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Seminar valve reconstruction and replacement
Valve reconstruction is a surgical technique used to repair defects in heart valves. It provides an alternative to valve replacement. In the US, about 99,000 heart valve operations are performed each year, most commonly to repair or replace the mitral or aortic valves which are on the left side of the heart. Valve repair techniques include commissurotomy to open narrowed valves, annuloplasty to provide support with a ring, and reshaping, patching or shortening valve leaflets. Conditions requiring surgery include severe valve damage or complications from issues like infection.
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Seminar valve reconstruction and replacement
- 2. Valve reconstruction hasproved to be an effective, reproducible and durable treatment for life-threatening Cardiac diseases.In the United States, surgeons perform about 99,000 heart valve operations each year. Nearly all of these operations are done to repair or replace the mitral or aortic valves. These valves are on the left side of the heart, which works harder than the right. They control the flow of oxygen-rich blood from the lungs to the rest of the body.If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed. 11/22/2013 Template copyright www.brainybetty.com 2005 2
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- 4. Heart valve repairis a surgical technique used to fix defects in heart valves in valvular heart diseases, and provides an alternative to valve replacement. 11/22/2013 Template copyright www.brainybetty.com 2005 4
- 5. COMMISSUROTOMY For narrowed valves,where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet. 11/22/2013 Template copyright www.brainybetty.com 2005 5
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- 8. VALVULOPLASTY Valvuloplasty is thewidening of a stenotic valve using a balloon catheter 11/22/2013 Template copyright www.brainybetty.com 2005 8
- 9. RING ANNULOPLASTY When avalve loses its shape and strength, it's unable to close tightly. An annuloplasty gives the leaflets support through ring-like devices that your surgeon attaches around the outside of the valve opening. 11/22/2013 Template copyright www.brainybetty.com 2005 9
- 10. RESHAPING The surgeon cutsout a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly. DECALCIFICATION Decalcification removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly. REPAIR OF STRUCTURAL SUPPORT which replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly. 11/22/2013 Template copyright www.brainybetty.com 2005 10
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- 12. PATCHING The surgeon coversholes or tears in the leaflets with a tissue patch. 11/22/2013 Template copyright www.brainybetty.com 2005 12
- 13. Mitral valve repair Aorticvalve repair Tricuspid valve repair Pulmonary valve repair 11/22/2013 Template copyright www.brainybetty.com 2005 13
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- 15. Mitral valve repairis a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. 11/22/2013 Template copyright www.brainybetty.com 2005 15
- 16. In 1923 Dr.Elliott Cutler of the Peter Bent Brigham Hospital performed the world’s first successful heart valve surgery - a mitral valve repair. The patient was a 12-year-old girl with rheumatic mitral stenosis. Replacement of the mitral valve with an artificial valve in the 1960s 11/22/2013 Template copyright www.brainybetty.com 2005 16
- 17. ANNULOPLASTY Inserting a cloth-coveredring around the valve to bring the leaflets into contact with each other QUADRANGULAR RESECTION removal of redundant/loose segments of the leaflets 11/22/2013 Template copyright www.brainybetty.com 2005 17
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- 19. RE-SUSPENSION of theleaflets with artificial (Gore-Tex) cords. 11/22/2013 Template copyright www.brainybetty.com 2005 19
- 20. Bacterial endocarditis Mitral regurgitationmay also occur as a result of ischemic heart disease (coronary artery disease) or nonischemic heart disease (dilated cardiomyopathy). Surgery for MR is recommended when Patient have symptoms of heart failure, or when ejection fraction drops below 55% 11/22/2013 Template copyright www.brainybetty.com 2005 20
- 21. Examples of seriousdamage or complicated conditions that might lead to mitral valve replacement include: Extensive ballooning of the mitral valve (rather than a single flap that puffs up). Severe hardening (calcification) of the valve. Prolapse (bulging) of the valve at an unusual location. Damage to the valve from infection (endocarditis) 11/22/2013 Template copyright www.brainybetty.com 2005 21
