Professional Documents
Culture Documents
Valve Surgery
Valve Surgery
Valve Surgery
of
Valvular
Heart
Disease
I Nyoman Semadi
Thoracic Cardiovascular devision
Surgery Department School of Medicine Udayana
University
Management of
Valvular Heart
Disease
Asymptomatic
Medical tx
Problem !!
Poor
outcome
Symptomatic
Surgery
Good
outcome
another problem !!
Severity
of the disease
Comorbidity
age
CAD
vitality
etc
Guidelines..
HELP !
The experience
of
the center
What to consider
Risk
-General condition ?
Benefit
-Cardiac condition ?
-Quality of life ?
-Psychological
-Survival ?
condition ?
Primum
-Symptom relieve ? non nocere.. ! -Comorbidities ?
The Patophysiology
of valvular heart disease
Pressure
overload
Mitral
Stenosis
(to LA)
Volume
overload
Aortic
Regurgitation
Mitral
Regurgitation
Aortic
Stenosis
JACC 1984;3:916-23
Mitral Stenosis
Reduce LV preload
Increase LA pressure
Intervention ?
LV dysfunction
Mehta RH
Am J Cardiol 2000;86:1193-7
Supranormal EF
Carabello BA.
J Heart Valve Dis 2000;9:600-99
Aortic Regurgitation
Volume and pressure overload
Increase preload and afterload
therapy
Mild symptoms but progresive haemodynamic
deteoritation
Increase afterload
Decrease preload
Mitral Valve
Surgery
(newer concept)
Restoration of mitral competence
Destruction of mitral
apparatus
maintaining LV
shape & contractility
Significant reduction of EF
Little / no reduction of EF
Sarris GE. J Thorac Cardiovascular Surg 1988;95:969-79
Intervention
stenosis
for Mitral
Surgical intervention
repair (Mitral Valve repair = MVr)
Replacement ( Mitral Valve Replacement = MVR )
Mitral regurgitation
with LA
Mitral regurgitation
Surgery
Indication
MR , asymptomatically: NYHA class 1-
MVR )
Surgical implantation of
the ring
Aortic Regurgitation
Surgery
Indication
a/ symptomatically, severe AR with LV
diameter
EF >30%
Surgical intervention
No calcification of leaflet
Comissurotomy
Moderate Calcification
Debridement : Repair (AVr)
Severe Calcification
Replacement (AVR)
Valve Prostheses
Two Type of Prostheses :
Man made
Boll in cage type( Starr-Edward )
Tilting disc
Bileaflet prostheses
Tissue graft
Homograf (human)
Xenograf (animal) can be expected 8 12
years
Prosthetic Valves
Aortic Stenosis
Aortic Stenosis patients has a good prognosis as long as they
LV dysfunction
good
(Circulation 1995; 92 suppl 9:II-13742)
Valve Replacement is
associated 3,5% operative
mortality over all
thromboembolism
To prevent valve thrombosis and
dysfunction
Summary
In most cases, there is never too late to operate
established
Surgery depend on heart and whole
body condition (indication and
contraindication)
The management of cardiac diseases
by team
General phycision should be referral
cardiac diseases patient to cardiac
centre