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Double Valve Replacement

The aortic valve replacement is a procedure used to repair or replace the diseased aortic heart valve.

Description

For the heart to function there are four valves, the Aortic,Mitral,tricuspid and the pulmonary valves, these valves are designed to control the flow of blood through the heart, and the opening and closing of the heart valves which produce the sound of the heartbeat.

Replacement of the aortic valve is also known as open-heart surgery, which is done while the patient are under general anaesthesia, and the incision is made through the breast bone (sternum).The tubes are also used to re-route the blood away from the heart to a heart lung machine to keep the blood oxygenated and circulating, when the heart is operated upon.

Medical Facts

Purpose

The four valves which direct blood to and from the body through the heart, the aortic valve, the pulmonic valve,the tricuspid valve, and the mitral valve, these valves may malfunction due to a birth defect,or due to infection disease or trauma. If these malfunctions are severe , and it interferes with the blood flow, then an individual will have heart palpitations, fainting spells/or difficulty in breathing, these symptoms will worsen and cause death unless the damage of the valve is replaced surgically.

If there is an abnormality with the tricuspid valve,then usually they are not replaced because the symptoms are not serious, even if the mitral valves may not need to be replaced as their symptoms are tolerable and they can be treated with drugs, such as beta blockers, or calcium antagonists,which help to slow the heart rate, however if the mitral valve is diseased it should be repaired or replaced, unless otherwise due to the condition of the patient.

To gain access to the heart the surgeon will cut through and separate the breastbone and ribs, after this is done the surgeon places the patient on an cardiopulmonary bypass machine which helps in performing the functions of the heart and lungs during the operation. The surgeon then opens the heart and locates the faculty valve, the surgeon cuts around the edges of the valve to loosen it from the tendons which are connected to the rest of the heart, and then withdraw it. The new valve is then inserted and sutured into place. The patient is then taken off the bypass machine, and the chest is closed. The surgery takes up to 3-5 hours and this type of surgery is usually covered with insurance plans.

The patient spends usually 3 days in the hospital ICU after the heart valve replacement, so that the working of his or her heart and circulation can be monitored closely. After the patient is brought to the ICU an neurological examination is done to make sure he or she has not suffered a stroke. The patient continues to breathe by the help of a tube, which is inserted in the trachea at the time of the surgery, this mechanical ventilation is not withdraw until the patient is fully awake and stable from anaesthesia, and also shows signs that he or she can breathe normally without mechanical support, and has a steadfast circulation.

As soon as the heart is stabilized, the patient is transferred to a standard medical/surgical unit where he or she receive medication which will prevent excess fluid from building up around the heart. The patient begins to walk and exercise gradually to regain strength, and also maintains a low diet and balances the cholesterol level.

Complications:

There are complications, which can arise following the heart valve replacement which are not so common, but at the same time can be serious. All the valves, are made from animal tissue, and these valves in time develop calcium deposits over time. If these deposits,hamper the functions of the valve, the valve must be replaced. The valves may become dislodged. It could be that blood clots form on the surface of the valve, which is substituted,and then break off into the general circulation and become attached in an artery which supplies blood to the brain,kidneys or legs. These blood clots could be serious and make the patient to faint, fall into a stroke , kidney failure or loss of circulation to the legs. These blood clots, can be treated with drugs or surgery.

Description

There are three type of replacement valves. One class is made from animal tissue, known as pig's aortic valve, the other mechanical is made of metal and plastic, the third valve is made up of human valves that have been removed form an organ donor or which rarely, are the patient's own pulmonic valve.

There is no such thing as single replacement valve. The choice between an animal valve and a mechanical valve depends upon the age of the patient, this is because valves obtained from animals with a life expectancy 7-15 years, they usually are given to aged patients. Mechanical valves are used in younger patients because they are more durable,as mechanical valves are made of foreign material,however blood clots can form on their surface, therefore it is important that patient take anticoagulants for the rest of their lives.

Patients who suffer from aortic stenosis,and given donor valves or pulmonic valves, as, otherwise they would deteriorate rapidly due to the narrow passageway between the aorta and the left ventricle. These valves are limited in their use due to the less supply available from donors and the strain that could be caused by removing and transferring a patients own pulmonic valve.

Preparation

Before a patient can undergo surgery for a repair or replacement of a valve , the patient must be evaluated carefully for any kinds of signs that may not tolerate the surgery.

Preoperative tests include:

  • Electrocardiography-which help to assesses the electrical activity of the heart.
  • Electrocardiography- The test is done, to show the extent of the obstruction of blood flow through the heart and determine the degree of loss of the heart functioning due to the malfunction of the valve.
  • Electrocardiography- Which assesses the electrical activity of the heart.
  • Chest X-ray- which provides an overall view of the anatomy of the heart and the lungs
  • Cardiac catheterization-Is also performed,to further asses the valve, and also to determine if a coronary bypass surgery should be done.

After-care

After the patient is discharged from the hospital, the patient continues to go for a daily exercise program, which includes vigorous walking, and he or she may also join an cardiac rehabilitation program. The patient can resume to normal activities within two months.

Risks

Risks could be due to infection of the heart muscle, which can affect up to 2% of patients who have heart valve replacement, such an infection is treated with an intravenous and antibiotics, if the infection persists, then the new valve may have to be replaced.