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- 23. During valve surgery,patient is given general anesthesia. Surgeon makes a large incision in patient chest. Patient placed on a heart-lung machine during the surgery. Blood is circulated outside of the body and oxygen is added to it using a heart-lung (cardiopulmonary bypass) machine. 11/22/2013 Template copyright www.brainybetty.com 2005 23
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- 26. TO PROTECT THEHEART MUSCLE FROM DAMAGE DURING SURGERY TO REPLACE THE HEART VALVE, THE HEART MAY BE COOLED. IN ADDITION, A CARDIOPLEGIA SOLUTION (WHICH IS A FLUID WITH HIGH CONCENTRATIONS OF POTASSIUM AND MAGNESIUM) IS INTRODUCED TO STOP THE HEART COMPLETELY.THE DAMAGED MITRAL VALVE IS EITHER REPAIRED OR REMOVED AND REPLACED WITH AN ARTIFICIAL (PROSTHETIC) HEART VALVE. 11/22/2013 Template copyright www.brainybetty.com 2005 26
- 27. Aortic valve repairis a surgical procedure used to correct some aortic valve disorders as an alternative to aortic valve replacement. 11/22/2013 Template copyright www.brainybetty.com 2005 27
- 28. Aortic valve repairis most commonly performed in patients with aortic regurgitation caused by; a dilated aortic annulus conjoined cusp prolapse in bicuspid aortic valves (BAV) single cusp prolapse in tricuspid aortic valves, and aortic valve cusp perforation from endocarditis 11/22/2013 Template copyright www.brainybetty.com 2005 28
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- 31. There are twosurgical techniques of aortic-valve repair: The Reimplantation-Technique (David-Procedure) The Remodeling-Technique (Yacoub-Procedure) 11/22/2013 Template copyright www.brainybetty.com 2005 31
- 32. A complete mediansternotomy is performed. In patients requiring only aortic valve repair, a complete median sternotomy is performed through a limited 8 cm skin incision After establishing cardiopulmonary bypass, a transverse aortotomy is performed 2 cm above the sinotubular junction. For better visualization, the aorta can be completely transected and suspended with stay sutures positioned above the commissures to better Template visualize the anatomy. copyright 11/22/2013 www.brainybetty.com 2005 32
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- 34. 1.annular dialatation This typeof AR is caused by a dilated aortic annulus resulting in a sagging of the belly of the cusp resulting in lack of central cusp apposition. Reduction annuloplasty corrects the problem by increasing the surface area of cusp coaptation. 11/22/2013 Template copyright www.brainybetty.com 2005 34
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- 36. Intraoperative photograph priorto repair. Note: loss of cusp coaptation. The pledgeted sutures are stay sutures for improved exposure. 11/22/2013 Template copyright www.brainybetty.com 2005 36
- 37. Intraoperative photograph following pledgetedcommissuroplasty 11/22/2013 Template copyright www.brainybetty.com 2005 37
- 38. This type ofAR results from the prolapse of the conjoint cusp. The usual conjoint cusp is a fusion of the right and left coronary cusps. The goal of the correction is to shorten the redundant conjoint cusp thus elevating the free margin of the cusp to coapt with the other non-prolapsing cusp. 11/22/2013 Template copyright www.brainybetty.com 2005 38
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- 40. Intraoperative photograph afterresection of a central triangle of redundant prolapsing conjoint cusp. The first interrupted suture reapproximating the cut edges of the cusp is being placed. 11/22/2013 Template copyright www.brainybetty.com 2005 40
- 41. This type ofAR is caused by the prolapse of one or more cusps. The free margin is elongated. This can occur by rupture of a small fenestration. The goal of this repair is to shorten the free margin to meet the other cusps. 11/22/2013 Template copyright www.brainybetty.com 2005 41
- 42. Intraoperative photograph demonstrating completed repair ofcusp prolapse in tricuspid valve. Repair was performed by plicating prolapsed cusp and pledgeted commissuroplasty. 11/22/2013 Template copyright www.brainybetty.com 2005 42
- 43. This type ofAR is caused by infective endocarditis or iatrogenic perforation. The goal of this repair is to patch the defect in the cusp. An autologous pericardial patch is prepared and used to cover the defect with either running or interrupted 6-0 polypropylene suture 11/22/2013 Template copyright www.brainybetty.com 2005 43
