The cardiac surgery

THE VALVULAR SURGERY

- The different types of valvular prostheses
- The valvular surgery of the aorta
- The surgery of the mitral valve
- The surgery of the tricuspid valve

The valvular surgery of the aorta

The aortic valve is replaced when it is narrowed (aortic stenosis) or when it regurgitates (aortic insufficiency).

The operation requires the opening of the thorax, with a section of the sternum (median sternotomy) that permits to reach the heart directly.

This surgery requires the achievement of an extra corporeal circulation.

a - The replacement of the aortic valve

The aorta is cut just above the opening of the right coronary artery.

Aortic valves are excised and the ring of the aorta (basis on which the valves fit) is cleaned and decalcified if necessary.

The size of the aortic ring is then measured in order to choose the prosthesis size.

The valvular prosthesis is fixed with the help of stitches fixed on to the aorta ring and the prosthesis sides. If the calibre of the aortic opening is too small, the surgeon may widen it.

b - Replacing the aortic valve and the ascending part of the aorta

These replacements must be achieved when the initial part of the aorta is dilated and induces the occurrence of an aortic insufficiency. This abnormality is observed in an annulo-aortic ectasia and a surgical treatment is necessary when the diameter of the ascending aorta is superior to 55 or 60 mm, or when the aortic insufficiency induces a dilation of the left ventricle.

When the dilation of the aorta begins precisely at the exit of the heart, the coronary arteries are jeopardized and it is then necessary to change the part of the aorta from which these coronary arteries leave.

This operative technique consisting in replacing simultaneously the aortic valve and the initial part of the aorta with a re-implantation of the coronary arteries is called Bentall’s operation.

Sometimes, the part of the aorta very close to the heart is dilated, and the operation solely consists in replacing the aorta by a Dacron tube, without touching the origin of the coronary arteries.

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File last modified on june 21, 2006