Aortic valve replacement . It consists of open-heart surgery performed by cardiothoracic surgeons to treat tightness (stenosis) or leakage (regurgitation or insufficiency) of the aortic valve .
Summary
[ hide ]
- 1 Aortic valve location
- 2 The reason why the aortic valve malfunctions
- 3 Criteria for determining aortic valve replacement surgery
- 4 Opinions to replace an aortic valve
- 1 The mechanical valves
- 2 Biological Valves
- 5 Need for surgery
- 6 Risks of surgery
- 7 Physical conditions after aortic valve replacement
- 8 Sources
Aortic valve location
The heart has two sets of pumping chambers: the one on the right side pumps blood to the lungs , the one on the left side goes to the rest of the body. Thus, the left side does the most work. The most important chambers are called ventricles. Because the ventricle is a pump, it must have an inlet valve and an outlet valve. The aortic valve is the outlet of the left ventricle . The valve opens to allow blood to be pumped out of the left ventricle (the heart’s most important chamber) and closes to prevent blood from returning to the ventricle.
The reason why the aortic valve malfunctions
The aortic valve malfunctions for various reasons. For example, the valve may be an abnormal valve by birth (congenital aortic valve disease), or it may get sick over the years (acquired aortic valve disease). The most common congenital abnormality is the bicuspid aortic valve. As shown below, the aortic valve normally has 3 leaflets or cusps, and a bicuspid aortic valve has only two. Thus, it does not open or close completely. A bicuspid aortic valve is a common abnormality and occurs in 1 or 2% of people. This is the second leading cause of aortic valve disease requiring surgery. These valves can function normally for years before becoming stenotic, regurgitant, or both. People with a bicuspid aortic valve need antibiotic prophylaxis before going to the dentist, and there are no more specific requirements beyond visiting a qualified cardiologist for follow-up. The most common cause of aortic valve disease that needs surgery is calledsenile aortic calcification , which means that the valve has deteriorated over the years. When a valve degenerates, calcium is deposited for unknown reasons. The calcium limits the movements of the leaflets. This causes problems opening (stenosis) or closing (insufficiency or regurgitation). Less frequent causes of aortic valve disease include diseases of the aorta, the main vessel that leaves the heart to carry blood to the rest of the body, and include ascending aortic aneurysms, aortic dissection, and Marfan syndrome .
Criteria for determining aortic valve replacement surgery
Decision-making about surgery should be made by a team of doctors that generally consists of your chest or cardiothoracic surgeon and cardiologist . The team of doctors will base their recommendations on symptoms and findings from studies such as echocardiography and even cardiac catheterization. The echocardiogram can show growth of the heart, and can help measure the degree of stenosis or regurgitation. A cardiac catheterization provides similar information, but can also identify any narrowing of the coronary arteries.
Reviews to replace an aortic valve
Unlike the mitral valve, which can be frequently repaired, the aortic valve requires replacement. Once the decision is made to proceed to surgery, the type of artificial valve (prosthesis) to be chosen should be considered. Broadly speaking, there are two types of prostheses or artificial valves: mechanical valves and biological valves.
Mechanical valves
An excellent number of mechanical valves or prostheses for valve replacement are
Bivalve Carbonedics Mechanical Prosthesis
available today.
Most surgeons have a preference for one or another prosthesis depending on technical factors (how they implant it), however from the patient’s point of view, the differences between the valves are few. The main advantage of mechanical valves is their durability.
From a practical point of view, they should not be changed. The main disadvantage is that there is a tendency for the blood to coagulate with any mechanical valve. Therefore, patients with artificial valves have to take blood thinners or “blood-thinning medications” for the rest of their lives. There is still a very small but definitive risk that a clot will cause a stroke .
Biological valves
There is also a variety of natural or biological prostheses that can be used to replace
Pig Biological Valve
an abnormal valve.
All of them tend to reduce the risk of clots; however, they are less durable valves than mechanical prostheses. After a certain time they must be changed. Options in this category include “valvular xenografts” made from animal tissue (the most common are porcine aortic valves), “valvular homografts or allografts” collected from human cadavers, and “valvular pulmonary autografts” taken from the pulmonary valve itself patient to move the valve from the right side to the left side of the heart. The decision of the type of valve should be made jointly with the cardiothoracic surgeon and the cardiologist. Finally, the choice will depend on the patient’s preferences, on his lifestyle,
Need for surgery
The aortic valve is the blood outlet valve on the left side of the heart, which means it opens during systole (when the ventricle contracts or squeezes blood out through the aorta into the rest of the body). When the aortic valve is narrow or stenotic, the ventricle has to work harder to pump blood throughout the body. This extra work consumes a significant amount of energy and requires extra blood to nourish the heart. If there is not enough blood, the heart develops ischemia causing anginal chest pain. The aortic stenosisIt is often progressive, getting much worse over time. Once the valve becomes thick, the heart has more and more work to do to keep the blood out of the heart. At a certain point, the heart can no longer compensate resulting in episodes of low blood pressure or hypotension and even syncope. Once the heart fails to compensate, the fluid that is retained tends to congest the lungs. When the aortic valve leaks, the heart tends to work harder and harder, and a similar problem occurs. The ventricle has to pump more blood with each contraction to produce the flow that must come out, which is known as cardiac output. The heart can compensate the cardiac output for several months and even years causing the evolution of the leak to develop slowly. Eventually,
Surgery risks
Individual risks of surgery should be calculated by your cardiothoracic surgeon and cardiologist. Risks generally depend on age, general health, specific medical conditions, and heart function.
Physical conditions after aortic valve replacement
After a successful aortic valve change, patients should expect to return to their preoperative and even better conditions. Anticoagulants (blood-thinning medications) such as warfarin should be indicated for 6 weeks and up to 3 months after surgery for those with biological valves and for life for those with mechanical prostheses. Once the wounds are healed, most patients should have some physical activity if there are no contraindications to it. A patient should require antibiotics in a preventive or prophylactic way if any type of dental work is to be performed and should always mention his valve replacement surgery before any surgical procedure.
