The Different types of surgical intervention of heart valves
The valve surgery on replacement or repair of the various valves of the heart. Relatively rare before age 60, valvular diseases reach about 8% of the population between 65-74 years and 14% beyond 75 years. Any patient with "valvular disease" should not undergo surgery at the outset. The aim of the cardiac assessment is to analyze the type of valvular disease and to determine whether it is sufficiently important to justify surgery. In-case of illness advanced, a regular medical follow-up is generally recommended. Transthoracic echocardiography is the standard examination for the diagnosis of valvular diseases. Transesophageal echocardiography allows us to better define the mechanisms of dysfunction. This examination therefore, important when surgical treatment is decided.
There are essentially two types of valvular dysfunction: one is called "stenosis", which corresponds to a narrowing of the valve (failure to open the valve), and the other is called "insufficiency" which corresponds to a leakage of the valve Valve (incorrect closing of the valve). The distinction between these two dysfunctions is essential because their treatment is different. In general, incase of stenosis, the valve is replaced and incase of insufficiency the valve is repaired. The valvular repair makes it possible to avoid the disadvantages of the valvular prostheses, such as the use of anticoagulant or wear. In Saint-Luc, several valvular repair techniques have been developed and the Cardiovascular Surgery Service has gained international recognition in this field.
The valvular operations are performed by the median sternotomy or by different approaches less invasive initially according to the indications.
The heart has 4 valves; Among them, it is the aortic valve that is most often reached, then it is the mitral valve then the tricuspid and pulmonary valves.
The valvular operations are performed by the median sternotomy or by different approaches less invasive initially according to the indications.
The heart has 4 valves; Among them, it is the aortic valve that is most often reached, then it is the mitral valve then the tricuspid and pulmonary valves.
Aortic valve
The aortic stenosis is the most frequent valvular disease. It occurs mostly beyond 60 years and increases incidence with age. The treatment consists of a valve replacement by a prosthesis. In Saint-Luc, all types of prostheses available are used. Mechanical prostheses, mainly composed of carbon, do not wear out but require anticoagulant (sintrom, coumadin) for life. Biological prostheses, made of porcine or bovine tissue, do not require anticoagulant but can be damaged over time. The choice between the different types of valvular prostheses is made according to the age of the patient, certain characteristics of the patient and his preferences with regard to the advantages and disadvantages of each prosthesis. Introduced more recently, biological prostheses (bovine tissue in a stent) implantable percutaneously ("transfemoral" pathway) or by left mini-thoracotomy ("transapical" pathway) allow the treatment of aortic stenosis in elderly patients and / Fragile to support cardiac surgery by sternotomy. The diseased aortic valve can also be replaced by the pulmonary valve which is in this case itself replaced by a pulmonary homograft or a bioprosthesis. This operation, called the "Ross" operation, is generally reserved for children and young adults. Finally, the aortic valve can be replaced by an aortic valve of human origin taken from a corpse. This aortic valve substitute is called homograft. This is used mainly in the case of infection of the aortic valve when the infection damages the tissues of the heart that support the aortic valve, such as, for example, an abscess of the aortic ring.
The aortic insufficiency is rarer than the stenosis and can affect all age groups. When the insufficiency is not associated with fibrosis or calcification of the valve, it can be repaired. The dilation of the aorta at the emergence of the heart is often a cause of aortic insufficiency. When the diameter of the aorta exceeds a certain size (4.5-5.5 cm as indicated), it should be replaced to prevent serious complications such as rupture or dissection of the aorta and also to treat the aorta Aortic insufficiency. In these cases, the aortic valve can be preserved.
The bicuspid aortic valve is the most common congenital heart defect, it affects 1-2% of the population. The bicuspid aortic valve alters more rapidly than normal aortic valves causing insufficiency which is often accompanied by dilation of the aorta. In these cases also, the preservation and repair of the aortic valve are the preferred treatments over replacement by a prosthesis.
Mitral valve
Unlike the aortic valve, the affections of the mitral valve are more often insufficient as a stenosis. The mitral regurgitation is almost always fixable. Regarding the mitral stenosis, repair is carried out only if the tissue quality permits. Indeed, the repair of the mitral valve allows a better preservation of the left ventricular function in the long term compared to the replacement of the valve by a prosthesis. In order to treat the different types of lesions of the mitral valve, several repair techniques have been developed in Saint-Luc. Thanks to this, we are currently benefiting from an important expertise in complex mitral repair such as in infections, calcifications or in case of rheumatic disease. Non-complex mitral surgery can also be performed by right mini-thoracotomy for cosmetic purposes and to reduce the cumbersomeness of the surgical procedure.
If the mitral valve is not repairable, it is replaced by a mechanical prosthesis or a bio-prosthesis. As for aortic replacement, the choice of the prosthesis is made according to the age and certain characteristics of the patient and according to his preference for the type of prosthesis.
Tricuspid valve
The insufficiency of the tricuspid valve can almost always be repaired by a simple annuloplasty. However, more complex repairs may be required in some situations. It is rare that the tricuspid valve should be replaced by the prosthesis.
Pulmonary valve
Pulmonary valve diseases are very rare in adulthood. This valve is rather affected in congenital heart pathologies that may require surgical correction during the first years of life.
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