Heart Valve Repair

Definition

Heart valve repair is a surgical procedure used to correct a malfunctioning heart valve. Repair usually involves separating the valve leaflets (the one-way "doors" of the heart valve which open and close to pump blood through the heart) or forcing them open with a balloon catheter, a technique known as balloon valvuloplasty.

Purpose

To correct damage to the mitral, aortic, pulmonary, or tricuspid heart valves caused by a systemic infection, endocarditis, rheumatic heart disease, a congenital heart defect, or mitral and/or aortic valve disease. Damaged valves may not open properly (stenosis) or they may not close adequately (valve regurgitation, insufficiency, or incompetence).

Precautions

Patients who have a diseased heart valve that is badly scarred or calcified may be better candidates for valve replacement surgery.

Description

Heart valve repair is performed in a hospital setting by a cardiac surgeon. During valve repair surgery, the patient's heart is stopped, and his/her blood is circulated outside of the body through an extracorporeal bypass circuit, also called heart-lung machine or just "the pump." The extracorporeal circuit consists of tubing and medical devices that take over the function of the patient's heart and lungs during the procedure. As blood passes through the circuit, carbon dioxide is removed from the bloodstream and replaced with oxygen. The oxygenated blood is then returned to the body. Other components may also be added to the circuit to filter fluids from the blood or concentrate red blood cells.

In cases of valve disease where the leaflets have become fused together, a procedure known as a valvulotomy is performed. In valvulotomy, the leaflets of the valves are surgically separated, or partially resected, with an incision to increase the size of the valve opening. The surgeon may also make adjustments to the chordae, the cord-like tissue that connects the valve leaflets to the ventricle muscles, to improve valve function.

Another valve repair technique, balloon valvuloplasty, is used in patients with pulmonary, aortic, and mitral valve stenosis to force open the valve. Valvuloplasty is similar to a cardiac angioplasty procedure in that it involves the placement of a balloon-tipped catheter into the heart. Once inserted into the valve, the balloon is inflated and the valve dilates, or opens. Valvuloplasty does not require a bypass circuit.

Preparation

A number of diagnostic tests may be administered prior to valve repair surgery. Magnetic resonance imaging (MRI), echocardiogram, angiogram, and/or scintigram are used to help the surgeon get an accurate picture of the extent of damage to the heart valve and the status of the coronary arteries.

Aftercare

The patient's blood pressure and vital signs will be carefully monitored following a valve repair procedure, and he or she watched closely for signs of edema or congestive heart failure.

Echocardiography or other diagnostic tests are ordered for the patient at some point during or after surgery to evaluate valvular function. A cardiac rehabilitation program may also be recommended to assist the patient in improving exercise tolerance after the procedure.

Risks

As with any invasive surgical procedure, hemorrhage, infarction, stroke, heart attack, and infection are all possible complications of heart valve repair. The overall risks involved with the surgery depend largely on the complexity of the procedure and physical condition of the patient.

Normal results

Ideally, a successful heart valve repair procedure will return heart function to age-appropriate levels. If valvuloplasty is performed, a follow-up valve repair or replacement surgery may be necessary at a later date.

KEY TERMS

Angiogram— An angiogram uses a radiopaque substance, or dye, to make the blood vessels or arteries visible under x ray.

Calcified— Hardened by calcium deposits.

Catheter— A long, thin, flexible tube used in valvuloplasty to widen the valve opening.

Echocardiogram— Ultrasound of the heart; generates a picture of the heart through the use of soundwaves.

Edema— Fluid accumulation in the body.

Scintigram— A nuclear angiogram; a scintigram involves injection of a radioactive substance into the patient's circulatory system. As the substance travels through the body, a special scanning camera takes pictures.

Stenosis— Narrowing of the heart valve opening.

Resources

BOOKS

DeBakey, Michael E., and Antonio Gotto, Jr. The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997.