心脏瓣膜修复或置换手术

心脏是由肌肉组织组成的泵. It has 4 pumping chambers: 2 upper chambers, called atria, and 2 lower chambers, called ventricles. Valves between each of the heart's pumping chambers keep blood flowing forward through the heart.

Tricuspid valve. Located between the right atrium and the right ventricle
Pulmonary valve. Located between the right ventricle and the pulmonary artery
Mitral valve. Located between the left atrium and the left ventricle
Aortic valve. 位于左心室和主动脉之间

When valves are damaged or diseased and do not work the way they should they may need to be repaired or replaced. Conditions that may cause heart valve dysfunction are valve stenosis (stiffness) and valve regurgitation (leaky valve).

当一个(或多个)阀门变得狭窄(僵硬)时, the heart has to work harder to pump the blood through the valve. Valves can become narrow and stiff from infection (such as rheumatic fever or staph) and aging. 如果一个或多个阀门泄漏, 血液向后渗漏, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your healthcare provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.

Traditionally, open-heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve(s). Newer, less invasive techniques have been developed to replace or repair heart valves. 微创手术的切口更小, and mean less pain afterward and shorter hospital stays.

The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be made of carbon coated plastic or tissue (made from animal valves or human valves taken from donors). You and your healthcare provider will talk about the pros and cons of each type and what might be best for you.

Why might I need heart 瓣膜修复或置换手术?

Valve repair or replacement surgery is done to correct the problems caused 由一个或多个患病的心脏瓣膜引起.

If your heart valve(s) becomes damaged or diseased, you may have the 以下症状:

Dizziness
Chest pain
呼吸困难
Palpitations
Edema (swelling) of the feet, ankles, or abdomen (belly)
体液潴留导致体重迅速增加

There may be other reasons for your healthcare provider to recommend heart 瓣膜修复或置换手术.

What are the risks of heart 瓣膜修复或置换手术?

Possible risks of heart 瓣膜修复或置换手术 include:

手术中或手术后出血
Blood clots that can cause heart attack, stroke, or lung problems
Infection
Pneumonia
Pancreatitis
呼吸困难
心律失常(心律失常)
修理或更换的阀门不能正常工作
Death

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for heart 瓣膜修复或置换手术?

Your healthcare provider will explain the procedure and you can ask questions.
You will be asked to sign a consent form that gives your permission 做手术. 仔细阅读表格并提出问题什么都不清楚.
Along with a complete medical history, your healthcare provider may do a complete physical exam to make sure that you are in otherwise 手术前身体健康. 你可能需要验血或其他 diagnostic tests.
You will be asked to fast (not eat or drink) for 8 hours before the 程序，一般在午夜之后.
If you are pregnant or think you could be, tell your healthcare provider.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic 代理(本地及一般).
Be sure your healthcare provider knows about all medicines (prescription and over-the-counter), vitamins, herbs, and 你正在服用的补充剂.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicine, aspirin, or other medicines that affect blood clotting. You may be told to stop some of these medicines before surgery.
Your healthcare provider may do a blood test before surgery to see 你的血液要多久才能凝结.
Tell your healthcare provider if you have a pacemaker or any other 植入心脏装置.
如果你吸烟，请尽快戒烟. 这会提高你的 chances for a successful recovery from surgery and benefits your 总体健康状态.
Based on your medical condition, your healthcare provider may 要求其他特殊准备.

What happens during heart 瓣膜修复或置换手术?

Heart 瓣膜修复或置换手术 requires a stay in a hospital. Procedures may vary depending on your condition and your healthcare 提供者实践.

Generally, open-heart valve repair or replacement follows this process:

