Pulmonary valve repair and pulmonary valve replacement are procedures that treat diseases affecting the pulmonary valve.
The pulmonary valve is one of four valves that regulate blood flow in the heart. The valve lies between the lower right heart chamber (right ventricle) and the pulmonary artery.
Pulmonary valve disease is a condition in which the pulmonary valve doesn't work properly. The condition can interrupt blood flow from your heart to your lungs. It may occur on its own or as part of other congenital heart defects, such as tetralogy of Fallot. Often, the condition may only be detected by a physical evaluation or heart imaging for another reason.
Pulmonary valve repair or pulmonary valve replacement can treat pulmonary valve disease and help restore normal blood flow, reduce symptoms, prolong life and help preserve the function of your heart muscle.
Why it's done
Pulmonary valve disease treatment depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.
For some people with mild pulmonary valve disease without symptoms, careful monitoring under a doctor's supervision may be all that's needed. But in many cases, pulmonary valve disease and dysfunction progress in adulthood and get worse without medical treatment.
Types of pulmonary valve disease that may require treatment with pulmonary valve repair or pulmonary valve replacement include:
- Pulmonary valve regurgitation. A leaky pulmonary valve allows blood to flow backward into the heart (pulmonary valve regurgitation) rather than directly to the lungs for oxygen.
- Pulmonary valve stenosis. In this condition, the pulmonary valve is thickened or obstructed, which makes it harder for it to open properly. As a result, the heart has to work harder to pump blood into the pulmonary artery and to the lungs.
- Pulmonary atresia. This is a congenital heart defect in which a child is born without a well-defined pulmonary valve. In pulmonary atresia, blood can't flow from the right ventricle into the pulmonary artery. The only blood flow to the lungs is through an open passageway between the pulmonary artery and the main artery supplying blood to the body (aorta).
The decision to repair or replace a damaged pulmonary valve depends on many factors, including:
- The severity of your pulmonary valve disease
- Your age and overall health
- Whether you need heart surgery to correct another heart problem in addition to pulmonary valve disease so both conditions can be treated at once
In general and whenever possible, pulmonary valve repair is the preferred option because it's associated with a lower risk of infection, preserves valve strength and function, and eliminates the need to take blood-thinning medications, which may be necessary with pulmonary valve replacement.
Pulmonary valve repair and pulmonary valve replacement surgery risks vary depending on your health, the type of procedure, and the expertise of the surgeon and health care team. To minimize potential risk, pulmonary valve surgery should generally be performed at a medical center with staff experienced in these procedures and that performs high volumes of pulmonary valve surgeries.
Risks associated with pulmonary valve repair and pulmonary valve replacement may include:
- Blood clots
- Valve dysfunction in replacement valves
- Heart rhythm problems
- Heart attack
How you prepare
Before surgery to have your pulmonary valve repaired or replaced, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.
Discuss with your doctor and treatment team any questions you may have about the procedure.
Before being admitted to the hospital for your surgery, talk to your caregivers about your hospital stay and discuss any help you may need when you return home.
Food and medications
Talk to your doctor about:
- When you can take your regular medications and whether you can take them before your surgery
- When you should stop eating or drinking the night before the surgery
Clothing and personal items
Your treatment team may recommend that you bring several items to the hospital, including:
- A list of your medications
- Eyeglasses, hearing aids or dentures
- Personal care items, such as a brush, comb, shaving equipment and toothbrush
- Loose-fitting, comfortable clothing
- A copy of your advance directive or living will
- Items that may help you relax, such as portable music players or books
During surgery, avoid wearing:
- Contact lenses
- Nail polish
Your body hair will be shaved off at the location where the procedure will take place.
What you can expect
During the procedure
For most pulmonary valve repair and replacement procedures, you'll receive medications (anesthetics) that put you in a sleep-like state so you won't feel any pain during the surgery.
You'll also be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Pulmonary valve repair
Pulmonary valve repair is usually performed via open-heart surgery and opening of the chest bone (sternotomy). Doctors wire the bone back together after the procedure to prevent movement and aid in healing.
Pulmonary valve repair procedures may involve several different types of repair, including:
- Separating fused valve leaflets
- Reconstructing one or more new leaflet(s) from your own heart tissues such as from your own pericardium
- Removing previous patches that were placed at the time of the initial repair of congenital heart disease, such as tetralogy of Fallot, and bringing the pulmonary valve leaflets together to create a working valve
- Reshaping or removing tissue to allow the valve to close more tightly
- Tightening or reinforcing the ring around a valve (annulus) by implanting an artificial ring (annuloplasty)
Pulmonary valves that can't open fully due to pulmonary valve stenosis may be repaired with surgery or a less invasive procedure called balloon valvuloplasty, which uses an approach called cardiac catheterization. You're usually awake during cardiac catheterization, and it requires a much shorter hospital stay than traditional heart surgery.
During balloon valvuloplasty, your doctor inserts a thin, hollow tube (catheter) in a blood vessel, usually in your groin, and threads it to your heart. The catheter has a balloon at its tip that can be inflated to help widen the narrowed pulmonary valve and then deflated for removal.
Balloon valvuloplasty is often used to treat infants and children with pulmonary valve stenosis. However, the valve tends to narrow again in adults who have had the procedure. You may need additional procedures to treat the narrowed valve over time.
Pulmonary valve replacement
In this procedure, your doctor removes the pulmonary valve and replaces it with a mechanical valve made from artificial materials or a biological valve made from cow or pig valves.
Pulmonary valve replacement may be done using open-heart surgery or minimally invasive methods, which involve smaller incisions than those used in open-heart surgery.
Minimally invasive pulmonary valve replacement helps reduce the number of open-heart surgeries over a person's lifetime.
Transcatheter pulmonary valve replacement
The most common type of minimally invasive pulmonary valve replacement is transcatheter pulmonary valve replacement (percutaneous pulmonary valve replacement).
In this procedure, your doctor inserts a catheter in a large blood vessel in the groin or chest and guides it to the heart. A new, balloon-expandable replacement pulmonary valve sits at the end of the catheter and is then put into place. A catheter may also be used to insert a new pulmonary valve within an existing replacement valve that is failing in a valve-in-valve procedure.
After the procedure
After open-heart pulmonary valve repair or pulmonary valve replacement, you'll generally spend a day or more in the intensive care unit (ICU).
You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may be given oxygen.
After the ICU, you'll be moved to a regular hospital room for a few days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure.
During your hospital stay, your treatment team will:
- Watch for signs of infection in your incision sites
- Periodically check your blood pressure, breathing and heart rate
- Work with you to manage any pain you have after surgery
- Instruct you to walk regularly to gradually increase your activity and do breathing exercises as you recover
You'll receive instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.
Recovery time depends on the specific procedure, your overall health before the procedure and any complications.
If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots. Biological valves often eventually need to be replaced, as they degenerate over time Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you.
After pulmonary valve repair or pulmonary valve replacement surgery, you may eventually be able to return to daily activities, such as working, driving and exercise.
You'll need to take certain medications and attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition.
Your doctor and health care team may instruct you to incorporate healthy lifestyle changes — such as physical activity, a healthy diet, stress management and avoiding tobacco use — into your life to reduce the risk of future complications and promote a healthy heart.
Your doctor may recommend that you participate in cardiac rehabilitation — a program of education and exercise designed to help you improve your health and help you recover after heart surgery.
The success and safety of minimally invasive pulmonary valve replacement depends largely on the skill and expertise of your doctor and medical center. When performed by experienced doctors and centers, the results of minimally invasive pulmonary valve replacement can be similar to those of traditional open-heart surgery. But the long-term results of some of these procedures are not yet known.