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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 blood with oxygen in it from the heart to the body. After each heartbeat, the valve closes tightly to stop blood from flowing backwards into the heart. Aortic insufficiency happens when the aortic valve does not close tightly enough.

There are 2 types of aortic insufficiency:

  • Acute—symptoms appear very fast and surgery may be needed right away
  • Chronic—symptoms appear over 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

Things that may raise the risk of aortic insufficiency include:

  • Family history of it
  • High blood pressure
  • Using drugs to reduce feelings of hunger and to lose weight

Symptoms

A person with aortic insufficiency may have:

  • Shortness of breath with activity
  • Trouble working out
  • Light-headedness
  • Chest pain
  • Heart palpitations or irregular heartbeat— arrhythmia
  • Fainting
  • Problems breathing when lying flat

Diagnosis

The doctor will ask about symptoms and medical history. A physical exam will be done.

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

Treatment

The goal of treatment is to stop the leaking. How this is done depends on:

In chronic aortic insufficiency that is slowly getting worse, medicine may be advised. Surgery may be needed if the leak is very bad or the heart is not working well.

The doctor may schedule routine physical exams and echocardiograms.

Medication

Medicines cannot fix the valve, but they can treat aortic insufficiency. The doctor may advise:

  • 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 medicine
  • Antibiotics to take before dental and surgical procedures to prevent infection

If a person is getting worse quickly, 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 doctor doing the surgery.

Prevention

Aortic insufficiency cannot always be prevented. People who have a family history of it should talk to the doctor about having screening tests done.

References

  • Aortic regurgitation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/aortic-regurgitation.
  • Coarctation of aorta. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/coarctation-of-aorta.
  • Congenital heart defects. Kids Health—Nemours Foundation website. Available at: https://kidshealth.org/en/parents/if-heart-defect.html.
  • What are congenital heart defects? National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/congenital-heart-defects.
  • Problem: Aortic valve regurgitation. American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-regurgitation.
 
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