Ajith Kumar P MPT Cardiopulmonary Sciences
Ajith Kumar P MPT Cardiopulmonary Sciences
Ajith Kumar P MPT Cardiopulmonary Sciences
▪ The mitral valve is affected in more than 90% of cases; the aortic valve is the next
most frequently involved, followed by the tricuspid and then the pulmonary valve.
Isolated mitral stenosis accounts for about 25% of all cases, and an additional 40%
have mixed mitral stenosis and regurgitation
▪ Infection tends to occur at sites of endothelial damage because they attract deposits of
platelets and fibrin that are vulnerable to colonization by blood-borne organisms. The
avascular valve tissue and presence of fibrin and platelet aggregates help to protect
proliferating organisms from host defense mechanisms.
▪ If the affected valve is damaged by tissue distortion, cusp perforation or disruption of
chordae, Valve regurgitation may develop or increase.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861980/
▪ Surgical treatment of valvulopathies started closed mitral
commissurotomy by passing a finger or instrument through the
narrow orifice of the mitral stenosis to dilate or cut it as did Cutler
in 1923 for the first time.
▪ The Hufnagel cage and ball valve was the first artificial valve
introduced in 1952. It was placed in the descending thoracic
aorta to prohibit blood flow reversal in aortic regurgitation.
▪ In 1967 a similarly structured valve, the Edwards cage and ball
valve, had been implanted 1000 times for mitral valve disease.
▪ Surgical techniques improved from early, single valve procedures
to 4-valve replacement in 1992.
▪ Special techniques were introduced, for example, the Ross
procedure replacing the aortic valve with pulmonic valve
autograft.
ref:https://www.statpearls.com/ArticleLibrary/viewarticle/18904
▪ The results of replacement of any
valve are dependent primarily on
(1) The patient’s myocardial function
and general medical condition at
the time of operation.
(2) The technical abilities of the
operative team and the quality of
the postoperative care.
(3) The durability, hemodynamic
characteristics, and
thrombogenicity of the prosthesis.
▪ Increased perioperative mortality is associated with advanced age and
comorbidity (e.g., pulmonary or renal disease, the need for nonvalvular
cardiovascular surgery, diabetes mellitus) as well as with greater levels of
preoperative functional disability and pulmonary hypertension.
▪ Late complications of valve replacement include paravalvular leakage, thrombo-
emboli, bleeding due to anticoagulants, structural deterioration of the prosthesis,
and infective endocarditis.
Bio Prosthesis Artificial Prothesis
1. The primary advantage of bio prostheses 1. All patients who have undergone
over mechanical prostheses is the virtual replacement of any valve with a mechanical
absence of thromboembolic complications 3 prosthesis are at risk of thromboembolic
months after implantation, and except for complications and must be maintained
patients with chronic AF, few such instances permanently on anticoagulants, a treatment
have been associated with their use. that imposes a hazard of hemorrhage.
2. The major disadvantage of bioprosthetic 2. They more durable.
valves is their structural deterioration. 3. Traditionally, a mechanical prosthesis was
3. Bioprostheses were recommended for older considered preferable for a patient younger
(>65 years) patients who did not otherwise than 65 years who could take anticoagulation
have an indication for anticoagulation (e.g.,, reliably.
AF).
Reference: https://www.heart-valve-surgery.com/
▪ For patients being considered for
aortic valve surgery, especially due
to aortic stenosis, transcatheter
aortic valve implantation (TAVI) is
an emerging alternative to surgical
aortic valve replacement.
▪ The native valve is not removed but
is compressed by the new
bioprosthetic valve, which is
implanted within it.
▪ The bioprosthetic valve is mounted
on a large stent-like structure and is
implanted through a catheter
inserted in the femoral artery.
TAVI has several major advantages.
▪ It avoids the need for a sternotomy,
▪ It is associated with a short recovery period,
▪ It can be used in high-risk and
▪ In inoperable patients, and
▪ It is much better tolerated by elderly patients.
▪ Complications includes,
1. Stroke (2%) and
2. Heart block necessitating pacemaker implantation (5–15%)
▪ REF: Davidson’s principles and practice of medicine 23rd edition
▪ Ref : Harrison’s cardiovascular medicine17TH EDITION
▪ ref:https://www.statpearls.com/ArticleLibrary/viewarticle/18904
▪ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861980/
▪ Reference: https://www.heart-valve-surgery.com/