Rheumatic heart disease is the main cause of damage to heart-valves in India. It is an auto-immune reaction to a common throat infection caused by a particular bacterium; antibodies produced by our body damage own valves inside our hearts as a result of an unrelated throat infection because of similarity in the protein structure of this bacteria and our valves. Because of this, antibodies wrongly recognise valves and bacteria as one and attack both. Rheumatic heart disease usually affects women or men in their teens and after 10-12 years by the time the person is a young adult, it damages the valves of our heart severely. Out of the four valves in our heart, two are in the left half and two are in right half of heart. Rheumatic heart disease usually affects the valves on the left half of our heart more often. If rheumatic heart disease has affected you, it causes poor health, tiredness, weakness, chest pain or heaviness, irregular heart rate and breathlessness on minimal work. It can lead to brain stroke also if left untreated.
Mild to moderate valve disease is managed medically. A periodic 6-monthly check-up with blood tests and 2-D echo heart is done. During this medical treatment the disease may worsen and become severe. The severity is detected and assessed by echo test and the patient’s symptoms. The treatment of a severely affected heart valve is to replace it with an artificial prosthetic valve by open heart surgery. This ‘VALVE REPLACEMENT SURGERY’ is very safe and effective. After the surgery the person can lead a normal life. It is done free-of-cost under the BSKY scheme of Government of Odisha for poor patients who cannot afford it. For this the person requires valid Aadhar card, Voter I card, and a Ration Card or a BSKY card (Biju Swasthya Kalyan Yojana Card). The rules keep changing periodically, so please enquire about the latest guidelines for treatment under BSKY scheme.
Once you are planned for a valve replacement, either a TISSUE VALVE or a MECHANICAL VALVE is chosen. Tissue valve is made from animals such as pig or cow. Mechanical valve are made from metal and special high-quality plastics. Mechanical valves last life-long; however any artificial non-biological material like plastic or metal will cause blood to clot on it and this will disable the valve. To prevent this, the patient has to take ANTI-CLOTTING medicines life-long. These ANTI-CLOTTING medicines have life-threatening side-effects if taken wrongly; therefore the patient has to be careful, regular and has to do blood tests every few months life-long. Further, any injury or overdose will cause excessive bleeding, any stoppage of drug leads to the mechanical valve getting blocked and death. Tissue valve do not require life-long anti-clotting drugs, but they last for only 15-20 years on average. THEREFORE MECHANICAL VALVES ARE PUT IN FOR YOUNG PATIENTS AND TISSUE VALVE IN OLD PATIENTS AND THOSE WHO CANNOT TAKE ANTI-CLOTTING DRUGS. The average cost of a mechanical valve is about 40,000 to 60,000 rupees whereas the same for a tissue valve is about 65,000 to a few lakh rupees.
After admission to hospital routine blood tests, ECG, 2-D echo heart, Chest X-ray are done, 4 to 5 bottles of blood are arranged, anaesthetic check-up is done. If everything is all right, valve replacement is done. This can be done by cutting open the front of patient’s chest (STANDARD OPEN HEART SURGERY) or even without opening it (MINIMALLY INVASIVE OPEN HEART SURGERY). MICS causes less pain and scar and easier recovery; it is slightly more expensive. The entire surgery takes about 3 to 5 hours. After the surgery, the patient stays in ICU for 2 to 3 days and then in ward for another 2 to 3 days before being discharged to home if the recovery is smooth and uneventful.
After the surgery, the patient is recalled back to OPD after 10-12 days to remove stitches and then a check-up is done which includes 2-D echo heart, Chest X-ray and blood tests. After this every 3 months the patient has a blood test done called PT-INR test to assess the adequacy of anti-clotting. If it is low the dose of anti-clotting tablet is increased, if it is high the dose is decreased. Anti-clotting tablet is to be taken 2 hours after food either at noon or at night. The effect of this tablet can be assessed with a simple PT-INR test in a laboratory. The INR should be maintained between 2 to 3. More than 3.5 means the dose is too high; there is a risk of bleeding from nose, mouth, ear or periods. Below 1.5 INR his means dose is too low; the valve may get blocked leading to catastrophe. Never stop or change anti-clotting medicines without medical advice, never miss 3-monthly check-ups. If you are on anti-clotting medicines, DO NOT EAT GREEN LEAFY VEGETABLES like cabbage, turnip, saag etc since these can cancel out the action of ANTI-CLOTTING medicines.
Anti-clotting medicines are not safe for unborn or lactating baby and should be stopped or changed if the patient wants to get pregnant. Please discuss it with your surgeon or a cardiologist and make sure your gynaecologist is informed and aware of your heart disease. Similarly, any emergency or accident needs stoppage of anti-clotting drugs to prevent blood-loss. INFORM ANY PHYSICIAN OR SURGEON IF YOU ARE PLANNED FOR ANY OTHER SURGERY OR TAKING ANY MEDICINES that you have a heart condition and are on ANTI-CLOTTING medicines or other heart medicines. Please store your treatment-related papers and files carefully as they are requires even decades after the original surgery.
