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Cardiac Valve Replacement

Heart plays a role of pump made of muscle tissue.

There are four valves/pumping chambers in the heart:

1. Tricuspid valve – located between the ventricle and atrium both at the right side.

2. Pulmonary valve – it is located between the right ventricle and the pulmonary artery.

3. Mitral valve – located between the ventricle and atrium both at the left side.

4. Aortic valve – located between the left ventricle and the aorta.

These 4 valves ensure the blood flows in the right direction through the heart. The upper two chambers are called atria and two lower chambers are called ventricles. If one or more of the valve is diseased or damaged it can affect the blood flows through the heart in two ways:

1. Valve Stenosis or narrowing – when a valve does not open completely and obstructs the flow of blood. It can happen due to infection (rheumatic fever or staphylococcus infections) and old age.

2. Valve incompetence or regurgitation or leaky valve – when valve does not close properly and allows blood to leak backwards.

Mostly heart valve replacement is an open heart operation. This means that the surgeon will make a large incision for opening the chest and heart to remove or replace the damaged valve by sewing the new artificial (prosthetic) valve into place. Now day’s surgeons can repair or replace the valve by using less invasive technologies which does not require the large opening of the chest, the damaged valve is replaced through a small incision near the "breastbone" or under the chest muscle on the right side. This is called minimally invasive surgery.

Heart valve surgery can be treated majorly in two ways:

1. Valve repair is used for mitral valves that become flabby and leak, not seriously damaged though. Surgeon can use the following procedures for repairing the valve depending on the age factor, severity of the disease, overall health.

a. Commissurotomy – surgeon opens the valves narrowed by the thickened and stuck leaflets by cutting the points where the leaflets meets.

b. Valvuloplasty – surgeon will attach the ring like device around the outside of the valve opening that provides support and strengthen the leaflets to close the valve tightly.

c. Reshaping – when surgeon cuts out the part of the leaflets and sew back together to close the valve properly.

d. Decalcification- is used to remove excess calcium buildup form the leaflets. Leaflets can close properly once the calcium is removed.

e. Repair – of support replaces or shortens the chordate tendineae and the papillary chords which gives valve support to the right length so that valve can close properly.

f. Patching – when there are holes or tears in the leaflets, patching technique can be used for repairing the valve with tissue patch.

2. Valve replacement needs diseased valve that can be life threatening to be replaced by new working valve. Mechanical valve or tissue valve are the common ones for the replacement.

a. Mechanical valve - also known as artificial valve are made up of materials like plastic, carbon, metal. These valves are strong and long lasting. Patients need to have anticoagulants, blood thinning medicines for whole life as blood tends to stick to the mechanical valves creating blood clots.

b. Tissue valve (animal valve) – made up of animal tissue or can be taken from human tissue who had donated heart. In some cases it can be taken from patient’s own tissue. These valves are not strong and long lasting needs replacement every ten years. Tissue valves are often used for elders as it breaks down faster in children and young adults.

Minimal invasive surgery can be done in some cases in which smaller cut or incision is made in the chest to repair or replace the valves. It takes less hospital stay time and patient can recover early with less pain. But this technique cannot be used for the patients with severe valve damage, atherosclerosis (clogged arteries), overweight or patient who need more than one valve repair or replacement.

Tran catheter aortic valve replacement (TAVR):-

It is a minimally invasive procedure to repair a damaged/diseased aortic valve. Surgeon will put a catheter into an artery in the groin just like angioplasty threading to the heart. A compressed tissue heart valve placed on the balloon at the end of the catheter positioned inside the aortic valve. Balloon is inflated once the new tissue valve takes it place. Then the balloon is deflated and the catheter is withdrawn. This surgery is performed using general anesthesia.

Most of the patients in cardiac valve replacement surgery can feel discomfort and will be given pain relievers post surgery. It can take 2 to 3 months to get recovered completely depending on the individual condition. Patient needs to take proper care and healthy diet as suggested by the cardiologist for healthy long life.

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