What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
What Surgical Techniques Are Used For Mitral Valve Repair
Providers use several different techniques for mitral valve repair. Talk with your provider about the techniques you can expect for your surgery.
All mitral valve repairs include an annuloplasty. This means your surgeon places a complete or partial ring around the rim of your valve. The ring may be flexible or rigid. An annuloplasty makes your repair last for a long time.
Triangular or quadrangular resection
This is the technique surgeons use most often for posterior leaflet prolapse. Your posterior leaflet and anterior leaflets are the two flaps that make up your valve.
Your surgeon resects the damaged part of your leaflet and then sews the remaining edges together. Usually, surgeons can make a small, triangular cut to remove the damaged part. But if a larger area of your leaflet is diseased, your surgeon may need to make a rectangular cut to remove a bit more tissue.
Surgeons use this technique to repair anterior leaflet prolapse. It involves replacing some of your chordae , which are the tough, fibrous strings that support your mitral valve. Your surgeon removes the ruptured or elongated chords. Then, they create and attach new chords.
Your surgeon may create new chords out of a tough, synthetic material called Gore-Tex®. Or, your surgeon may take healthy chords from another area and put them in place of the damaged ones. This is called chordal transposition or chordal transfer. Both options provide excellent long-term results.
What Happens Before Heart Valve Surgery
- A healthcare provider will shave and clean the area where your surgeon will be working.
- Dont eat or drink anything after midnight the day of your surgery.
- Check with your healthcare provider about which medications you can take before surgery.
Bring loose, comfortable clothes and shoes that are easy to put on. If you wear a bra, you may want to bring one thats easy to put on without raising your arms. The person who brought you to the hospital can hold on to these items for you during surgery.
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Tips To Improve Your Aortic Health
Your aorta is the main blood vessel that carries blood from your heart to the rest of your body. Its about the size of a garden hose, and its made up of smooth muscle tissue and elastic fibers. Over time, the aorta can become weak and stretch out. This is called aortic aneurysm, and it can cause life-threatening bleeding. You can strengthen your aorta by eating a healthy diet, exercising regularly, and not smoking. You can also talk to your doctor about taking medications to improve your aortic health.
Patient Realities About Open Heart Surgery Recovery Time
In creating this website and writing my book, I decided to find out if I was alone in these thoughts. That said, I ran an extensive survey. I asked hundreds patients about their recovery experience.
As I learned during this research, most heart valve surgery patients surveyed suggested that heart valve surgery recovery was more difficult than expected. The patients surveyed also suggested that their cardiologists and surgeons could have better prepared them for their recovery.
My research suggested that the recovery time from heart surgery has a significant range. When answering the question, How long did it take you to return to work?, some patients stated they felt recovered in 2 to 3 weeks. Others responsed that it took over 15 weeks to recover from heart surgery.
I also wanted to get surgeon feedback. So, at the Heart Valve Summit, I filmed this interview with Dr. David Adams, the Surgeon-in-Chief at Mount Sinai Health System in New York City, New York. It was interesting to hear Dr. Adams research and clinical experience as he has treated thousands of patients during his 20+ year career.
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Types Of Replacement Valves
Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve. Theyre created from carbon and polyester materials that the human body tolerates well. They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. If you receive a mechanical heart valve, youll need to take blood thinners for the rest of your life to reduce your risk of stroke.
Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. There are three types of biologic heart valves:
- An Allograft or homograft is made of tissue taken from a human donors heart.
- A porcine valve is made from pig tissue. This valve can be implanted with or without a frame called a stent.
- A bovine valve is made from cow tissue. It connects to your heart with silicone rubber.
Biologic valves dont increase your risk of developing blood clots. This means you most likely wont need to commit to a lifetime of anti-clotting medication. A bioprosthetic doesnt last as long as a mechanical valve and may require replacement at a future date.
Your doctor will recommend which type of heart valve you get based on:
Tavi For Aortic Stenosis
This minimally invasive procedure is similar to placing a stent inside an artery. A catheter, a thin wire or tube, is threaded through an artery to the diseased valve and a new valve is placed inside the old valve. Some implanted valves are spring-loaded and expand themselves. Others are expanded using a balloon. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the replacement valve takes over the job of regulating blood flow.