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- 45. Illustration demonstrating cuspperforation and subsequent patch repair. 11/22/2013 Template copyright www.brainybetty.com 2005 45
- 46. Intraoperative photograph demonstrating cusp perforation priorto repair. 11/22/2013 Template copyright www.brainybetty.com 2005 46
- 47. Intraoperative photograph followingpatch repair of cusp perforation with non-fixed autologous pericardium. 11/22/2013 Template copyright www.brainybetty.com 2005 47
- 48. Depending on theextent of valve disease, Patient need to have the valve repaired or replaced. To repair the valve, surgeon may commissurotomy or implant a valve ring. perform a A commissurotomy is performed for a tight valve (stenosis). The valve leaflets are cut to loosen the valve slightly, allowing blood to pass easily. Another type of valve repair is a valve ring annuloplasty, which is sewn in place when the valve is leaking (regurgitant or insufficient). The valve leaflets are tucked in place with the ring. Template copyright 11/22/2013 www.brainybetty.com 2005 48
- 49. Heart valve replacementsurgery involves the removal of the badly damaged valve. The valve is replaced with a plastic or metal mechanical valve, or a bioprosthetic valve, which is usually made from pig tissue. The damaged valve is cut out, and the new valve is sewn into place 11/22/2013 Template copyright www.brainybetty.com 2005 49
- 50. Mechanical valves, whichare usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time Biological valves : which are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft) Template copyright 11/22/2013 www.brainybetty.com 2005 50
- 51. Surgery to repairor replace the mitral valve is often required in MR. Surgery is generally done for mitral valve prolapse (MVP) only when MR is present. Conditions that are most likely to require surgery include: Sudden (acute) MR. MR with symptoms of heart failure. MR with mild-to-moderate left ventricular dysfunction (ejection fraction less than 55%) 11/22/2013 Template copyright www.brainybetty.com 2005 51
- 52. CONDITIONS THAT MAYREQUIRE SURGERY INCLUDE: MR with an irregular heartbeat (atrial fibrillation) but no symptoms and no signs of functional damage to the left ventricle. MR with elevated blood pressure in the lungs (pulmonary hypertension) but no symptoms and no signs of functional damage to the left ventricle. MR with mild to severe left ventricular dysfunction, no symptoms, and a high likelihood of preserving some of the related structures of the Template copyright mitral valve. 11/22/2013 www.brainybetty.com 2005 52
- 53. People who receivea mechanical heart valve are more likely than those who receive a bioprosthetic heart valve to develop blood clots in the heart. The clots may break loose, travel to the brain , and cause a stroke. So if patient received a mechanical heart valve to treat severe MR, patient need to take medicine for the rest of your life to prevent clots from forming (anticoagulant medicine). 11/22/2013 Template copyright www.brainybetty.com 2005 53
- 54. Most patients areadmitted to the hospital the day before surgery or, in some cases, on the morning of surgery. The night before surgery, patient should take bathe to reduce the amount of germs on skin. After admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved. 11/22/2013 Template copyright www.brainybetty.com 2005 54
- 55. Patient is askednot to eat or drink after midnight the night before surgery. An electrocardiogram (ECG or EKG) , blood tests, urine tests, and a chest x-ray should be done. A (mild tranquilizer) is given before taken into the operating room. 11/22/2013 Template copyright www.brainybetty.com 2005 55
- 56. During valve repairor replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine. Because the heart or the aorta must be opened, heart valve surgery is open heart surgery. After hooked up to the heart-lung machine, heart is stopped and cooled. Next, a cut is made into the heart or aorta, depending on which valve is being repaired or replaced. 11/22/2013 Template copyright www.brainybetty.com 2005 56
- 57. Once the surgeonhas finished the repair or replacement, the heart is then started again, and are disconnected from the heart-lung machine. The surgery can take anywhere from 2 to 4 hours or more, depending on the number of valves that need to be repaired or replaced. 11/22/2013 Template copyright www.brainybetty.com 2005 57
