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Valvuloplasty
Heart valve repair is a cardiac surgery procedure, carried out to repair one or more faulty heart valves. In some valvular heart diseases repair where possible is preferable to valve replacement. A mechanical heart valve is a replacement valve that is not itself subject to repair. General Valvuloplasty is the widening of a stenotic valve using a balloon catheter. Types include: * Aortic valvuloplasty in repair of a stenotic aortic valve * Mitral valvuloplasty in the correction of an uncomplicated mitral Valvulotomy Commissurotomy of heart valves is called a valvulotomy. By valve Mitral valve repair ''Mitral valve repair'' is mainly used to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. Aortic valve repair Aortic valve repair is a surgical procedure used to correct some aortic valve disorders as an alternative to aortic valve replacement. Aortic valve repair is performed less often and is more technically difficult than mitral valve repair. There ...
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Aortic Valvuloplasty
Aortic valvuloplasty, also known as balloon aortic valvuloplasty (BAV), is a procedure used to improve blood flow through the aortic valve in conditions that cause aortic stenosis, or narrowing of the aortic valve. It can be performed in various patient populations including fetuses, newborns, children, adults, and pregnant women. The procedure involves using a balloon catheter to dilate the narrowed aortic valve by inflating the balloon. Medical Uses Guidelines and indications are specific to different patient populations. For adults with aortic stenosis, guidelines suggest that balloon aortic valvuloplasty (BAV) is to be used as a temporary procedure to improve blood flow through the aortic valve to alleviate symptoms and stabilize clinically before having more invasive procedures done, including aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). The most common conditions that deem patients too unstable for AVR or TAVI are pulmonary edema and card ...
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Mitral Valvuloplasty
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during diastole. Any decrease in area below 2 cm2 causes mitral stenosis. Early diagnosis of mitral stenosis in pregnancy is very important as the heart cannot tolerate increased cardiac output demand as in the case of exercise and pregnancy. Atrial fibrillation is a common complication of resulting left atrial enlargement, which can lead to systemic thromboembolic complications like stroke. Signs and symptoms Signs and symptoms of mitral stenosis include the following: * Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea (PND) * Palpitations * Chest pain * Hemoptysis * Thromboembolism in later stages when the left atrial volume is increased (i.e., dilation). The latter leads to increase risk of ...
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Cardiac Surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, Rheumatic fever, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation. History 19th century The earliest operations on the pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero (surgeon), Francisco Romero (1801) in the city of Almería (Spain), Dominique Jean Larrey (1810), Henry Dalton (1891), and Daniel Hale Williams (1893). The first surgery on the heart itself was performed by Axel Cappelen on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. Cappelen ligature (medicine), ligated a bleeding coronary circulation, coronary ...
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Aortic Valve Repair
Aortic valve repair or aortic valve reconstruction is the reconstruction of both form and function of a dysfunctional aortic valve. Most frequently it is used for the treatment of aortic regurgitation. It can also become necessary for the treatment of aortic aneurysm, less frequently for congenital aortic stenosis. Background An aortic valve repair will realistically be possible in the absence of calcification or shrinking (retraction) of the aortic valve. Thus, congenital aortic stenosis may be treated by aortic valve repair.Schäfers HJ, et al. Bicuspidization of the unicuspid aortic valve: a new reconstructive approach. Ann Thorac Surg. 2008 Jun;85(6):2012-8. In acquired aortic stenosis valve replacement will be the only realistic option. In most instances, aortic valve repair will be performed for aortic regurgitation (insufficiency). Aortic valve repair may also be performed in the treatment of aortic aneurysm or aortic dissection if either aneurysm or dissection involves ...
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Bentall Procedure
The Bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with re-implantation of the coronary arteries into the graft. This operation is used to treat combined disease of the aortic valve and ascending aorta, including lesions associated with Marfan syndrome. The Bentall procedure was first described in 1968 by Hugh Bentall and Antony De Bono. It is considered a standard for individuals who require aortic root replacement, and the vast majority of individuals who undergo the surgery receive mechanical valves. Alternatives The Bentall operation entails replacement of the aortic valve, aortic root and ascending aorta, but other operations may be used when all three components are not involved. * Normal aortic root: The re-implantation of the coronary arteries is prone to complications, and aortic root replacement should be avoided when possible. The aortic valve and ascending aorta can be repla ...