The TAVI procedure is performed using one of several approaches, allowing the cardiologist or surgeon to choose the best and safest way to access the valve. The two most common approaches are transfemoral and transapical:
- Transfemoral: enters through the femoral artery , which does not require a surgical incision in the chest, or
- Transapical: uses a minimally invasive surgical approach with a small incision in the chest and enters the heart through the tip of the left ventricle called the apex.
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Will I Need A Pacemaker After Mitral Valve Replacement
Some people do receive mitral valve replacement surgery and need a pacemaker at a later time, but this isnt common. For most people, mitral valve replacement surgery improves their quality of life and eliminates symptoms, such as a racing heart that might be associated with the need for a pacemaker. Talk to your doctor if you are concerned you might need a pacemaker in the future.
What Is Mitral Valve Surgery
Mitral valve surgery repairs or replaces the mitral heart valve. Heart valves control blood flow through the four chambers of the heart. The mitral valve sits between the left atriumor upper chamberand the left ventricleor lower chamber.
Another name for the mitral valve is the bicuspid valve because it has two leafletsor flaps. The flaps open to allow blood to flow forward and close tightly to prevent blood from leaking backwards. When the valve becomes diseased or damaged, it cant regulate this flow properly. Mitral valve surgery can correct this problem.
There are two main types of mitral valve surgery:
- Mitral valve repair fixes a diseased or damaged mitral valve. There are several types of valve repair surgeries, depending on the specific valve problem. Doctors may make the valve open wider , fix holes or tears in a valve , tighten valve openings , or separate, remove or reshape valve tissue .
- Mitral valve replacement removes a diseased or damaged mitral valve and replaces it with a new valve. New valves can either be mechanical or biological. Mechanical valves are man-made and consist of materials such as titanium or carbon. Biologicalor tissuevalves can come from humans or animals, either pigs or cows
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Recovery After Heart Surgery
Although your heart itself is resilient theres not much it cant handle the type of incision used by your HonorHealth heart specialist for your heart surgery will dictate how soon you return to your usual exercise routine.
Even with traditional heart surgery, when the breastbone is broken to repair the heart, you can be exercising strenuously in two to three weeks. Just keep in mind that youre recovering not only from surgery, but also from heart disease.
Types of heart surgeries, from least to most invasive are:
- Transcatheter procedures, such as transcatheter aortic or mitral valve replacement. The cardiologist and a team of specialists thread a catheter through a small incision at the top of your leg or in an artery in your chest, guiding the catheter and the valve inside it to the heart to replace the faulty valve.
- Minimally invasive surgery is another option if you need a heart valve repair. HonorHealth is one of the few health systems in the country to offer this type of surgery to repair a heart valve. The surgery has no age limit heart specialists operate on patients from age 18 to 90 and even older.
Aortic valve surgery involves a two-inch incision between the ribs above the breastbone. Mitral valve surgery involves a two-inch incision between the breastbone and the armpit.
- Traditional open-heart surgery, in which the chest is opened by breaking the breastbone. Recovery from this type of surgery involves time to allow the bones to mend back together.
When Is A Heart Valve Replacement Necessary
A heart valve replacement is necessary when valve repair surgery isnt a treatment option. Valve replacement surgery is most often used to treat people with aortic valve disease, particularly aortic stenosis .
Other conditions that may require a heart valve replacement include:
- Mitral, pulmonary or tricuspid valve stenosis .
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What Happens During An Open Aortic Valve Replacement
Check with your doctor about the details of your procedure. In general, during your open aortic valve replacement:
- You will be given anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards you wont remember it.
- The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
- Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
- The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
- Your surgeon will remove your current heart valve and replace it with a new valve.
- The surgery team will remove the heart-lung machine.
- The team will wire your breastbone back together.
- The team will then sew or staple the incision in your skin back together.
Surgical Options For Valve Replacement Include:
- Mechanical valve a long-lasting valve made of durable materials
- Ross ProcedureBorrowing your healthy valve and moving it into the position of the damaged valve aortic valve and replacing the borrowed valve with a new valve.
