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Aortic Valve Disease and Surgery

Aortic valve surgery is a highly specialized aspect of the cardiac surgery practice at Cardiac Vascular and Thoracic Surgery Associates.  We serve patients in Virginia, Maryland and Washington, DC and pride ourselves on the quality of our program and very low rates of complications.

What is the Aortic Valve?

The aortic valve is one of four valves in your heart that act as gates to move blood through your heart. It is comprised of three leaflets that open and close to allow blood to pass, and the root, which attach the valve to the rest of the heart. The aortic valve connects to the large blood vessel called the aorta which starts in the abdomen and runs all the way to the heart. Sometimes, the aortic valve becomes diseased and requires repair or replacement. When that is necessary, a cardiac surgeon performs aortic valve surgery.

aortic valve, function 

What are Diseases of the Aortic Valve?

While disease of the aortic valve can be caused by many things, including syphilis, aortitis, tumors, hypertension, aneurysms and connective tissue disorders of the ascending aorta, the main causes are aortic stenosis and aortic regurgitation.

Aortic stenosis occurs when the valve becomes stiff and can no longer open all the way, which means the proper amount of blood cannot flow through the valve to the heart.

 

Normal v. defective aortic valve 

Aortic Valve Stenosis Occurs in Three Different Ways:

  1. Congenital or calcific - a person is born with an abnormal valve which sometimes creates problems in people in their fifties and sixties. 
  2. Rheumatic - the valve does not function properly because one or more the leaflets in the valve have become too thick.
  3. Degenerative – most often seen in people in their seventies, this is wear and tear of the valve which becomes problematic in some patients.

aortic valve 

Aortic regurgitation occurs when the aortic valve does not close properly, causing it to leak.   Aortic valve regurgitation occurs in four different ways:

  1. Rheumatic – the leaflets of the valve do not fit together properly
  2. Aortoannular ectasia – the root of the aortic valve becomes enlarged, causing the valve to expand so that the leaflets of the valve can no longer pump blood properly. 
  3. Endocarditis – certain types of infection in the body can spread to the heart valves, causing them to fail.
  4. Congenital – a person is born with an abnormal valve which can become problematic as they age.

 Aortic valve regurgitation

What are the Symptoms of Aortic Valve Disease?

  1. Waking up short of breath or coughing
  2. Becoming short of breath when you exert yourself, lie down or are emotionally stressed
  3. Excessive tiredness, with activity or as the day goes on
  4. Dizziness or lightheadedness
  5. Swollen ankles or feet
  6. A fast, pounding or irregular heartbeat
  7. A fluttering feeling in your chest

How is Aortic Valve Disease Diagnosed?

  1. Physical examination. 
  2. Electrocardiogram (EKG or ECG). In this test, electrodes are attached to your chest and the rhythms of your heart are recorded.
  3. Chest x-ray. This x-ray provides your doctor with information about your heart and lungs. It lets the doctor know if you heart is enlarged or if there is fluid in your lungs. 
  4. Echocardiogram. The most commonly used diagnostic tool, an echocardiogram is an ultrasound of your heart that helps define the severity (mild, moderate, or severe) of the problem with your heart valve. 
  5. Cardiac catheterization. An examination of your heart conducted by threading a catheter through a blood vessel in your groin and advancing it to your heart. A cardiac catheterization can be used to assess the condition of your heart and coronary arteries.

Who Needs Aortic Valve Surgery?

Aortic valve replacement is the only effective treatment for severe aortic stenosis and aortic regurgitation in the adult population. At CVTSA, we are proud of our high volume of valve surgery and our clinical outcomes. 

Aortic Valve Repair

While the aortic valve is most often replaced, aortic valve repair may be an option for some patients. Repair can be performed for:

  1. Valve tears/holes can sometimes be patched with tissue.
  2. Enlarged aorta/annuloaortic ectasia can be conducted to replace an abnormally dilated ascending aorta while preserving the valve.

 Arotic valve replacement procedure

Aortic Valve Replacement

There are four types of valves available for aortic valve replacement.

Biological valve  Biological valves (tissue valves) can be made from pig tissue (porcine), pericardial cow tissue (bovine), or pericardial tissue from other species. These valves are easy to insert, generally last fifteen to twenty years and allow patients to avoid lifetime use of anticoagulants (blood thinning medication) such as Coumadin. Stentless tissue valves are porcine tissue valves that have no supporting stents. At CVTSA, the majority of tissue valves being used are stentless. These valves allow the aortic valve surgeon different implantation technique. The flow of blood through the valve is excellent because without a stent a larger effective orifice area may be implanted.

Mechanical valve  These are made completely of mechanical parts, are easy to insert and are durable (generally lasting greater than twenty years), but all patients need to take anticoagulant medication such as Coumadin for the rest of their lives. The disadvantage of a mechanical valve is the risk of developing clots or bleeding problems because of anticoagulation medication.

Homograft  A homograft is an aortic or pulmonic valve that was removed from a donated human heart and is generally ideal for aortic valve replacement when endocarditis (infection) is present.

The Ross Procedure  This procedure is usually performed on younger patients who want to avoid anticoagulant medication. In this procedure, the patient's normal pulmonary valve is used to replace the diseased aortic valve, and the pulmonary valve is then replaced with a pulmonary homograft (prosthetic tissue).

At CVTSA, surgeons have dramatically decreased the use of mechanical valves in the last decade, thus reducing the number of patients who require life-long anticoagulation medications.

mechanical v. tissue_2010

Will I Have a Large Incision?

Depending on the type of surgery, minimally invasive aortic valve surgery is performed through a small incision. The benefits of a small incision include a smaller scar, and may include a reduced risk of infection, less pain and trauma, decreased length of hospital stay, and perhaps even decreased recovery time. Most of the time, patients do require an open chest incision for valve surgery. Your doctor will talk to you about the best option for your medical condition.

What Are the Risks of Aortic Valve Surgery?

While most valve surgeries have excellent outcomes, any major surgery does carry some risk of complications. For valve surgery, these include:

  1. The need for a blood transfusion due to bleeding
  2. Blood clots
  3. Infection
  4. Damage to the heart
  5. Failure of the new valve
  6. Problems with your heart rhythm
  7. Stroke, heart attack or death
  8. Problems with the lungs or kidneys
Subtitles: 
Aortic Insufficiency, Aortic Regurgitation, Aortic Stenosis, Valve Disease-Aortic

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