Definition and Overview
Patients with at least one damaged heart valve are scheduled for an initial consultation before surgery to correct the condition is performed.
The heart has four valves namely tricuspid, aortic, mitral and pulmonary. They facilitate the flow of the blood as it passes through the heart’s different chambers.
The tricuspid valve is found on the right side of the heart, and it is where the desaturated blood coming from the veins passes toward the right ventricle. From the right ventricle, the blood proceeds to the lungs via the pulmonary valve. In the lungs, the carbon dioxide in the blood is removed for exhalation while oxygen from inhalation mixes with the blood.
The oxygenated blood goes back to the heart through the left ventricle and then to the mitral valve. It continues to the right ventricle before going out through the aortic valve where the blood gets distributed to the arterial network.
Valves help control the flow of the blood and the pressure of the heart. If they are defective or damaged, they can cause issues with the electrical and pumping activity of the heart.
Damaged or diseased valves can either be repaired or replaced. As much as possible, the surgeon will try to repair the valve unless the one that is affected is the aortic valve.
Who Should Undergo and Expected Results
A heart valve surgery consultation is conducted for patients with a congenital heart valve defect or those who were diagnosed with a heart valve disease. These are often long-term conditions that can easily progress unless they are treated or preventative measures are taken promptly.
A consultation may also be recommended if the patient wants a second opinion. Considering the serious risks that come with a surgical procedure that involves the heart, a patient may elect to explore other treatment options that another surgeon can provide.
How Does the Procedure Work?
A heart valve surgery consultation is performed as soon as the patient is referred by a cardiologist (a specialist in conditions affecting the heart) to a cardiovascular surgeon. Around this time, the patient has already been diagnosed with a heart valve disease or a congenital defect that can no longer be treated with medications and other non-surgical therapies. The patient is also expected to have gone through the needed tests to diagnose the disease or the condition.
During the consultation, the surgeon goes over the patient's medical records. If necessary, additional examinations may be requested, but usually, they are intended to help plan the upcoming surgical procedure. If there are symptoms associated with the disease, the surgeon may refer the patient back to the cardiologist who can prescribe certain medications.
The surgeon is expected to discuss the following during the consultation:
- Technique to be used
- Risks and complications
- Costs of the treatment
- Follow-up care
- Management of the heart, especially the valve, after the surgery
- Preparations needed prior to the surgery
After the surgical date has been determined, the patient is scheduled for a pre-admission testing, which is performed at least one or two weeks prior to the surgery.
A typical consultation can take at least an hour, and follow-up sessions may have to be scheduled before the surgery depending on the patient’s unique circumstances. However, in situations where the surgery is urgent, one consultation may be enough.
The patient may be accompanied by a loved one or a caregiver who can also be educated by the surgeon on the procedure and be counseled on how to help the patient before and after the surgery. The patient is also encouraged to ask questions during the consultation.
Possible Risks and Complications
For a heart valve surgery to be successful, there should be a close coordination between the cardiologist and the surgeon. Both of them must agree that surgery is necessary and work together to ensure the safety and health of the patient before and after the operation. The problem comes in if both of them cannot establish a good working relationship.
Another possible risk is the non-appearance of the patient. This usually happens when the patient becomes apprehensive, anxious, or overwhelmed by the idea of surgery. Surgeons are not allowed to withheld any information from the patient, particularly those that relate to surgical risks and complications, but they can help ease the patient’s mind by providing sound and evidence-based assurances.
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.
Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 66.