valve repair & replacement

8/4/2019 Valve Repair & Replacement

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VALVE REPAIRAND

REPLACEMENTPROCEDURES



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 valve’s orifice.



Repair may be made to the;

• Commissures between the leafletsknown as Commissurotomy,

•

Annulus of the valve byAnnuloplasty,

• Leaflets repair

• Chordoplasty



VALVULOPLASTY

•Repair of cardiac

valve



1. COMMISSUROTOMY

• Separate the fused leaflets

Indication :

1. Stenosis { mitral/ aortic}

2. Regurgitation

Types :

1. Closed commissurotomy1. 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 dilatormay be used toopen thecommissures



2. ANNULOPLASTY

Indication :

1. Regurgitation

• Techniques

1. Use of annuloplasty

ring2. Tucking valve

leaflets to the

atrium with suture



ANNULOPLASTY



LEAFLET REPAIR

Indication:• Damage to cardiac valve

leaflets resulting from

stretching, shortening,

or tearing

Types :

1. Leaflet plication –

The elongated tissue may

be folded over onto itself (ie,

tucked) and sutured

2. Leaflet resection –

A wedge of tissue may be

cut from the

middle of the leaflet and thegap sutured closed

3. Pericardial patch

For tear/ holes in leaflets



Leaflet repair



Chordoplasty

INDICATION

• Mitral valve

Regurgitation

• Tricuspid valve

• Stretched chordaetendineae can be

shortened,

•Shortened onescan be elongated

• Torn ones can be

reattached to theleaflet, 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. Jude’s valve



Ball and Cage (Starr Edwards)



Monoleaflet

• TTK-ChitraValve



Mechanical valves cTD… ADVANTAGES :

• Do not deteriorate orbecome infected as easily

as the tissue valves

• Mechanical valves are used

if the patient has renal

failure, hypercalcemia,

Endocarditis, or sepsis

• More durable than tissueProsthetic valves

DISADVANTAGES :

• Thromboemboli

• Long-term

anticoagulation



2. Biological valves



Three types:

• Xenografts : animal heart valve

(synonym: heterograft)

•Homografts : human heart valve

(synonym:allograft)

• Autografts: patient’s 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 requireReplacement more frequently.

valve repair & replacement

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