Patient education: Prosthetic valves (The Basics)

What is a prosthetic valve? — A prosthetic valve is a valve that a doctor puts in the heart to replace a damaged heart valve (figure 1). Prosthetic valves are used when a valve condition is severe. These conditions include:

●Stenosis – This is when a valve doesn't open fully. Examples include aortic stenosis (figure 2) and mitral stenosis.

●Regurgitation – This is when a valve leaks, so blood flows in the wrong direction. Examples include aortic regurgitation and mitral regurgitation.

There are 2 main types of prosthetic heart valves:

●Mechanical – These valves are made from man-made materials. They can last 20 to 40 years or longer.

●Bioprosthetic – These are made from valve tissue from a pig, cow, or horse. In some cases, they come from another person. These valves usually last 10 to 15 years or more when used in middle-aged adults. They might not last as long in younger people.

Although prosthetic valves help treat heart conditions, they can cause problems of their own.

What problems can happen with prosthetic valves? — The problems that can happen depend on the type of valve and where it is in the heart.

Problems that can happen with prosthetic valves include the following:

●Blood clots can form on the valve. This is a problem because clots can break off and travel through the blood vessels to other parts of the body. The clots can then block off small blood vessels. This can cause organ damage and symptoms. Sometimes, a blood clot can also block the valve. Blood clots are more common with mechanical valves than bioprosthetic valves.

There are medicines that can help prevent blood clots. These are called "anticoagulants."

●People can have side effects from treatments they take. For example, people who take anticoagulant medicines can bleed much more easily than normal.

●The valve can get infected, which doctors call "endocarditis." The infection can damage the valve and the heart tissue around the valve. With endocarditis, small growths can form on the prosthetic valve. These growths can break off, travel to, and block small blood vessels in other parts of the body.

●The valve can leak or get blocked by scar tissue. If the prosthetic valve is leaking a lot or is badly blocked, it might need to be replaced.

●The valve can damage red blood cells as blood flows through the heart. This can cause a condition called "anemia." This is usually mild.

How do I manage my prosthetic valve? — Long-term management for a prosthetic valve depends on the type of valve, where it is in the heart, and your individual situation.

Most people need to take some kind of medicine to help keep blood clots from forming. The medicines you get depend on the type of valve you have:

●Most people with a prosthetic valve (either mechanical or bioprosthetic) need to take aspirin every day for the rest of their life.

●Most people with a mechanical valve also need to take an anticoagulant called warfarin (brand name: Jantoven) for the rest of their life.

●Most people with a bioprosthetic valve need to take an anticoagulant for only a short time after the valve is put in.

If you take warfarin, you need to take it exactly as instructed. If you forget or miss a dose, call your doctor to find out what to do. People who take warfarin also need regular blood tests. That's because the medicine's effects can change over time. People sometimes need extra blood tests if certain things change, such as their other medicines (for example, starting an antibiotic) or their diet. At the wrong doses, the medicine can either stop working or lead to serious bleeding.

Below are some other things you should do to manage your health if you have a prosthetic valve:

●Call your doctor right away if you have a fever or chills, or an infection in any part of your body (such as a skin or dental infection). If an infection is not treated, it can sometimes spread and cause a valve infection.

●Call your doctor right away if you have fatigue (feeling much more tired than usual) or shortness of breath. These could be symptoms of a valve problem.

●Go to all your follow-up visits and tests. At these visits, your doctor will talk with you and do an exam. Sometimes, they will order an echocardiogram (also called an "echo"). An echo uses sound waves to create a picture of your heart as it beats. It shows the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working (figure 3).

●Take good care of your teeth, including brushing, flossing, and seeing a dentist regularly. Ask your doctor about antibiotic medicines to take before having certain dental or medical procedures. This can help prevent a valve infection.

●Ask your doctor about advice on physical activity and sports. If you take an anticoagulant medicine, your doctor will probably recommend that you avoid sports and activities in which you could easily get hurt or bleed.

What if I have a prosthetic valve and want to get pregnant? — If you have a prosthetic valve and want to get pregnant, talk with your doctor before you start trying to get pregnant. People who take anticoagulant medicines sometimes need to change their medicine during pregnancy. Different anticoagulant medicines have different risks for the mother and the baby.

You, your heart doctor, and your obstetrician will work together to decide which anticoagulant medicine is right for you.

More on this topic

Patient education: Mitral regurgitation (The Basics)
Patient education: Aortic stenosis (The Basics)
Patient education: Endocarditis (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Stroke (The Basics)
Patient education: Exercise and movement (The Basics)
Patient education: Mitral valve prolapse (The Basics)
Patient education: Mitral stenosis in adults (The Basics)
Patient education: Aortic regurgitation in adults (The Basics)

Patient education: Mitral regurgitation (Beyond the Basics)
Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Warfarin (Beyond the Basics)