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Chapter 2
•
Cardiovascular Care
Valve Treatments
Valve treatments are used to prevent
HF in patients with valvular stenosis
or insufficiency accompanied by
severe, unmanageable symptoms.
Depending on the patient’s
condition, they may undergo one of
three types of valve surgery. Types of
valve surgery include valvuloplasty
(valvular repair), commissurotomy
(separation of the adherent,
thickened leaflets of the mitral
valve), and valve replacement (with
a mechanical or prosthetic valve).
When valve surgery is not an option,
percutaneous balloon valvuloplasty
is used to enlarge the orifice of
a stenotic heart valve, improving
valvular function.
Although valve surgery carries
a low risk of mortality, it can cause
serious complications. Hemorrhage,
for instance, may result from
unligated vessels, anticoagulant
therapy, or coagulopathy resulting
from cardiopulmonary bypass
during surgery. Stroke may result
from thrombus formation caused by
turbulent blood flow through the
prosthetic valve or from poor cerebral
perfusion during cardiopulmonary
bypass. With valve replacement,
bacterial endocarditis can develop
within days of implantation or
months later. Valve dysfunction or
failure may occur as the prosthetic
device wears out.
Valve Replacement
With valve replacement, the natural heart valve is excised, and a prosthetic
valve is sutured in place.
Prosthetic
tissue valve
Sutures
placed
through
valve’s
rings
Sutures placed
through
valve’s rings
Valve orifice
Sutures
placed around
the annulus to
anchor the
prosthetic
valve
PLACEMENT OF PROSTHETIC VALVE
Prosthetic valve in place
at the completion of
the procedure
Sutures
placed around
the annulus to
anchor the
prosthetic
valve
F I N I S H E D V A L V E R E P L A C E M E N T
Types of Replacement Valves
Replacement valves can be mechanical or tissue.
Bileaflet valve (St. Jude, mechanical)
Tilting-disk valve (Medtronic-Hall, mechanical)
Porcine heterograft valve (Carpentier-Edwards,
tissue)