- TAVI/TAVR procedureTranscatheter aortic valve implantation/transcatheter aortic valve replacement
The procedure chosen will depend on the valve that needs replacement, the severity of symptoms and the risk of surgery. Some procedures may require long-term medication to guard against blood clots.
*Age is not the only factor in making a decision on treatment. It is critical to talk to your care team to weigh the risks and benefits of each approach and take into account your values and preferences.
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Heart Valve Surgery Without Cracking Open The Chest
May 2, 2022
The man sitting across from me had traveled a long way from Saudi Arabia. He needed heart valve surgery. He could have had traditional surgery at home, but he wanted to know if we could fix his valve without the pain of breaking his breastbone. I told him we could with minimally invasive heart valve surgery.
Unfortunately, way too many people dont know about minimally invasive heart valve surgery. This is, in part, for two reasons: these procedures are fairly uncommon in most centers, so only a few doctors perform them, and they are highly complex surgeries that are only performed at a handful of centers across the country. This approach is so rare that fewer than 1% of aortic valve surgeries worldwide are performed this way, as well as fewer than 20% of mitral valve surgeries.
What Is Heart Valve Repair Or Replacement Surgery
Heart valve repair or replacement surgery is a treatment option for valvular heart disease. When heart valves become damaged or diseased, they may not function properly. Conditions which may cause heart valve dysfunction are valvular stenosis and valvular insufficiency .
When one valve becomes stenotic , the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection or congenital heart defects . If one or more valves become insufficient , blood leaks backwards, which means that less blood is pumped in the proper direction. Based on the childs symptoms and overall condition of their heart, the doctor may decide that the diseased valve needs to be surgically repaired or replaced.
Traditionally, repair or replacement of heart valves has involved open-heart surgery, which means that the chest is opened in the operating room and the heart stopped for a time so that the surgeon may repair or replace the valve. In order to open the chest, the breastbone, or sternum, is cut in half and spread apart. Once the heart is exposed, large tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine . The bypass machine is necessary to pump blood because the heart is stopped and kept still while the surgeon performs the valve repair or replacement procedure.
Other related procedures that may be used to assess the heart include:
Transcatheter Mitral Valve Repair
While the transcatheter mitral valve repair is a newer procedure, the Structural Heart Programs multidisciplinary team of interventional cardiologists and imaging specialists have been performing it for years.
The transcatheter mitral valve repair treats mitral valve regurgitation. With this condition, the mitral valves flaps dont close completely, allowing some blood to flow backward into the heart when the powerful left ventricle squeezes to push oxygenated blood out to the body. The result is strain on the heart and backed up blood that can lead to heart failure.
Our interventional cardiologists thread a thin catheter through blood vessels to the site of the faulty mitral valve and place a clip, MitraClip, on the two leaflets of the mitral valve to help it close completely. While the clip is in place, real-time images show how well its working, and adjustments to the clip can form a tighter fit.
With the clip in place, your interventional cardiologist removes the catheter and tools.
Theres no incision in your chest or need for a heart-lung machine to do the work of your heart. The mitral valve repair procedure takes a few hours, and typically youd be home in one to three days.
Most people experience improvement in their leaky valve-related symptoms a short time after the procedure.
Why Might I Need Heart Valve Repair Or Replacement Surgery
Valve repair or replacement surgery is done to correct the problems causedby one or more diseased heart valves.
If your heart valve becomes damaged or diseased, you may have thefollowing symptoms:
The repaired or replaced valve doesn’t work correctly
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.
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Risks Of Aortic Valve Replacement
After an aortic valve replacement, several complications could occur, although most of these are rare. Some possible complications are:
- infection the new valve can become infected and inflamed , which can damage your heart. You will be given antibiotics to reduce the risk
- clotting this is more likely if you have had mechanical valve replacement. You will be prescribed anticoagulant medication if this is a significant risk
- stroke the supply of blood to the brain becomes blocked
- the valve may wear out or become damaged this is more likely if you are under 60 years old and have had a biological valve replacement
- irregular heart beat this affects 25% of people temporarily, and 12% of people need to have a pacemaker fitted
In some cases, complications can be fatal. Recent data suggest that around 2% of people treated with aortic valve replacement will die in the first 30 days after surgery.
However, the risk of death from surgery is far lower than the risk of death associated with not treating severe aortic disease.