicines can bleed much more easily than normal.
  • The valve can get infected, which called as an “endocarditis.” The infection can damage the valve and the heart tissue around the valve. With endocarditis, small growths can form on the prosthetic valve.
  • The valve can leak or get blocked by scar tissue. If the prosthetic valve is leaking a lot or is badly blocked, it might need to be replaced.
  • The valve can damage red blood cells as blood flows through the heart. This can cause a condition called “low grade anemia.”

How do I manage my prosthetic valve?

Long-term management for a prosthetic valve depends on the type of valve, where it is in the heart, and your individual situation.

Most people need to take some kind of medicine to help keep blood clots from forming. The medicines you get depend on the type of valve you have:

  • Most people with a prosthetic valve (either mechanical or bioprosthetic) need to take aspirin every day for the rest of their life.
  • Most people with a mechanical valve also need to take an anticoagulant called warfarin for the rest of their life.
  • Most people with a bioprosthetic valve need to take an anticoagulant for only a short time (~3 months) after the valve is put in and can be prolonged duration in such case like AF.
  • If you take warfarin, you need to take it exactly as instructed. If you forget or miss a dose, call your doctor to find out what to do.
  • At the wrong doses, the medicine can either stop working or lead to serious bleeding.
  • People who take warfarin also need regular blood tests like PT-INR. That’s because the medicine’s effects can change over time.
  • People sometimes need extra blood tests if certain things change, such as their other medicines (for example, starting an antibiotic) or their diet.

Things you should do to manage your health if you have a prosthetic valve :

  • Call your doctor right away if you have a fever or chills, or an infection in any part of your body (such as a skin or dental infection). If an infection is not treated, it can sometimes spread and cause a valve infection – infective endocarditis.
  • Call your doctor right away if you have fatigue (feeling much more tired than usual) or shortness of breath. These could be symptoms of a valve problem.
  • Go to all your follow-up visits and tests. At these visits, your doctor will talk with you and do an exam. Sometimes, they will do an echocardiogram An echo uses sound waves to create a picture of your heart as it beats. It shows the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working (figure 3).
  • Take good care of your teeth, maintain dental hygiene, and seeing a dentist regularly. Ask your doctor about antibiotic medicines to take before having certain dental or medical procedures. This can help prevent a valve infection.
  • Ask your doctor about advice on physical activity and sports. If you take an anticoagulant medicine, your doctor will probably recommend that you avoid sports and activities in which you could easily get hurt or bleed.

What if I have a prosthetic valve and want to get pregnant?

  • If you have a prosthetic valve and want to get pregnant, talk with your doctor before you start trying to get pregnant.
  • People who take anticoagulant medicines sometimes need to change their medicine for first 45 days.
  • Different anticoagulant medicines have different risks for the mother and the baby.