Heart Valve Diseases and Heart Valve Surgery
Heart valves have key roles in regulating blood flow through the heart, opening and closing in sequence with each heartbeat. These valves act like one-way doors, allowing blood to flow either forward into the next chamber, or out of the heart via one of two main blood vessels that carry blood away from the heart. The valves close to prevent back flow.
Heart Valve Functions
On the right side of the heart, blood flows through the tricuspid valve, which lies between the right atrium and the right ventricle. On the left side of the heart, the mitral valve controls the blood flow between the left atrium and left ventricle.
The pulmonary valve controls flow from the right ventricle into the pulmonary artery, which carries blood to the lungs for oxygenation. On the left side, the aortic valve opens the way for oxygenated blood to pass from the left ventricle into the aorta, the body?s largest artery.
Causes of Heart Valve Malfunction
Heart valves may become impaired for a variety of reasons. Rheumatic fever, the most common cause of valve malfunction, causes a valve to stiffen over time. This limits the ability of the valve to open and close properly. Some people are born with heart valve abnormalities, which may be corrected at birth or later in life. Other people may acquire valve damage from infection (as with bacterial endocarditis) or other diseases. The results are a tight, rigid valve limiting forward blood flow (called a stenotic valve), or a valve which does not close properly, permitting back flow (called a regurgitant valve).
Symptoms of Valve Disease
The heart tries to compensate for improper valve function by working harder to deliver oxygen-rich blood to other organs and tissues. This may result in:
- Shortness of breath
- Chest pain
- Syncope (fainting)
- Reduced blood output from the heart
People whose valve disorders cause no symptoms or only minimal symptoms may not require treatment. Others do well with drug therapy. However, if a patient?s condition worsens, the patient may require surgery.
Surgical Treatment of Diseased Heart Valves
Heart Valve Surgical Repair
Repairing the valve can be done by one of three ways: commissurotomy, valvuloplasty, or valve replacement. Commissurotomy and valvuloplasty are repair procedures, whereas valve replacement involves surgical implantation of a new valve.
When a patient has a stenosed or narrow valve, which limits the blood flow, the flap-like doors (cusps or leaflets) may thicken and adhere to one another. The cardiovascular surgeon cuts or shaves the points where the cusps meet (commissures) to address this problem.
Valvuloplasty is a procedure that reinforces the cusps to provide more support and permit proper closure of the valve that has regurgitation (back flow leakage). In order to accomplish this, the cardiovascular surgeon attaches a ring-like device to the outside of the valve.
Surgical Replacement of Heart Valves
Valve replacement entails surgical removal of a defective valve and suturing (sewing) in its place a prosthetic valve. The new valve is made of either synthetic materials (mechanical valve) or of biological tissue (bioprosthesis). In the illustration at right a mechanical St. Jude valve has been used to replace a diseased mitral valve. Valve surgery requires the use of a heart-lung machine, since the heart must temporarily stop beating. Following uncomplicated valve surgery, a patient will stay in the intensive care unit (ICU) for about one day, followed by a few more days in a hospital room.
The surgeons who make up
Surgical Associates of Texas, P.A. are distinguished by their extensive experience in coronary bypass surgery, valvular repair and replacement, aortic and left-ventricular aneurysm surgery, and successful outcomes with high-risk patients with multiple disease comorbidities. They are deeply involved in clinically oriented research where advances and developments are transferred directly to patient care, and have long term relationships with an excellent team of cardiovascular anesthesiologists and cardiologists. Based at the Texas Heart Institute, our surgeons are affiliated with St. Luke?s Episcopal Hospital, and Texas Children?s Hospital. They hold academic appointments at The University of Texas Medical School, Houston, and Baylor College of Medicine, Houston.
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Last revised April 2005