VALVE REPAIR AND REPLACEMENT PROCEDURES

INDICATIONS
Prolapse (of a valve): stretching of an atrioventricular Heart valve leaflet into the atrium during systole. Regurgitation: backward flow of blood through a heart valve Stenosis: narrowing or obstruction of a cardiac valves orifice.

Repair may be made to the;

Commissures between the leaflets known as Commissurotomy, Annulus of the valve by Annuloplasty, Leaflets repair Chordoplasty

VALVULOPLASTY

Repair of cardiac valve

1. COMMISSUROTOMY
Separate the fused leaflets Indication : 1. Stenosis { mitral/ aortic} 2. Regurgitation Types : 1. Closed commissurotomy
1. Balloon Valvuloplasty. 2. Using dilator/fingers

2. Open commissurotomy

a. Closed Mitral Commissurotomy

Midsternal incision Finger or a dilator is used to break open the commissure.

Closed commissurotomy/ Balloon valvuloplasty

Percutaneous Mitral, Aortic and Pulmonic Valvotomy for Stenosis

b. open commissurotomy
Direct visualization Under general anesthesia, A median sternotomy or left thoracic incision is made. Cardiopulmonary bypass

Finger, scalpel, balloon, or dilator may be used to open the commissures

2. ANNULOPLASTY
Indication : Techniques

1. Regurgitation

1. Use of

annuloplasty

ring 2. Tucking valve leaflets to the atrium with suture

ANNULOPLASTY

LEAFLET REPAIR
Types :
Indication: 1. Leaflet plication Damage to cardiac valve The elongated tissue may leaflets resulting from be folded over onto itself (ie, stretching, shortening, tucked) and sutured or tearing 2. Leaflet resection A wedge of tissue may be cut from the middle of the leaflet and the gap sutured closed 3. Pericardial patch For tear/ holes in leaflets

Leaflet repair

Chordoplasty
INDICATION Mitral valve Regurgitation Tricuspid valve

Stretched chordae tendineae can be shortened, Shortened ones can be elongated Torn ones can be reattached to the leaflet, and

VALVE REPLACEMENT
Two kinds of replacement valves are available: Mechanical valves Biological valves are made of animal or human tissue.

1. Mechanical valves
Ball and Cage (Starr Edwards) Monoleaflet (Medtronic) Bileaflet( St.Jude's)

St. Judes valve

Ball and Cage (Starr Edwards)

Monoleaflet

TTK-Chitra Valve

Mechanical valves cTD

ADVANTAGES : DISADVANTAGES :

Do not deteriorate or become infected as easily as the tissue valves Mechanical valves are used if the patient has renal failure, hypercalcemia, Endocarditis, or sepsis More durable than tissue Prosthetic valves

Thromboemboli Long-term anticoagulation

2. Biological valves

Three types: Xenografts : animal heart valve

(synonym: heterograft)

Homografts : human heart valve (synonym:allograft) Autografts: patients own heart valve
(ie, the pulmonic valve is excised and used as an aortic valve)

Biological valves
ADVANTAGES :
1. Tissue valves are less likely to generate Thromboemboli 2. Long-term anticoagulation is not required.

DISADVANTAGES :
Not as durable as mechanical valves and require Replacement more frequently.