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For the heart to pump blood effectively, the valves must open fully to allow forward blood flow and then close completely to prevent backflow. If the valves leak or don't allow smooth passage of blood, it leads to increased workload on the heart. These heart valves, each a marvel of nature, can sometimes fail to perform their mechanical duties due to various diseases. In such cases, surgical intervention is required. The most frequently repaired valves, with encouraging results, are those located between the atria and ventricles. The valve between the right atrium and ventricle is called the tricuspid valve, and the one on the left is the mitral valve. Heart valve disease is most commonly treated with valve replacement surgery. During this surgery, the diseased valve is removed, repaired, or replaced with a mechanical or biological valve.
However, not all heart valves are repairable. In valve disease caused by rheumatic diseases, thickening and calcification due to increased connective tissue in the valve tissue limit repair options. Conversely, very successful results are obtained in valve insufficiency due to causes such as dilation of the valve annulus or prolapse, elongation, or sagging of a part of the valve. Mitral valve insufficiency can also occur as a result of a heart attack. A heart attack or endocarditis (heart infection) can cause rupture of one of the chordae tendineae supporting the mitral valve or thinning of the heart wall (aneurysm), impairing valve function. In these patients, valve repair is often necessary in addition to coronary bypass surgery.
The targeted durability of valve repairs is 10 years or more. During and after surgery, the transesophageal echocardiography (TEE) probe placed in the esophagus allows detailed assessment of the structure and function of the heart valves. The expertise of the surgeon and their team, as well as the anesthesiologist and cardiologist performing the echocardiographic examination, plays a crucial role. This allows verification of the success of the surgery before the patient leaves the operating room.
Heart valve prostheses have some weaknesses compared to the heart's native valves. Mechanical valve prostheses, also known as metal valves, require the use of anticoagulant medication to reduce blood clotting. Without these medications, clot formation on the valve and subsequent embolization to other organs is possible. For example, disruption of cerebral blood flow can cause a stroke. Bioprosthetic valves, also known as tissue valves, require anticoagulation for a shorter period (3-6 months). However, a weakness of these valves is that they can undergo calcification and degeneration within about 10 years.
Another drawback of replacing the mitral or tricuspid valve with a prosthetic valve is the severance of the muscles and fibers that anchor the valve to the heart base. Severing these muscles, which facilitate valve opening and closing and play a role in heart contraction, affects heart performance. Therefore, if valve repair is possible and is expected to provide long-term physiological function, it is far superior to valve replacement.
After valve repair, time is needed for tissue coverage of the suture ends in the repaired area of the heart and the ring (annulus) often placed to support the repair. This period is 3 to 6 months. During this time, anticoagulant medications are used to prevent clot formation on the prosthesis and suture lines. Blood tests should be performed at intervals determined by the cardiologist, at least once a month, to monitor the effect of this medication. Recent developments in home monitoring devices for INR testing have greatly simplified the management of this medication. After this period, an annual check-up with a cardiologist and echocardiography are usually sufficient.
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However, not all heart valves are repairable. In valve disease caused by rheumatic diseases, thickening and calcification due to increased connective tissue in the valve tissue limit repair options. Conversely, very successful results are obtained in valve insufficiency due to causes such as dilation of the valve annulus or prolapse, elongation, or sagging of a part of the valve. Mitral valve insufficiency can also occur as a result of a heart attack. A heart attack or endocarditis (heart infection) can cause rupture of one of the chordae tendineae supporting the mitral valve or thinning of the heart wall (aneurysm), impairing valve function. In these patients, valve repair is often necessary in addition to coronary bypass surgery.
The targeted durability of valve repairs is 10 years or more. During and after surgery, the transesophageal echocardiography (TEE) probe placed in the esophagus allows detailed assessment of the structure and function of the heart valves. The expertise of the surgeon and their team, as well as the anesthesiologist and cardiologist performing the echocardiographic examination, plays a crucial role. This allows verification of the success of the surgery before the patient leaves the operating room.
Heart valve prostheses have some weaknesses compared to the heart's native valves. Mechanical valve prostheses, also known as metal valves, require the use of anticoagulant medication to reduce blood clotting. Without these medications, clot formation on the valve and subsequent embolization to other organs is possible. For example, disruption of cerebral blood flow can cause a stroke. Bioprosthetic valves, also known as tissue valves, require anticoagulation for a shorter period (3-6 months). However, a weakness of these valves is that they can undergo calcification and degeneration within about 10 years.
Another drawback of replacing the mitral or tricuspid valve with a prosthetic valve is the severance of the muscles and fibers that anchor the valve to the heart base. Severing these muscles, which facilitate valve opening and closing and play a role in heart contraction, affects heart performance. Therefore, if valve repair is possible and is expected to provide long-term physiological function, it is far superior to valve replacement.
After valve repair, time is needed for tissue coverage of the suture ends in the repaired area of the heart and the ring (annulus) often placed to support the repair. This period is 3 to 6 months. During this time, anticoagulant medications are used to prevent clot formation on the prosthesis and suture lines. Blood tests should be performed at intervals determined by the cardiologist, at least once a month, to monitor the effect of this medication. Recent developments in home monitoring devices for INR testing have greatly simplified the management of this medication. After this period, an annual check-up with a cardiologist and echocardiography are usually sufficient.