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Aortic Valve Surgery

Aortric Stenosis

The aortic valve is a heart valve which allows blood to flow out of the heart to the rest of the body, but does not permit it to go backwards. Aortic stenosis refers to the condition where the orifice or opening of the aortic valve is narrowed. This may occur due to many reasons including rheumatic disease, congenital bicuspid valve, or calcium deposits. The normal orifice area of the valve is at least 2-4 square centimeters. When this narrows to less than 1 square centimeter patients may become symptomatic.

Once the valve is significantly diseased usually medicines or catheter based interventions do not help. The majority of the time repair is also not an option. This leaves valve replacement. Although there are currently many choices to replace the aortic valve, the most common two options include a mechanical valve or a tissue valve (please refer to the section entitled Types of valves for replacement). Unlike the CABG procedure, aortic valve surgery requires the use of the heart-lung machine because the surgeon is working inside the heart. The possible complications are similar to CABG plus the new valve may leak and the chances of having a stroke are slightly higher.

Aortic Insufficiency (Regurgitation)

Aortic insufficiency refers to the aortic valve leaking and allowing blood to flow backwards from the aorta into the heart after it has been ejected from the heart. There are many causes of this problem. Some of the causes include rheumatic disease, endocarditis (infection of the valve), connective tissue diseases (weakening of the tissues that make up the support structures within the body), and congenital diseases. Although the aortic valve may rarely be repaired more often it requires replacement. The options for replacement may be viewed in the section Types of valves for replacement and the complications are similar to those of aortic valve replacement in aortic stenosis.

Types of valves used for replacement

There are several categories of valves that may be utilized for cardiac valve replacement. These include mechanical, tissue, cadaveric, and the transplantation of the patients healthy pulmonary valve to replace the diseased valve. The most common types of valves are tissue valves and mechanical valves. Tissue valves are based on animal hearts and surrounding structures. The advantage of tissue valves is that warfarin (coumadin) is not required long term after their placement. The disadvantage is that they eventually wear out. This time period varies from patient to patient, and they tend to last longer in the aortic position than the mitral position. Mechanical valves on the other hand rarely need to be replaced due to detioration. They do require the use of coumadin daily for the entire time they are in place.

Definition

The aorta is the main artery carrying oxygen-rich blood from the heart to the body. After each heartbeat, the valve closes tightly to prevent blood from flowing backwards into the heart. Aortic insufficiency occurs when the aortic valve does not close tightly enough.

There are two types of aortic insufficiency:

  • —symptoms develop rapidly, and in severe cases, immediate surgery may be needed
  • —symptoms develop over the course of many months or years
Aortic Valve Insufficiency
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Causes

Aortic insufficiency can be caused by:

Sometimes the cause of aortic insufficiency is unknown.

Risk Factors

Factors that may increase your chances of aortic insufficiency include:

  • Family history of aortic insufficiency
  • High blood pressure
  • Use of drugs such as weight loss and appetite suppressant medications

Symptoms

Symptoms of aortic insufficiency include:

  • Shortness of breath with activity
  • Exercise intolerance
  • Lightheadedness
  • Chest pain
  • Heart palpitations
  • Irregular heartbeat— arrhythmia
  • Fainting
  • Difficulty breathing when lying flat

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Images may be taken of your heart. This can be done with:

Treatment

Treatment options depend on the severity and history of the valve leakage. It also depends on its effects on the heart’s size and function. Talk with your doctor about the best treatment plan for you.

In chronic and slowly progressive aortic insufficiency, treatment may involve taking medication. Surgery is needed in severe cases.

Depending on your condition, your doctor may schedule routine physical exams and echocardiograms.

Medication

Medications cannot fix the valve, but they can be used to treat aortic insufficiency. Medication used may include:

  • Diuretics—to treat high blood pressure and rid the body of excess fluids
  • Calcium channel blockers—to reduce leaking and, in some cases, delay the need for surgery
  • High blood pressure medications
  • Antibiotics used before dental and surgical procedures to prevent infection

If the condition is rapidly declining, surgery is needed.

Surgery

There are several open heart surgeries that can fix leaking valves. The type chosen will depend on the valve and the knowledge of the surgeon.

Prevention

Aortic insufficiency may not be preventable. If you have a family history, talk with your doctor about screening tests.

References

  • Aortic regurgitation. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113982/Aortic-regurgitation . Updated September 1, 2017. Accessed September 15, 2017.
  • Coarctation of aorta. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116066/Coarctation-of-aorta . Updated June 16, 2017. Accessed September 15, 2017.
  • Congenital heart defects. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/congenital-heart-defects.html. Updated April 2015. Accessed September 15, 2017.
  • Explore congenital heart defects. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/chd. Updated July 1, 2011. Accessed September 15, 2017.
  • Problem: Aortic valve regurgitation. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Aortic-Valve-Regurgitation%5FUCM%5F450611%5FArticle.jsp#.WbvwebKGNxA. Updated September 7, 2017. Accessed September 15, 2017.
 
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