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Heart valve surgery

Heart valve surgery is used to repair or replace diseased heart valves. During heart valve surgery, the surgeon trims, shapes, or rebuilds one or more of the leaflets (flaps that open and close the valve). Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired but replaced. Replacement means your diseased valve is removed and a new valve is inserted in its place. Most valve replacements involve the aortic and mitral valves. The aortic valve separates the left ventricle (your heart’s main pumping chamber) and the aorta (the major artery that carries blood to your body).

There are a number of procedures for repairing or replacing valves.

Surgical Valve repair:

A Commissurotomy (Valvuloplasty or valve re-shaping) is surgery to open up valves that are thickened and are stuck together. The valve is opened by cutting the points where the leaflets of the valve meet.

Annuloplasty is a technique to repair an enlarged Annulus (a ring of fibrous tissue) at the base of the heart valve. To repair the Annulus, sutures are sewn around the ring to make the opening smaller. Alternatively, a ring-like device is attached around the outside of the valve opening. The ring provides support to the valve so it can close more tightly. A surgeon may reshape a valve by cutting out a section or sections of a leaflet and then sewing the leaflet back together.

Decalcification is surgery to remove calcium buildup from the leaflets. Valves are supported by cords and papillary muscles. If these are stretched or weak, the valve may not close properly. By replacing or shortening the cords, the valve will be strengthened and able to close properly. If there are holes or tears in the leaflets of the valve, a surgeon may repair them with a tissue patch.

Minimally invasive valve repair – Unlike conventional surgery, minimally invasive surgery (also called Endoscopic or robotic heart surgery) does not involve sawing through the breastbone and opening the chest. The surgeon watches the heart on a video screen and operates using long-handled surgical tools inserted through small incisions.

Non-surgical valve repair includes:

Percutaneous or Catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in the groin or the arm and then threaded up into the interior of the heart.

Percutaneous or balloon Valvuloplasty is used in people with stiffened or narrowed (Stenosed) pulmonary, mitral or aortic valves. A balloon tip on the end of the catheter is positioned in the narrowed valve and inflated to enlarge the opening or to crack open calcified tissue.

Valve Replacement – Is more commonly used to treat Aortic valves or severely damaged mitral valves. There are two kinds of valves that are used for valve replacement:

I.  Mechanical valves are made from durable metals, carbon, ceramics and plastics. A fabric sewing ring is used to attach the valve to the tissues in the patient’s heart. The major advantage is durability. However, blood thinners must be taken the rest of the patient’s life to prevent blood clots. The valve makes a soft clicking sound when it floats shut, which may bother some patients. People generally adjust quickly to this sound.

II.  Biological valves are made from:

a)      Animal tissue, either an actual pig valve or a bovine pericardial engineered valve (a xenograph).

b)      Human tissue of a donated heart (an allograft or homograft), used most often to replace infected valves.

c)      A patient’s own tissues (an autograft). A Ross Procedure (also called a Switch Procedure) involves taking the patient’s normally functioning pulmonary valve and using it to replace a diseased aortic valve. The pulmonary valve is then replaced with a donated (homograft) pulmonary valve.

Heart valve surgery can result in improved quality of life, prolonged life and reduced symptoms.

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