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For the heart to pump normally, the valves must open fully, allowing for forward blood flow, and then close completely, preventing backflow. If these valves leak or don't allow for smooth blood passage, they will cause strain on the heart. Heart valves, each a marvel of nature, sometimes fail to perform their mechanical duties due to certain diseases. In this case, problems with the heart valves are solved with surgical treatment. The valves most frequently requiring repair and yielding the most 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 called the mitral valve. Heart valve disease is most often treated with heart valve replacement surgery. During surgery, the diseased valve is removed, repaired, or replaced with a mechanical or biological valve.
However, not all types of heart valves can be repaired. In valve disease resulting from rheumatic diseases, the thickening and calcification due to increased connective tissue growth in the valve tissue limit the possibility of repair. On the other hand, very successful results are obtained in valve insufficiency caused by reasons such as dilation of the valve annulus or prolapse, elongation, or sagging of a part of the valve. Mitral valve insufficiency can also result from a heart attack. After a heart attack or endocarditis (heart infection), the rupture of one of the chordae tendineae supporting the mitral valve or thinning of the heart wall where it is attached (aneurysm) impairs valve function. In these patients, valve repair is also necessary in addition to coronary bypass surgery.
The targeted durability of valve repairs is 10 years or more. During and after surgery, the structure and function of the heart valves can be evaluated in detail using a transesophageal echocardiography (TEE) device placed in the esophagus. In this process, the experience of the surgeon and their team, as well as the anesthesiologist and cardiologist performing the echocardiographic examination, plays a major role. This allows the success of the surgery to be confirmed before the patient leaves the operating room.
Heart valve prostheses have certain weaknesses compared to the heart's own valves. Mechanical valve prostheses, also known as metal valves, require the use of medications that reduce the blood's clotting ability. If these medications are not used, clot formation on the valve and the possibility of this clot breaking off and disrupting the circulation of some organs exists. For example, disruption of brain circulation can lead to a stroke. Bioprosthetic valves, also known as tissue valves, require medication for a shorter period (3-6 months). However, the weakness of these valves is that they can undergo calcification and degeneration within about 10 years.
Another negative aspect of replacing the mitral or tricuspid valve with a prosthetic valve is the cutting of the muscles and fibers that anchor these valves to the base of the heart. The cutting of these muscles, which facilitate the opening and closing of the heart valve and also play a role in the contraction of the heart, affects the heart's performance. Therefore, if the heart valve can be repaired and is expected to maintain physiological conditions for a long time, it is much better than replacing the valve.
After valve repair, a certain amount of time is needed for the tissue to cover the suture ends in the repaired area of the heart and the ring-shaped prosthesis often placed to support the repair. This period ranges from 3 to 6 months. During this period, anticoagulant medications are used to prevent clot formation from the prosthesis and suture ends. Blood tests should be performed at the frequency determined by the cardiologist, at least once a month, to evaluate the effectiveness of this medication. The use of home devices in recent years to perform INR testing has greatly simplified the regulation of this sensitive medication. After this period, an annual checkup by a cardiologist and echocardiography control will suffice.
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However, not all types of heart valves can be repaired. In valve disease resulting from rheumatic diseases, the thickening and calcification due to increased connective tissue growth in the valve tissue limit the possibility of repair. On the other hand, very successful results are obtained in valve insufficiency caused by reasons such as dilation of the valve annulus or prolapse, elongation, or sagging of a part of the valve. Mitral valve insufficiency can also result from a heart attack. After a heart attack or endocarditis (heart infection), the rupture of one of the chordae tendineae supporting the mitral valve or thinning of the heart wall where it is attached (aneurysm) impairs valve function. In these patients, valve repair is also necessary in addition to coronary bypass surgery.
The targeted durability of valve repairs is 10 years or more. During and after surgery, the structure and function of the heart valves can be evaluated in detail using a transesophageal echocardiography (TEE) device placed in the esophagus. In this process, the experience of the surgeon and their team, as well as the anesthesiologist and cardiologist performing the echocardiographic examination, plays a major role. This allows the success of the surgery to be confirmed before the patient leaves the operating room.
Heart valve prostheses have certain weaknesses compared to the heart's own valves. Mechanical valve prostheses, also known as metal valves, require the use of medications that reduce the blood's clotting ability. If these medications are not used, clot formation on the valve and the possibility of this clot breaking off and disrupting the circulation of some organs exists. For example, disruption of brain circulation can lead to a stroke. Bioprosthetic valves, also known as tissue valves, require medication for a shorter period (3-6 months). However, the weakness of these valves is that they can undergo calcification and degeneration within about 10 years.
Another negative aspect of replacing the mitral or tricuspid valve with a prosthetic valve is the cutting of the muscles and fibers that anchor these valves to the base of the heart. The cutting of these muscles, which facilitate the opening and closing of the heart valve and also play a role in the contraction of the heart, affects the heart's performance. Therefore, if the heart valve can be repaired and is expected to maintain physiological conditions for a long time, it is much better than replacing the valve.
After valve repair, a certain amount of time is needed for the tissue to cover the suture ends in the repaired area of the heart and the ring-shaped prosthesis often placed to support the repair. This period ranges from 3 to 6 months. During this period, anticoagulant medications are used to prevent clot formation from the prosthesis and suture ends. Blood tests should be performed at the frequency determined by the cardiologist, at least once a month, to evaluate the effectiveness of this medication. The use of home devices in recent years to perform INR testing has greatly simplified the regulation of this sensitive medication. After this period, an annual checkup by a cardiologist and echocardiography control will suffice.