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Heart Valve Surgery

A series of one-way valves within the heart keeps the blood moving smoothly in the right direction. A valve that does not fully close, or that does not fully open, impedes the efficient functioning of the heart. In serious cases this puts the patient at risk for heart failure, arrhythmia, or other issues. Several surgical and interventional procedures are available to correct valve problems, whether through repair or, occasionally, replacement. Depending on the location and what needs to be done, the procedure may be performed using open surgery or minimally invasive approaches.

The right side of the heart takes in oxygen-depleted blood from the rest of the body and sends it to the lungs through the pulmonary valve. The more powerful left side of the heart receives oxygenated blood from the lungs and pumps it out to the rest of the body through the aortic valve. The mitral valve separates the two left heart chambers on the left side, and the tricuspid valve does the same on the right side.

Valve Repair and Reshaping

Temple surgeons can use a variety of tools and methods to repair damaged valves (called leaflets) to help them open and close properly. Holes or tears can be sewn or patched, and the cords or tendons that attach to the valves can be repaired or shortened if necessary. Learn more about tricuspid valve repair and mitral valve repair.

 

Commissurotomy

In this procedure, the surgeon separates valve leaflets (cusps) that have thickened or are fused together, widening the valve opening and allowing more blood to flow through.

Decalcification

Sometimes the mineral calcium accumulates as hard deposits that line blood vessels and heart valves (often the aortic valve); eventually, the build-up may restrict blood flow and valve operation. Surgeons can remove the limited amounts of calcium deposits to reopen the valve or allow it to function more effectively.

Annuloplasty

If the base of the heart’s mitral or tricuspid valve (the annulus) becomes enlarged, dilated or damaged, a surgeon can sew a synthetic ring into the base of the valve to provide additional support. This also allows the valve to seal more tightly, preventing backflow of blood. Annuloplasty can now be done using minimally invasive techniques.

Mitral Valve Repair

Weak or thickened mitral valve leaflets may bulge backward with every heartbeat, letting blood flow backward into the left atrium. To reshape the valve opening so it seals correctly, a surgeon can remove a section of one or more leaflets. An annuloplasty ring may also help strengthen the base of the valve.

Mitral Balloon Valvuloplasty

In some cases of milder mitral stenosis (a narrowed mitral valve), a balloon-tipped catheter can be guided into the heart and the balloon gently inflated to push open the valve and improve blood flow. This minimally invasive procedure is also known as balloon valvotomy.

Repair of Bicuspid Aortic Valve

About 1% to 2% of people are born with two of their three aortic valve leaflets fused together—“bicuspid” means “with two valve tips”. A bicuspid valve often leaks (regurgitation) or doesn’t open all the way (stenosis). This may not cause significant problems, but if it does, a surgeon may be able to separate the leaflets. Otherwise, a valve replacement may be necessary (see below).

Aortic, Mitral, Pulmonary, or Tricuspid Valve Replacement

Severely diseased, narrowed or damaged valves can sometimes be replaced with a new valve—either mechanical or tissue (from pig, cow, or human donor). Different types of valves have different benefits and tradeoffs, which the surgeon will discuss with the patient. Sometimes heart valves can be replaced via minimally invasive procedures.

Ross Switch Procedure

One option for younger patients with severe aortic valve problems may be a Ross procedure: the patient’s aortic valve is removed and replaced with the patient’s own pulmonary valve, which in turn is replaced by a donor pulmonary valve. This procedure may reduce the need for medications and future valve replacements, and may allow the patient to be more active.

Why Temple?

Temple has a strong focus on minimally invasive valve procedures. These methods use smaller incisions and often result in a faster recovery. Patients whose health makes other types of surgery risky have valve repair/replacement options at Temple that may not be available elsewhere: thanks to our extensive cardiac catheterization facilities and skilled interventionist team, we can sometimes repair or replace heart valves using a thin tube (a catheter) threaded through the blood vessels, avoiding traditional surgery.