Valve surgery
Heart valves maintain pressure gradients between cardiac chambers to ensure unidirectional flow.
Valve leaflets supported by chordae tendinae + papillary muscles
| Valve | Cusps | Description |
| Aortic | 3 | Semilunar leaflets Attached at annulus Coronary arteries arise from (1) Left = Left posterior sinus (2) Right = Anterior sinus |
| Mitral | 2 | Anterior/Posterior cusps |
| Pulmonary | 3 | |
| Tricuspid | 3 |
| Aortic | Mitral | |
| Stenosis | Rheumatic heart disease Calcification Congenital |
Rheumatic heart disease Calcification of valve/chordae Congenital |
| Regurgitation | Rheumatic heart disease Endocarditis Congenital Inflammatory - SLE, Ank spond Dilation of aortic root - Marfan's, dissection Systemic disease - UC, syphilis |
Rheumatic heart disease Valve prolapse LV dilation Ischaemia / papillary muscle disruption Bacterial endocarditis |
Technique of Aortic Valve replacement
- Transverse incision across valve
- Dissect out / remove diseased valve
- Insert + secure new valve
- Close aorta (full thickness continous sutures)
- Apply tissue glue
- Add pro-coagulant covering
Indications for Mitral Valve replacement
- Severe symptoms (as classified by NYHA functional classification)
- Progressive increase in LV volume leading to ventricular impairment (Ejection fraction, end-diastolic volume)
- Endocarditis
Prosthetic Valves
| Type | Example | Complications |
| Mechanical |
|
Structural Valve failure Prosthetic valve endocarditis Paravalvular leak
Thrombosis / Thromboembolism
|
| Biological |
Autografts
Homografts/Allografts - Removed from cadavers
Xenografts - Prepared from animal tissue
|
