Mitral Valve Replacement

WHAT YOU SHOULD KNOW:

Mitral Valve Replacement (Inpatient Care) Care Guide

Mitral valve replacement is open heart surgery to replace all or part of the mitral valve. The mitral valve normally opens and closes to let blood pass through the heart. If your mitral valve does not open or close correctly, blood may not flow as it should through your heart.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • You may bleed or get an infection during or after surgery. You may need a blood transfusion or more surgery. After surgery, your new valve may not work or your heart may not beat as it should. Over time the new valve or area around it may become damaged. Symptoms you had before the surgery may come back or get worse after surgery. You may need to have heart valve surgery again.

  • You may get a blood clot in your arm or leg. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. You may need medicine to prevent blood clots for the rest of your life after your surgery. Without surgery, you may get short of breath or tired more often. Blood and fluid could build up in your lungs and cause heart failure.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Transesophageal echocardiogram:

    • A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as blood clots or infection inside the heart.

    • You will be given medicine to relax you during a TEE. Caregivers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

  • Your caregivers will make one or more incisions in your chest. Your heart will be connected to a heart-lung bypass machine. This machine does the work of your heart and lungs during surgery.

  • Part or all of your mitral valve will be removed. Your mitral valve will be replaced with a tissue valve or mechanical valve and sewn in place. Caregivers may put wires your chest that stay in for a short time after surgery. The wires can be used to improve your heartbeat. The bypass machine will be removed, and your own heart and lungs will start working again. The incision in your chest will be closed with stitches or staples and covered with a bandage. The bandage keeps the area clean and dry to help prevent infection.

After surgery:

You will be taken to the recovery room or an intensive care unit (ICU). Caregivers will watch you very closely. A caregiver may remove the bandage shortly after surgery to check the incision. Do not get out of bed until your caregiver says it is okay.

Oxygen and a ventilator:

You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

Blood transfusion:

You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.

Pulmonary artery catheter:

This is a balloon-tipped catheter (thin tube) inserted through a vein in your neck or groin. The pulmonary artery (PA) catheter goes into the right side of your heart and continues to your pulmonary artery. The balloon is inflated to wedge the catheter in place. The PA catheter has a device in it that measures the pressure in your heart and lungs. The catheter is attached to a monitor that shows the pressure measurements. The measurements can also show caregivers how your heart responds to certain heart medicines.

Chest tube:

A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.

You will be able to drink liquids and eat certain foods

once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

A Foley catheter

is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

Deep breathing:

This exercise should be done once an hour to keep you from getting a lung infection. Deep breathing opens the tubes going to your lungs. Slowly take a deep breath and hold the breath as long as you can. Then let out your breath. Take 10 deep breaths in a row every hour while awake. You may be asked to use an incentive spirometer to help you with this. Put the plastic piece into your mouth and slowly take a breath as deep and as long as you can. Hold your breath as long as you can. Then, let out your breath.

Activity:

Caregivers will help you begin to exercise. Exercise helps you recover from surgery and may help prevent other medical problems.

Medicines:

  • Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.

  • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.

  • Antiplatelets help prevent blood clots. This medicine makes it more likely for you to bleed or bruise.

  • Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.

  • Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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