Heart Valve Surgery and Valvuloplasty
Diagnosis & Testing
What If My Heart Valve 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 heart 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 the original. 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.
What Are the Pros and Cons of Each Type of Heart Valve?
- Mechanical valves. The advantage to mechanical heart valves is their sturdiness. They are designed to last for many years. There are also drawbacks. Due to the artificial material involved, people who receive these valves will need to take life-long blood-thinner medication (anticoagulants) to prevent clots from forming in the mechanical valve. These clots can increase the risk for a stroke. Also, some people report a valve ticking sound that is usually not bothersome. It is the sound of the valve leaflets opening and closing.
- Biological valves. The advantage of biological valves is that most people do not need to take life-long anticoagulants, unless they have other conditions (such as atrial fibrillation) that warrant it. Biologic valves, traditionally, were not considered as durable as mechanical valves, especially in younger people. Previously available biologic valves usually needed to be replaced after about 10 years. However, recent studies show that some biologic valves may last at least 17 years without decline in function. This represents a new milestone in the durability of biologic valves.
- Homograft valves. Homografts are ideal heart valves for aortic valve replacement, especially when the aortic root is diseased or there is infection. The heart’s natural anatomy is preserved and patients do not need to take life-long anticoagulants. However, the limited availability is a drawback in some settings.
Are There Non-Surgical Options for Heart Valve Disease?
There are alternatives to traditional heart valve surgery. Balloon valvotomy is used to increase the opening of a narrowed (stenotic) valve. It is used for select patients who have mitral valve stenosis (narrowing of the mitral valve) with symptoms, select older people who have aortic stenosis (narrowing of the aortic valve) but are not able to undergo surgery, and some patients with pulmonic stenosis (narrowing of the pulmonic valve).
What Happens During Balloon Valvotomy?
During a balloon valvotomy, a specially designed catheter is inserted into a blood vessel in the groin and guided to the heart. The tip is directed inside the narrowed valve. Once there, a tiny balloon is inflated and deflated several times to widen the valve opening. Once the cardiologist is satisfied the valve has been widened enough, the balloon is removed.
During the procedure, the cardiologist may perform an echocardiogram (ultrasound of the heart) to get a better picture of the valve.
New research-based, non-surgical percutaneous procedures to treat regurgitation (leaky valves) are being tested and may provide additional catheter-based treatment options for valve disease in the future.
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