From the surgeon's point of view, I think they're just saying that all of their stitches are permanent by then. The base wound to the heart (the muscle portion) is actually healed in days. It's a quick healer. As far as the muscle itself, there's nothing that's going to burst or unravel (assuming no aneurysms or work on the aorta) from the surgery after a week or so. The direct damage form the surgery is stable.
But that's not all that's going on.
- Electrical circuits are disrupted. They aren't the big ones that are responsible for the main contractions, but a much smalller neural net in the heart muscle through which the flow of the muscle contraction is smoothed, among other things. They can take some time to reattach or reroute, and can cause some palpitations.
- The heart itself is enlarged. It can take up to a year for it to remodel (that's the term that's used for it) to its more normal size. Mostly, it's back in six months. Some things, like enlarged atria, are less capable of returning to original sizes than the ventricles, and may never return to their old size, so they heart has to relearn its new configuration as it goes along. While the heart adjusts, there can be palpitations and other arrhythmias (usually temporary), because it doesn't always shrink perfectly evenly throughout. At various times, different parts of the heart may not be completely in sync. Due to this, you may also have temporary mild valve leakages on an echo, (usually in the non-replaced valves), that will go away as the heart continues to remodel.
- Due to the injury to the heart and the sudden change of demand level (your valve is no longer leaking or blocking bloodflow) your blood pressure can go all over the map (again, usually temporary).
- During the first three months (six, if you have work done on your aorta), you are regrowing inner skin (endothelium) on the areas that were operated on (where the valve is attached, places that got nicked, on and into the polyester aortic sleeve if you've had some aorta replaced, etc.). You are more susceptible to strokes and endocarditis until all the area is re-covered with endothelium (main reason why they often have you on Coumadin or Plavix to avoid strokes for that time period).
- You are usually placed on a beta blocker to make your heart beat less often and less hard. That can affect your blood pressure and your heart rhythm, as well as make you tired or cause other side effects of the BBs.
- Because these changes are dynamic and generally temporary, I usually caution people not to demand treatment for each, new thing from their doctor. We are all hyper aware of every nuance of our hearts after the surgery. We're often poor judges of the level of severity of the things that we feel.
I don't mean don't let your doctor know what's going on. I mean discuss with him any symptoms in the context of the fact that they may well be transient, and see how he reacts. You don't want a permanent fix for a temporary problem. By the same token, you don't want to ignore a potentially dangerous situation to avoid a few pills.
Best wishes,
