Asked by Marlynn McBain, Sudbury, Ontario
Are there any travel limitations on one who has had an aortic valve transplant two years ago?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
This is a good question given the upcoming holiday season. The answer is there are generally no travel restrictions for people who have had a heart valve replacement.
The heart is really two pumps made of muscle. The right side of the heart is filled with oxygen-depleted blood from the venous system, and it pumps this blood into the lungs where it is oxygenated. Oxygenated blood is returned to the left side of the heart, which pumps blood throughout the body. A series of four heart valves make sure that blood moves in the right direction.
The mitral valve and the aortic valve are both on the left side of the heart. They are the most common valves that need replacement. These valves fail for a number of reasons. Most commonly these valves fail due to buildup of calcification over years, because of damage due to rheumatic heart disease (as a severe result of strep throat), because of a bacterial infection or from years of high blood pressure.
Damaged valves can be surgically replaced with a manmade mechanical valves, which can last for years. Manmade valves require treatment with blood thinners. Blood thinners are anticoagulants, such as warfarin or Coumadin, which give patients increased risk of bleeding and of greatest concern confer an increased risk of hemorrhagic stroke. Some patients get an animal valve to replace their failing heart valve. Pig valves are most common; occasionally beef valves are used. Animal valves last for 10 to 15 years before they must be replaced, but these valves have the advantage that they do not require anticoagulation.
Patients who have replacement valves generally have few restrictions because of them. They can fly in airplanes and travel without restriction. I should note that patients with a prosthetic (manmade mechanical or animal) valve should receive an antibiotic prior to dental procedures. This decreases risk of the valve getting a bacterial infection. In one prospective randomized study, 3% of several hundred valve replacement patients getting dental work without taking an antibiotic beforehand got a valve infection. None of several hundred patients getting antibiotic prophylaxis got an infection.
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