Former first lady Barbara Bush and comedian Robin Williams made headlines recently because both underwent aortic valve replacement surgery. Although open-heart surgery sounds scary, Dr. John V. Conte, associate director in the division of cardiac surgery and a professor of surgery at the Johns Hopkins Heart and Vascular Institute, says aortic valve replacement is one of the most common procedures heart surgeons perform. Most patients can expect a full recovery.
What is the aortic valve?
It is the main valve that regulates the flow of blood from the heart's pumping chamber out to the rest of the body.
How does it become defective?
There is a lot of wear and tear on the valves. Once the protective outer layer of cells is worn off, you begin to get deposits of calcium. Over time, that causes the valves to stick together. Over time, this calcium becomes very hard and forms a stony cover over the valve. If it is stuck together, the blood doesn't flow as easily.
What causes the wear and tear on the aortic valve?
High blood pressure contributes significantly. There are other problems; people can be born with abnormal heart valves that wear out more easily. There are genetic causes as well.
What are the symptoms?
Patients can get short of breath, lightheaded or can even pass out. If you have any of those symptoms, you need to see a doctor. It can be a very insidious onset.
How is the problem diagnosed?
The doctor listens with a stethoscope and hears a murmur. Then he gets a echo cardiogram, which looks at all of the heart valves. It is like a sonogram, which women get when they're pregnant to look at the baby in the womb.
What are the treatment options?
If the problem is not too severe, the treatments are generally supportive. You take medicine to control blood pressure. Many people retain fluid, and you take a diuretic to help you get rid of the fluid. You are just trying to bide time. But over time, it is almost certain that, if you live long enough, you will need surgery.
What is involved in the surgery?
There are three ways to reach the heart: You can divide all of the breastbone, you can divide part of the breastbone, or you can cut beside the breastbone. We stop the heart and put the patient on the heart/lung machine. Once we open up the aorta, we cut out the valve, we get rid of all the calcium that has built up and sew the new valve in.
What are replacement valves made of?