- 58. Recovery from heartvalve surgery usually involves a few days in an intensive care unit (ICU) of a hospital. Full recovery from heart valve surgery can take several months. Recovery includes healing of the surgical incision, gradually building physical endurance, and exercising. Patient should activities. 11/22/2013 resume most of normal Template copyright www.brainybetty.com 2005 58
- 59. Continue to monitorpatient condition. Watch out for symptoms of blood clots and infections. An artificial valve may need to be replaced after a period of time. Should be informed. 11/22/2013 Template copyright www.brainybetty.com 2005 59
- 60. Effects from theoperation itself (such as bleeding, infection, and risks associated with anesthesia). These risks are low. Blood clotting caused by the new valve. Replacement with a mechanical valve requires lifelong treatment with medicine to prevent blood clots (anticoagulant). Infection in the new valve. Infection is more common with valve replacement than with valve repair. Failure of the new valve. Valve failure is more common with valve replacement than with valve repair. Bioprosthetic valves last for about 8 to 15 years. 11/22/2013 Template copyright www.brainybetty.com 2005 60
- 61. Patient has tostay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU). Recovery after valve surgery may take a long time, depending on how healthy patient were before the operation. Patient have to rest and limit your activities. Patient have to begin an exercise program or to join a cardiac rehabilitation program. 11/22/2013 Template copyright www.brainybetty.com 2005 61
- 62. Most valve repairand replacement operations are successful. The outcome of mitral valve replacement depends on a person's overall health, including other health conditions. In some rare cases, a valve repair may fail and another operation may be needed. Patients with a biological valve may need to have the valve replaced in 10 to 15 years. Mechanical valves may also fail, so patients should alert their doctor if they are having any symptoms of valve failure. Patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives. Because these medicines increase the risk of bleeding within the body, patient should always wear a medical alert bracelet and inform doctor or dentist about taking a Template blood-thinning medicine. copyright 11/22/2013 www.brainybetty.com 2005 62
- 63. Bacteria can enterthe bloodstream during these procedures. If bacteria get into a repaired or artificial valve, it can lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis. Patients with mechanical valves say they sometimes hear a quiet clicking sound in their chest. This is just the sound of the new valve opening and closing, In fact, it is a sign that the new valve is working the way it should. 11/22/2013 Template copyright www.brainybetty.com 2005 63
- 64. Minimally invasive heartvalve surgery is a technique that uses smaller incisions to repair or replace heart valves. This means there is less pain. Minimally invasive surgery also reduces the length of the hospital stay and the recovery time 11/22/2013 Template copyright www.brainybetty.com 2005 64
- 65. Minimally invasive valvesurgery can only be done in certain patients. This type of surgery cannot be done in patients With severe valve damage Who need more than one valve repaired or replaced Who have clogged arteries (atherosclerosis) Who are obese 11/22/2013 Template copyright www.brainybetty.com 2005 65
- 66. Transcatheter aortic valveimplantation is a minimally invasive procedure to repair a damaged or diseased aortic valve. A catheter is inserted into an artery in the groin and threaded to the heart. A balloon at the end of the catheter, with a replacement valve folded around it, delivers the new valve to take the place of the old. 11/22/2013 Template copyright www.brainybetty.com 2005 66
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- 68. Heart valve repairor replacement surgery is a treatment option for valvular heart disease. When heart valves become damaged or diseased, they may not function properly. Conditions which may cause heart valve dysfunction are valvular stenosis and valvular insufficiency (regurgitation).When one (or more) valve(s) becomes stenotic (stiff), the heart muscle must work harder to pump the blood through the valve. Template copyright www.brainybetty.com 2005 11/22/2013 68
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