Pulmonary Valve Stenosis: Understanding Valve Replacement

Female physician listens to senior patient's heart

If you have pulmonary stenosis, one of the valves of your heart–the pulmonary valve, which separates the right ventricle from your pulmonary artery–has narrowed. The valve has several flaps that open and shut, allowing it to control the flow of blood, but those flaps have thickened, which creates a narrower opening for the blood to flow through. As a result, your heart has to work harder to pump blood through that narrow opening into the pulmonary artery. Some people with mild cases don’t notice any symptoms while their heart is chugging away, but people with more moderate to severe cases may experience problems like fatigue, shortness of breath, dizziness, and chest pain. If the symptoms worsen, a doctor might suggest undergoing surgery to repair or replace that dysfunctional valve.

Understanding Your Options for Pulmonary Valve Replacement

If your pulmonary stenosis symptoms are getting worse, your doctor may talk to you about undergoing a procedure to stretch the valve open to improve the flow of blood. This is often accomplished by a procedure called balloon valvuloplasty, and it entails threading a flexible thin tube called a catheter through an artery in your groin up to your heart and inflating a balloon to stretch that narrowed pulmonary valve.

However, that process may not be enough. You may need surgery to repair or replace your pulmonary valve. You may have already contemplated the possibility of surgery, or you might not know what pulmonary valve stenosis treatments are available to you. Either way, it’s worth having a conversation with your doctor about the risks and benefits of the various procedures.

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Repair may be a possibility, depending on the severity of your stenosis. But in other cases, your doctor may recommend just going ahead and replacing the valve. Then, a decision must be made about the type of replacement procedure to choose, and you’ll have to consider the pros and cons of each.

One Option: Open-Heart Surgery

One way to replace your valve is through a traditional surgery. The surgeon will make a skin incision in your chest, then perform a sternotomy, which is an incision in the breastbone. This will allow the surgeon access to your heart. As with any major surgery, there are some risks associated with this, such as bleeding, blood clots, or infection. You will have a longer recovery time than you would with a less invasive procedure. You’ll likely spend at least several days in the hospital afterward.

When you undergo surgery, you can receive a mechanical valve made from plastic or metal or a bioprosthetic valve which is a valve from an animal, sometimes called a tissue valve. There are upsides and downsides to these choices. For example, a mechanical valve will be more durable and will last longer, but you’ll have to take blood-thinning medications for the rest of your life (or at least as long as you have a mechanical valve in place).

A Second Option: A Less-Invasive Procedure

If the idea of open-heart surgery doesn’t sit well for you, or your doctor doesn’t think you’re a good candidate for a more invasive procedure, a transcatheter pulmonary valve replacement (TPVR) might be a better choice for you. This process doesn’t require the surgeon to make a large incision in your chest in order to replace the valve.

Instead, the interventional cardiologist will put the replacement valve inside a catheter. Then, guided with special imaging equipment, the doctor will carefully thread this catheter up through the femoral vein in your groin to your heart. (Sometimes, they’ll choose to insert the catheter into the internal jugular vein in the neck instead.) Once the catheter reaches your diseased pulmonary valve, the surgeon will place the new valve directly into the old valve and gently expand it with a balloon until it’s situated correctly in place. Then the catheter is slowly withdrawn, and your new replacement valve is already on the job, working to facilitate the flow of blood through your heart.

The U.S. Food and Drug Administration (FDA) has approved two tissue valves for use with this procedure. You won’t be able to go with a mechanical valve if you choose a transcatheter pulmonary valve replacement. But you’ll have a relatively quick recovery period. Most people go home the next day after undergoing the procedure, and they’re back to life as usual within about a week.

Watch for Signs of Infection Afterward

After undergoing surgery, the last thing you want is for the new valve to become infected. An infection can lead to inflammation of the lining of the heart known as endocarditis.

You may also be vulnerable to other, common infections. Some symptoms to watch out for:

  • A fever above 101 degrees, or any fever that lasts more than two days
  • Urinary changes, such as a burning sensation, or an increase in frequency, or trouble urinating
  • Coughing up mucus
  • Chills and body aches

Call your doctor right away if you develop any of these symptoms, especially if you develop more than one, after open-chest surgery or a TPVR procedure.

Follow-up care is essential.

The replacement of your faulty pulmonary valve will hopefully significantly improve your symptoms and help you feel more energetic. But your doctor will want to monitor you to make sure everything is working correctly. Be sure to not skip any of your follow-up appointments after your replacement.

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