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There are 4 valves in the heart. Two of them control blood flow between the heart chambers and the other two control blood flow out of the heart. Valves that are not working properly can sometimes be repaired with surgery.

Who is a candidate for the procedure?

• heart valve defects that are present from birth, causing congenital heart disease
• heart valves that become narrow and stiff, blocking the flow of blood through the heart
• heart valves that leak, allowing blood to flow the wrong way through the heart
• heart valve infections, such as those caused by rheumatic fever

How is the procedure performed?

Some heart valve problems can be fixed without open heart surgery. In these cases, a narrow tube, called a catheter, is inserted into an artery in the groin. The catheter is threaded through the body into the heart. The physician can then repair the heart valve using special tools inserted through the catheter.

Most people, however, require open heart surgery for repair of heart valve defects. This is an extensive operation that is performed under general anesthesia. After the patient is put to sleep, the chest area is cleaned with antibacterial chemicals. Next, an incision is made into the breastbone or sternum to expose the heart.

The person is then put on a heart-lung bypass machine. This device keeps the blood supplied with fresh oxygen and moving throughout the blood vessels of the body at an appropriate pressure, until the heart can be reconnected.

A heart valve operation can involve repair of the valve or a complete replacement. There are two types of replacement valves: artificial and biologic. Artificial valves are generally made of metal or plastic. Biologic valves may come from human organ donors or from animals such as pigs.

After the valve is repaired or replaced, the person is taken off the heart-lung machine. Once the person's heart is working again to pump the blood, the chest incision is closed. The person is awakened from the anesthesia and taken to the surgery recovery room.

What happens right after the procedure?

The person will spend at least an hour in the surgery recovery room until the anesthesia has worn off. The person then must stay in the hospital a few days to recover. Pain medications are given as needed for discomfort.

What happens later at home?

It may take weeks or months for a person to fully recover from open heart valve surgery. Activity should be increased gradually as the person is able to tolerate it.

People with artificial valves are usually put on blood-thinning medications to prevent blood clots from forming on the valves. Individuals with biologic valves generally do not need blood-thinning medications long term. However, biologic valves tend to wear out after several years and may need to be replaced.

What are the potential complications after the procedure?

All major surgery carries the risks of bleeding, infection and death. Chest pain may last for months. Some numbness in the skin near the incision may also occur. However, this problem often gets better over time.