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Aortic valve disease aortic insufficiency aortic aneurysm causes of aortic aneurysm symptoms of aortic aneurysm complications of aortic aneurysm diagnosis of aortic aneurysm treatment for aortic aneurysms abdominal aortic aneurysm (AAA) symptoms of abdominal aortic aneurysm diagnosis of abdominal aortic aneurysm treatment for abdominal aortic aneurysm aortic valve regurgitation causes of aortic valve regurgitation symptoms of aortic regurgitation diagnosis of aortic valve regurgitation treatment for aortic regurgitation aortic valve stenosis causes of aortic stenosis symptoms of aortic stenosis diagnosis of aortic stenosis treatment for aortic stenosis aortic valve replacement surgery other heart valve disorders {mitral valve disease mitral valve prolapse mitral valve regurgitation mitral stenosis mitral valve repair and replacement pulmonic valve stenosis tricuspid regurgitation tricuspid stenosis heart valve replacement and repair}

Aortic valve replacement surgery

Aortic valve replacement surgery is an "open heart" procedure performed by cardithoracic surgeons for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve. Replacement of the aortic valve requires open-heart surgery, in which the breast bone (sternum) is split down the middle, allowing access to the heart. The heart is stopped

during critical parts of the operation and a special machine pumps oxygenated blood throughout the body. The diseased valve is removed and a new valve is sewn in.

There are several types of valve replacement operations and the choice of which operation is best for a child is decided through discussions with the parents, the pediatric cardiologist, and the pediatric cardiac surgeon.

Valve replacements alone are not always enough to relieve the narrowing out the ventricle. Sometimes the whole area leading out of the ventricle to the aorta is too small. The supporting structure of the valve, called the valve annulus, may be too narrow even if the leaflets are opened up as far as possible. In these cases the valve replacement is performed with a procedure called a Konno procedure. This involves enlarging the left ventricular outflow tract and the valve ring. It is done through an incision into the outflow tract of the right ventricle and the septum or wall between the right and left ventricles. A patch is placed in this area that enlarges it. The Konno procedure can be done with any type of aortic valve replacement.

Ross procedure: This is one type of valve replacement operation. The surgeon makes an incision down the center of the breastbone. The heart is stopped for a brief period of time while a heart lung bypass machine supports the body.

The coronary arteries are removed from the aortic valve and the diseased aortic valve is removed. The person's own pulmonary valve is then removed from its position in the right ventricular outflow tract and sewn into place as the new aortic valve. The coronary arteries are then reattached to the new valve. A tissue valve, called a homograft or an allograft, is then sewn in the place where the person's own pulmonary valve was removed. This valve is from a human donor and is not live tissue so it will not be rejected by the person's own immune system. It is expected that the tissue valves will need to be replaced in five to ten years but since this is a fairly new procedure the actual frequency of valve replacements is not yet known.

Mechanical valve replacement: When the surgeon performs this operation an incision is made down the center of the breastbone and the heart is stopped for a brief period of time while the body is supported by the heart-lung bypass machine. The coronary arteries are removed from the diseased aortic valve and the valve is removed. A prosthetic valve is then inserted into the aortic valve ring (annulus) and the coronary arteries are reimplanted. The mechanical valve works like a human valve, opening to let blood out of the heart and closing to keep blood from the body from getting back into the heart. It makes a clicking noise when closing that may be heard when the room is quiet or when listening near the chest.

In order to prevent clots from forming on the valve, people with mechanical valves must take a blood thinner called warfarin (Coumadin) for the rest of their lives. Blood tests are done, usually once a month; to make sure that the blood is thinned enough to prevent clots but not so much that the person is at risk for bleeding.

Mechanical valves usually last a long time, potentially for life, without needing to be replaced. A disadvantage is that the person must always take blood thinners. The use of Coumadin during pregnancy is associated with birth defects and early fetal demise, so this may not be the operation of choice for women of childbearing age.

