Living with a prosthetic heart valve

The NHS explains that heart valve disease occurs when a valve does not open fully (stenosis) or does not close properly, with the aortic and mitral valves most often affected. When medicine and monitoring can no longer control symptoms or protect the heart muscle, surgery may repair the valve or replace it. Replacement may be by open surgery or, for some people with aortic stenosis, through a catheter threaded through an artery. The decision is made by a multidisciplinary heart team that weighs age, other illnesses and the valve involved.

Mechanical valves are made from durable materials and are designed to last a lifetime, but their surfaces encourage clots, so lifelong anticoagulation with warfarin is needed, with regular INR blood tests. Tissue (biological) valves are made from animal tissue or, less commonly, human tissue. They do not cause clots in the same way, so many people need blood-thinning treatment for only a short time or not at all, but the tissue can degenerate, so a repeat procedure may be needed some years later.

The choice is individual. Younger people often lean to mechanical valves to avoid repeat surgery, whereas older people and those unable to take warfarin are commonly offered tissue valves. Pregnancy plans, work or sport with a high injury risk, and personal preference matter. Women who may become pregnant need specialist advice because warfarin carries risks to a baby.

• Mechanical: very durable, lifelong warfarin, regular INR monitoring.

• Tissue: less need for anticoagulation, but may wear out and need replacement.

• Transcatheter valves: placed through an artery in selected patients, with a shorter recovery.

The NHS notes that medicines for valve disease may be prescribed to lower blood pressure, reduce fluid build-up, slow heart rate or prevent blood clots. For people on warfarin, doses are adjusted according to INR results, and diet, alcohol, illness and many medicines, including some antibiotics and herbal products, can change the effect. Always tell any prescriber or pharmacist that you take warfarin, and carry an anticoagulant alert card.

Follow-up includes clinic visits, an ECG and an echocardiogram to check how the valve opens and closes and how the heart muscle is working. The BHF states that echocardiograms every 6 to 12 months are used for moderate or severe valve disease before surgery; after replacement, the schedule is set by your cardiac team.

Infective endocarditis is an infection of the heart lining or valves, and an artificial valve is a recognised risk factor. Good dental hygiene and regular dental check-ups reduce bacteria entering the blood. The BHF page flags antibiotics and going to the dentist as a topic to discuss with your doctor; current UK practice varies with national guidance, so ask your cardiac team what applies to you rather than relying on older advice.

Any unexplained fever lasting more than a day or two, drenching sweats, new weight loss or a new murmur needs prompt medical review, and you should mention your valve at the first contact so that blood cultures are taken before any antibiotics are started.

Most people can work, travel and exercise within the guidance of their team. The NHS advises following the care team's guidance on exercise and lifestyle. Mechanical valves may click audibly, which is normal. Tell the airline and security staff you have a valve if asked, and carry your valve card. MRI is usually safe for modern valves, but always mention your implant.

Driving rules depend on the procedure and recovery, so ask your team about when to restart and whether the DVLA needs to be told.

Call 999 for sudden severe chest pain, severe breathlessness, collapse, or stroke signs such as face drooping, arm weakness and slurred speech. Seek prompt advice for new breathlessness, swelling of the ankles, palpitations, fainting, fever, unusual bruising, black stools or prolonged nosebleeds if on warfarin.