Heart valve replacement
Heart valves play a key role in the passage of blood through the heart. As the blood flows in one direction only, changing the pressure on both sides of the valve causes it to open at the right time to let blood, and then tightly closed to prevent the backflow of blood. Therefore, without a proper operation of the valves, a full human life becomes impossible.
Today the technological advances in the field of cardiac surgery allow Israel to carry out operations to restore the valve function or replace it without long hospitalization and rehabilitation. In many cases the operation performed without opening the chest.
Israel’s leading experts in the treatment of heart valves are:
Dr. Raphael Hirsch – a specialist in congenital heart disease in adults, Director of the study of congenital heart defects in adults, Beilinson Hospital Division of Cardiology
Professor Ehud Raanani – a specialist in cardiothoracic surgery, Head of Cardiac Surgery Division of. Chaim Sheba Hospital, Tel Hashomer and Assuta Hospital, Ramat-Hahayal
Professor Shmuel Banai – a specialist in cardiology, catheterization, Director of Interventional Cardiology Dpt., Tel Aviv Medical Center (Ichilov)
Dr. Victor Guetta – a specialist in cardiology, catheterization, Deputy director of the Heart Institute and Director of Lab Services, Chaim Sheba Hospital, Tel Hashomer
Heart valves restoration
Human heart has four valves: tricuspid valve, pulmonary valve, mitral valve, aortic valve.
For successful operation of the heart all four valves must function perfectly circulating blood.
If the condition of the valve is only partially broken there is an opportunity that your doctor may prescribe medication without the need for surgery. If the injury is serious you may need surgery to correct or replace the valve.
Correction valve is usually performed when congenital defects and has a good success rate of treatment.
Commissurotomy – a method that is used in the narrowed valve This occurs when thickening and possible bonding of the valve leaflets. When such damage surgeon opens the valve eliminating the adhesion area.
Valvuloplasty – strengthening of the leaflets to its tight closure. Performed using special annular devices that surgeon sets around the outer opening of the valve.
Changing the shape of the valve – if such a procedure is performed resection of the valve leaflets. The surgeon then performs the correct stitching flaps causing the valve to close properly.
Decalcification – removal of calcium accumulation of the doors making the valve to close tight.
Correction tendon chords and papillary muscles – correct chords and muscle length restoration at which the valve closes properly.
Endoprosthesis (replacement) of the heart valves
When severe damage valve needs to be replaced. Most often this operation is used for the treatment of aortic valve and severely damaged mitral valve. It is also used for the treatment of any disease of the heart valves threatening human life. There are situations where more than one damaged valve. Such patients need surgery which combines several replacement valves.
Two kinds of valves are used in modern cardiac surgery:
Mechanical valve. Made of material such as plastic, carbon or metal. Mechanical valves are durable and have a long valid period. But since there is a tendency mechanical valve delay of blood flow and clots, patients with such valves in the future need to take blood-thinning medications (anticoagulants) throughout life.
Biological valve. Made from animal tissue (xenograft) or from human donor heart tissue (allograft). Sometimes valve replacement can be used the patient ‘s own tissue (autograft). Patients with biological valves typically do not need the adoption of drugs blood thinners. Biological valves are not as durable as mechanical, and may need to be replaced every 15 years or so. More rapidly destroyed such valves in children and young adults, so in such cases most often installed mechanical valves.
Type of the valve is determined by the doctor for each patient individually.
Surgical methods arthroplasty (replacement) heart valves:
Open surgery. During such an operation is performed the autopsy of the chest and heart failure. To sustain human life the blood is passed through a heart-lung machine.
Patient enters the hospital on the day before the operation or on the same day. 12 hours before surgery is required not to eat or drink. It is necessary for the safety of anesthesia.
Smoking patients should stop smoking for at least 2 weeks prior to surgery. Smoking before surgery can cause problems with blood clotting and breathing.
Before the surgery is performed preoperative examination which includes: ECG, blood test , urine tests and chest x-ray, consultation by anesthesiologist
The operation can take from 2 to 4 hours and more, depending on the number of valves which must be adjusted or replaced.
After open heart surgery patient remains hospitalized usually about a week. The first three days he spent in intensive care.
Reset after operation of the valve can take a long time, depending on whether the patient had prior to surgery. Surgeon may also prescribe an exercise program or join a cardiac rehabilitation program.
Life after valve replacement
Patients with mechanical valve in the future will need to constantly take anticoagulants. Even if the patient is not taking anticoagulants he still will have to notify the attending dentist and that he underwent surgery to replace the valve, and before any subsequent surgical or dental procedure will need to take an antibiotic. This is due to the fact that during these procedures bacteria can get into the bloodstream. If the bacteria get into the valve, this may lead to bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.
Patients with mechanical valves can also hear a soft click in the chest. This clicking sound is explained by opening and closing the valve. It should not bother, because, in fact, it is a sign that the new valve is working properly.
Minimally invasive surgery for valve replacement
Minimally invasive procedures for correction or replacement of heart valves are made without opening the chest. Instead, small incisions in the chest, rib area. As a result, such operations are less painful and entail minimal blood loss. These operations also require not more than one day of hospitalization.
Minimally invasive surgery is not shown in all patients and can only be determined by the results of the individual examination and investigation.
Transcatheter aortic valve implantation (TAVI) – a minimally invasive procedure for recovery record damaged aortic valve. During such an operation in an artery in the groin and the catheter is moving toward the heart. At the end of the catheter is balon, buyout puffing inside reveals a closed heart valve. The same method is carried out and the valve implantation.
TAVI is performed on a beating heart under general anesthesia and usually does not require cardiopulmonary bypass (heart-lung machine). It is performed by team of cardiac surgeons and anesthesiologists, using X-ray monitoring and echocardiography (ECHO).
This operation is planned. Execution time is determined by the surgeon and the patient together.
In addition, the surgeon must know in advance about all the medicines you are taking, especially on aspirin containing drugs.
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