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.