After successful aortic valve replacement, patients can expect to return to their preoperative condition or better. Anticoagulation ("blood thinners") with a drug like Coumadin may be prescribed for 6 weeks to 3 months after surgery for those with biological valves, and for life for those with mechanical valves. Once the wounds have healed, most patients should experience few if any restrictions to activity. A patient will require preventative or prophylactic antibiotics whenever having dental work, and should always tell a doctor about their valve surgery before any surgical procedure.

More information on aortic valve diseases

What is aortic valve disease? - An aortic valve disorder usually does not cause any symptoms in its early stages. Infection on an abnormal aortic valve leads to a disease called infective endocarditis.
What is aortic insufficiency? - Aortic insufficiency is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole.
What is an aortic aneurysm? - An aortic aneurysm is a localized dilatation or aneurysm of the aorta, usually representing an underlying weakness in the wall of the aorta at that location.
What causes an aortic aneurysm? - Most aortic aneurysms occur in the abdominal aorta, the main cause being arteriosclerosis. There is a familial tendency to aortic aneurysms.
What're the symptoms of aortic aneurysm? - Most intact aortic aneurysms do not produce any symptoms. The ballooning of the aneurysm does not cause any symptoms unless it becomes large enough.
What're the complications of aortic aneurysm? - Half of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years. Spontaneous blockage of the aorta can also occur.
How is aortic aneurysm diagnosed? - Aortic aneurysms can be diagnosed from their symptoms. An ultrasound scan is the easiest way to detect an aortic aneurysm.
What's the treatment for aortic aneurysms? - Medical therapy of aortic aneurysms involves strict blood pressure control. Symptomatic aneurysms require surgical treatment to prevent complications.
What's an abdominal aortic aneurysm (AAA)? - An abdominal aortic aneurysm (AAA) is a bulge in the aorta in abdomen. Most AAAs occur in association with advanced atherosclerosis.
What're the symptoms of abdominal aortic aneurysm? - Symptoms of abdominal aortic aneurysm include a pulsing sensation in the abdomen, and pain ranging from mild to severe.
How is abdominal aortic aneurysm diagnosed? - Because abdominal aortic aneurysms may not cause any symptoms at the beginning, they are diagnosed by chance during a physical examination.
What's the treatment for abdominal aortic aneurysm? - Treatment of abdominal aortic aneurysm depends upon the size of the aneurysm. Surgical treatment of abdominal aortic aneurysm is often preformed.
What's aortic valve regurgitation? - Aortic valve regurgitation develops hen the valve leaflets fail to close properly during the heart's relaxation phase.
What causes aortic valve regurgitation? - Causes of aortic valve regurgitation include being born with a defective aortic valve, wear and tear from aging, infection of the lining of the heart.
What're the symptoms of aortic regurgitation? - Symptoms of aortic regurgitation include chest pain, excessive sweating, palpitations, shortness of breath that worsens with exertion or lying down.
How is aortic valve regurgitation diagnosed? - A doctor diagnoses aortic valve regurgitation by hearing a heart murmur or other abnormal noises when listening with a stethoscope.
What're the treatments for aortic regurgitation? - Medicines to improve the pumping action of the heart may be given to reduce the severity of the regurgitation. Valve replacement surgery is usually recommended.
What is aortic stenosis? - Aortic valve stenosis is a heart condition caused by narrowing of the aortic valve. Aortic stenosis is the inability of the aortic valve to open completely.
What causes aortic stenosis? - Congenital aortic stenosis is caused by improper development of the aortic valve in the first 8 weeks of fetal growth. Age related calcification of the valve is the most common cause.
What're the symptoms of aortic stenosis? - Symptoms of aortic stenosis include shortness of breath (dyspnea), passing out (syncope), and chest pain (angina pectoris).
How is aortic stenosis diagnosed? - Aortic stenosis is often diagnosed due to the presence of a heart murmur. The gold standard for diagnosis is an echocardiogram.
What's the treatment for aortic stenosis? - Patients with mild aortic stenosis do not require treatment. Valve replacement surgery is indicated for patients with severe aortic stenosis.
Aortic valve replacement surgery - Aortic valve replacement surgery is an open heart procedure for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve.
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