You will be asked to remove any jewelry or other objects that may 干扰程序.
You will change into a hospital gown and empty your bladder.
The surgical team will position you on the operating table, lying on your back.
A healthcare professional will start an intravenous (IV) line in your arm or hand for injection of medicine and to give IV fluids. More catheters will be put in blood vessels your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
Your doctor will put a breathing tube through your mouth into your lungs and connect you to a ventilator, a machine that will breathe 在你手术期间.
Your doctor will place a transesophageal echocardiogram (TEE) probe into your esophagus (swallowing tube) so he or she can monitor the 阀门的功能.
A soft, flexible tube (called a Foley catheter) will be put into 你的膀胱需要排尿.
A tube will be put through your mouth or nose into your stomach to 排出胃液.
Someone on the surgical team will clean the skin over your chest 用消毒溶液. 如果有很多头发在手术部位，可以剃掉.
如果你有n open-heart surgery, your healthcare provider will make an incision (cut) down the center of the chest from just 喉结下方到肚脐上方. 如果你有 less invasive procedure it may require smaller incisions.
The sternum (breastbone) will be cut in half lengthwise. The healthcare provider will separates the halves of the breastbone and 把它们分开，露出你的心.
To do the valve repair or replacement, your doctor must stop your heart. He or she will put tubes into the heart so that the blood can be pumped through your body by a heart-lung bypass machine 当你的心脏停止跳动.
Once the blood has been completely diverted into the bypass machine for pumping, your doctor will stop your heart by injecting it with a cold solution.
When the heart has stopped, your doctor will remove the diseased valve and put in the artificial valve, in the case of a valve replacement. 对于一个阀门修复，所做的程序将取决于 the type of valve problem you have, for example, your doctor may separate fused valve leaflets, repair torn leaflets, or reshape 保证阀件更好的功能.
Once the surgery is done, your doctor will shock your heart with 让你的心跳重新开始. 接下来，他或她会允许 blood circulating through the bypass machine to re-enter your heart 然后把管子拿掉.
Once your heart is beating again, your doctor will watch it to see how well the heart and valves are working and be sure that there 手术没有泄漏吗.
你的医生可能会把起搏导线放入你的心脏. He or she can attach these wires to a pacemaker outside your body for a short time and your heart can be paced, if needed, during the initial recovery period.
Your doctor will rejoin the sternum sewing it together with small wires (like those sometimes used to repair a broken bone).
Your doctor will put tubes into your chest to drain blood and other 心脏周围的液体.
Your doctor will sew the skin over the sternum back together and 用缝合线或手术订书钉缝合切口.
A member of the surgical team will apply a sterile bandage or dressing.

What happens after heart 瓣膜修复或置换手术?

In the hospital

After the surgery, a member of the surgical team will take you to a recovery room and later the intensive care unit (ICU) to be closely 监测了几天. 护士会帮你接上机器 will constantly display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Open-heart 瓣膜修复或置换手术 generally requires an in-hospital stay of several days or longer.

You will most likely have a tube in your throat that's connected to a ventilator to help you breath until you are stable enough to breathe on your own. As you wake up from the anesthesia more and start to breathe by yourself, your doctor can adjust the breathing machine to allow you 来控制更多的呼吸. 当你足够清醒的时候 breathe completely by yourself and are able to cough, your doctor will 取下呼吸管. 他或她也可以取出胃管 at this time.

After the breathing tube is out, a nurse will help you cough and take 每隔几个小时深呼吸一次. 这将是不舒服的，由于 soreness, but it is very important that you do this to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while 咳嗽有助于缓解不适.

如果你感到疼痛，你会得到止痛药. 要药在你变得非常不舒服之前.

You may be on IV (intravenous) medicines to help your blood pressure and your heart and to control any problems with bleeding. As your condition stabilizes, your doctor will gradually decrease then stop these medicines. 他或她也会拆除你的起搏线你的心.

Once your doctor has removed the breathing and stomach tubes and you 都稳定了，你可以开始喝液体了吗. 你可以开始多吃点只要你能忍受固体食物就吃.

When your healthcare provider decides that you are ready, you will be moved from the ICU to a surgical unit or acute care unit. Your recovery 我们会继续. 你的活动量会随着你的成长而逐渐增加从床上爬起来，多走走.

A member of your healthcare team will arrange for you to go home and schedule a follow-up visit with your healthcare provider.

At home

Once you are home, it will be important to keep the surgical area clean and dry. 您将获得具体的洗澡指导. Your doctor will remove the sutures or surgical staples during a follow-up office visit, if they were not removed before leaving the hospital.

Do not drive until your healthcare provider tells you it's OK. Other 可能会有活动限制.

Tell your healthcare provider right away if you have any of these:

Fever of 100.4°F(38°C)或更高，或寒冷(这些可能是一个感染迹象)
Redness, swelling, bleeding, or drainage from the incision site 或者任何导管位置
切口周围疼痛加重
呼吸困难
腿部或腹部肿胀加重
Easy bruising
持续恶心或呕吐
快速或不规则脉搏
胳膊和腿无力

Your healthcare provider may give you other instructions after the 程序，取决于你的情况.

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