Heart Disease: Valve Disease Treatment

Heart valve surgery is performed by traditional surgery and minimally invasive balloon valvuloplasty.

What Happens During Traditional Heart Valve Surgery?

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.

What Happens During Minimally Invasive Heart Valve Surgery?

Minimally invasive heart valve surgery is a type of surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay.

Your surgeon will review your diagnostic tests prior to your surgery to determine if you are a candidate for minimally invasive valve surgery.

Often, the surgeon and cardiologist (heart doctor) will use transesophogeal echo (an ultrasound transducer probe that is passed down the esophagus) to help determine the functioning of the valve before and after surgery.

What Is Valve Repair Surgery?

The mitral valve is the most commonly repaired valve, but the aortic, pulmonic, and tricuspid valves may also undergo some of these repair techniques.

If your valve can be repaired, your surgeon will perform any of the following types of valve repair procedures.

• Commissurotomy. Fused valve leaflets are separated to widen the valve opening.
• Decalcification. Calcium deposits are removed to allow the leaflets to be more flexible and close properly.
• Reshape leaflets. If one of the leaflets is floppy, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. This procedure is called quadrangular resection.
• Chordal transfer. If the anterior leaflet of the mitral valve has prolapse (floppy; lacking support), the chordae are transferred from the posterior leaflet to the anterior leaflet. Then, the posterior leaflet is repaired by quandrangular resection (see above).
• Annulus support. If the valve annulus (the ring of tissue supporting the valve) is too wide, it may be reshaped or tightened by sewing a ring structure around the annulus. The ring may be made of tissue or synthetic material.
• Patched leaflets. The surgeon may use tissue patches to repair any leaflets with tears or holes.

The advantages of valve repair surgery include:

• decreased need for life-long blood thinner (anticoagulant) medication
• preserved heart muscle strength

What If My Valves Cannot Be Repaired?

When you have aortic or pulmonic valve disease, valve replacement surgery is usually performed. In some cases, the aortic valve can be repaired.

If your valves cannot be repaired, your doctor will replace the valve.

During the surgery, the native valve is removed and a new valve is sewn to the annulus of your native valve. The new valve can be a:

• Mechanical valve. It is made totally of mechanical parts that are tolerated well by the body. The bi-leaflet valve is used most often. It consists of two carbon leaflets in a ring covered with polyester knit fabric.
• Biological valve. Tissue valves (also called biologic or bioprosthetic valves) are made of human or animal tissue. Animal tissue valves may come from pig tissue (porcine) or cow tissue (bovine). Tissue valves may have some artificial parts to help give the valve support and to aid placement.
• Homograft valve. (also called allograft). It is an aortic or pulmonic human valve that has been removed from a donated human heart, preserved, and frozen under sterile conditions. A homograft may be used to replace a diseased aortic or pulmonic valve.