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VALVE SUGERY


Valve operation – Aortic or mitral valve surgery is an open-heart surgery performed by cardiac surgeons for the treatment of narrowing (stenosis) or relaxation (regurgitation) of the valve.

Causes

Valves developl illness in many ways. In some individuals, after the infection of the pharynx by a specific bacteria (streptococcus), occasionally there is damage to the valves, to which the bacteria gets through the bloodstream. This occurs as part of a syndrome called Rheumatic fever. In other people, some other bacteria can enter the bloodstream and make inflammation in the inner layers of the heart (so-called endocarditis), damaging the valves. Usually, people with already damaged valves are more susceptible to endocarditis. In some patients, there is a congenital defect on the valves, which makes them vulnerable to the development of endocarditis, or the disability itself is progressing and further damaging to the valve for years. Also, in some elderly persons, the valves gradually change over the years, becoming rigid and thicker (degenerate) which also creates damage to the valve

Forms

The valve disease can be manifested by the inability to close the valve completely when it is necessary (valve insufficiency, or regurgitation), or the inability to open the valve completely when necessary (stenosis of the valve).

Thus, if the mitral valve can not be completely closed, but it passes a part of the blood back from the left ventricle to the left atrium, we speak of mitral insufficiency (regurgitation). At the same time, the heart slightly returns back to the atrium part of the volume of blood that should be pushed forward, making the work of the heart ineffective. Therefore, the heart is trying to work harder, and this exhausts it over years, and the disease on the valve worsens, so the patient is easily weary, has a sense of lack of air, etc. But if the mitral valve can not open (mitral stenosis), then the left atrium pushes the blood to the left ventricle with effort. The heart strains again and weakens over years.

If the aortic valve can not be completely closed, but it passes a part of the blood back from the aorta to the left ventricle, it is the aortic insufficiency (regurgitation). At the same time, the heart slightly returns back to the ventricle part of the volume of blood that should be pushed forward, which makes the heart work ineffective. Therefore, the heart is trying to work harder, and this exhaust it over years and the disease on the valve worsens. But if aortic valve can not open (aortic stenosis), then the left ventricle pushes blood to the aorta with effort. The heart strains again and weakens over years. Patients may feel fatigue, choking, chest pain, have fainting, dizziness, even loss of consciousness, as well as severe heart failure.

If the tricuspid valve can not be completely closed, but it misses a portion of the blood back from the right ventricle to the right atrium, it’s a tricuspid insufficiency (regurgitation). At the same time, the heart slightly returns back to the ventricle part of the volume of blood that should be pushed forward, making the work of the heart ineffective. Therefore, the heart is trying to work harder, and this exhausts it over years and the disease on the valve worsens. But if the tricuspid valve can not open (tricuspid stenosis), then the right atrium pushes the blood to the right ventricle with effort. The heart strains again and weakens ove years.

If the pulmonary valve can not be completely closed, but it passes a part of the blood back from the pulmonary artery to the right ventricle, it is a pulmonary insufficiency (regurgitation). At the same time, the heart slightly returns back to the ventricle part of the volume of blood that should be pushed forward, which makes the heart work ineffective. Therefore, the heart is trying to work harder, and this exhausts it over years and the disease on the valve worsens. But if the pulmonary valve can not open (pulmonary stenosis), then the right ventricle pushes blood to the pulmonary artery with effort. The heart strains again and weakens over years.

When to operate

Not all valve illnesses are indicative of surgery. There are mild and moderate forms of valvular diseases that do not require surgical treatment, but can be controlled under medications. Severe valvular diseases, which are defined after the performed ultrasound examination of the heart, and which cause significant difficulties to patients, are an indication for surgery.

Valvular surgery is more severe than coronary bypass (bypass) and is more risky, and there must be a good justification for the patient to undergo such a procedure.

What is the done by surgery?

By surgery, the valve can be repaired or replaced.

Valvular reparation is a procedure in which the valve of the patient is left, but surgical seams and cuts are made on it, which after repair return the function of the valve and return it to normal. The patient retains his valve, it is not taken out of the heart.

The valve is replaced by a biological or mechanical valve. The patient’s ill valve is cut and pulled out of the heart, and a replacement valve is sewed in its place. Biological one comes from biological, living tissue, and  themechanical is made of artificial materials.

Advantages of the biological valve: the patient is not linked to anticoagulant therapy (by medicines Marivarin, Warfarin, Marcoumar, Sintra, Farin etc.) and there is no need for frequent control of the level of blood dilution (INR controls). Disadvantages of biological valves: degenerates over time, and after several years, resurgery is necessary, when this valve is replaced by a new one.

Advantages of a mechanical valve: considerably longer lasting, resurgery to replace with the new valve can be significantly delayed (several years) in relation to the biological one.Disadvantages of mechanical valves: anticoagulant blood thinning therapy is neded (by medicines Marivarin, Warfarin, Marcoumar, Sintra, Farin etc.) and the necessary frequent blood thinning degree controls (INR controls). Depending on the type of valve, the target value of the INR is determined by your cardiologist.

What to do after surgery

Take medications regularly. It is  absolute mandatory to comply with your cardiologist’s instructions. Prevention of bacterial endocarditis (prophylactic taking of antibiotics prior to some medical procedures) to prevent damage to the new valve is necessary. Gradual return to normal life activity depends on the overall state of the heart and organism. Act according to the instructions of your cardiologist.


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