Special
situation :
Patients
60-65 years -decision should be based on consultation with patient
Females
in reproductive age group. The option of implanting a tissue valve is idealas
it avoids the risk of damage to the foetus due to anticoagulant drugs. This
has to be discussed with patient as they would definitely need are-replacement
of the valve in 8-10 years time.
Patients
who want to pursue adventure sports -The option of a tissue valve is better
as anticoagulation would pose increased risk of bleeding in an injury situation.
Is
re-operation risky?
Any
re-operation in the heart poses additional risk due
to difficulty in re-entry. The heart will be stuck
to the pericardium and anatomical planes will not be
preserved. But in the present day the increased risk
still exists but is very small, due to better techniques
and expertise.
Anticoagulation :
Patients
receiving a mechanical heart valve require a blood thinner (Warfarin,
Acitrom) to prevent clots. Other associated conditions like
irregular heart beat (atrial fibrillation) and enlarged heart
may also be treated with warfarin. Some surgeons also prefer
to put their patients with biological valves also on a small
dose of warfarin for 6-12 weeks.
Warfarin
works by prolonging the time for the blood to clot. The drug
must be carefully monitored by doing a blood test called INR.
INR should be done once a month ideally. WHO recommends
that the INR should be between 2.5 to 3.5 for patients
with prosthetic mechanical valves. Too high a level will cause
bleeding problem and too Iow a level will cause embolism. To
keep the levels steady it is advisable to take this drug at a
specific time each day. We advice 6 pm. every day. One should
avoid heavy alcohol consumption, certain types of food (high
in vit-K) and some medicines. Please check with your doctor before
taking any over the counter medications including cold remedies,
antibiotics, vitamins and sleeping pills.
Patients
on warfarin should report to the doctor if they experience bleeding from gums,
nose bleeds, blood in urine or stool, spotting of blood while coughing or excessive
menstrual loss. Also report immediately to the doctor if they experience a transient
loss of consciousness, weakness of a limb or blurring of vision.
Other
Procedures
Patient
should inform any physician, surgeon or dentist that
he is on warfarin. The drug should be stopped two days
prior to any procedure including dental extraction.
The INR should be checked on the day of procedure and
it should read < 1.4. Warfarin is to be resumed
on the evening of procedure. If the patient cannot
take the drug orally, Heparin should be started.
Pregnancy
All oral anticoagulants
are teratogenic (can cause deformities in the fetus). The risk is maximal in
the first trimester. It is ideal to switch to Heparin in the first trimester
if pregnancy is planned. Currently we do not recommend switching to heparin if
pregnancy is detected after few weeks of exposure to the drug as the benefits
are not overwhelming.
Endocarditis prophylaxis
Endocarditis is a
serious life threatening infection of the heart. Patients with valve diseases
and prosthetic valves are at increased risk. All these patients need antibiotic
coverage to prevent infection before any procedure including dental extraction.
Always consult your doctor before any dental or surgical procedure.
Rheumatic Prophylaxis
All
patients with rheumatic heart disease are advised to
have Prophylaxis against further attacks. This is achieved
by taking a long acting penicillin (Penidure) injection
once every 3 weeks. Currently it is advised to have
this prophylaxis life long.
|
Heart valves can be abnormal
from birth or damaged by Rheumatic fever, bacterial infection and calcific
degeneration. Valves also degenerate with normal aging. Valve abnormality
can result in 
Most
commonly used. Various types available, Ball
and Cage (Starr-Edwards), Monoleaflet (Medtronic)
and Bileaflet( St.Jude's). Most
of them are made of graphite coated with carbon by a process
called pyrolysis which render it very strong.
This
is mono leaflet tilting disc valve made in India. Developed by
the Sree Chitra Institute in Trivandrum and presently manufactured
and marketed by TTK limited. Our centre was one of the five National
centers which participated in the trial of this valve initially.