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Cardiac Surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, Rheumatic fever, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation. History 19th century The earliest operations on the pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero (surgeon), Francisco Romero (1801) in the city of Almería (Spain), Dominique Jean Larrey (1810), Henry Dalton (1891), and Daniel Hale Williams (1893). The first surgery on the heart itself was performed by Axel Cappelen on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. Cappelen ligature (medicine), ligated a bleeding coronary circulation, coronary ...
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In Utero Surgery
Fetal surgery also known as antenatal surgery, prenatal surgery, is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance. Fetal intervention is relatively new. Advancing technologies allow earlier and more accurate diagnosis of diseases and congenital problems in a fetus. Fetal surgery draws principally from the fields of surgery, obstetrics and gynecology, and pediatrics- especially the subspecialties of neonatology (care of newborns, especially high-risk ones), maternal-fetal medicine (care of high-risk pregn ...
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Tricuspid Regurgitation
Tricuspid regurgitation (TR), also called tricuspid insufficiency, is a type of valvular heart disease in which the tricuspid valve of the heart, located between the right atrium and right ventricle, does not close completely when the right ventricle contracts (systole). TR allows the blood to flow backwards from the right ventricle to the right atrium, which increases the volume and pressure of the blood both in the right atrium and the right ventricle, which may increase central venous volume and pressure if the backward flow is sufficiently severe. The causes of TR are divided into ''hereditary'' and ''acquired''; and also ''primary'' and ''secondary''. Primary TR refers to a defect solely in the tricuspid valve, such as infective endocarditis; secondary TR refers to a defect in the valve as a consequence of some other pathology, such as left ventricular failure or pulmonary hypertension. The mechanism of TR is either a dilatation of the base (annulus) of the valve due to righ ...
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Tirone David
Tirone Esperidiao David, (born November 20, 1944) is a Brazilian-born Canadian cardiac surgeon and professor of surgery at the University of Toronto. He is an attending cardiac surgeon at the Peter Munk Cardiac Centre, Toronto General Hospital. He is known for his 2007 development of a valve sparing aortic root replacement procedure to preserve the aortic valve in patients with aortic root aneurysms such as in Marfan syndrome; it is now known as the " David Operation". Early life and education Born in Ribeirão Claro, Brazil, he graduated from the Universidade Federal do Paraná as a medical doctor in 1968. He completed his surgical internship at SUNY Downstate Medical Center and his general surgery residency at Cleveland Clinic in Cleveland. In 1975, he came to Toronto to train in cardiovascular and thoracic surgery at the University of Toronto. Career He joined the academic staff of Toronto General Hospital in July 1978. He was chief of cardiovascular surgery at Toronto Weste ...
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Mitral Valve Repair
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the heart. After the left atrium fills with blood, the mitral valve allows blood to flow from the left atrium into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the left atrium or lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets, known as cusps. The techniques of mitral valve repair include inserting a cloth-covered ring around the valve to bring the leaflets into contact with each other ( annuloplasty), removal of redundant/loose segments of the leaflets (quadrangular resection), and re-suspension of the leaflets with artificia ...
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Hans-Joachim Schäfers
Hans-Joachim Schäfers (born 1957) is a German surgeon, as well as cardiac, thoracic, and vascular surgeon and university professor. He is director of the department of Thoracic and Cardiovascular Surgery at the Saarland University Medical Center in Homburg/Saar, Germany. He is known for his activities in aortic valve repair, aortic surgery, and pulmonary endarterectomy. Biography Hans-Joachim Schäfers went to medical school from 1976 to 1982 at the University of Essen. He received his doctoral title in 1982 magna cum laude. After his military service he started his surgical training at the Hannover Medical School (Medizinische Hochschule Hannover). He added a 1-year clinical fellowship at the Toronto General Hospital, Department of Thoracic Surgery of the University of Toronto to study lung transplantation. In 1991 he was appointed staff surgeon in the Department of Thoracic and Cardiovascular Surgery at the Hannover Medical School. He achieved his habilitation in 1992. In 1 ...
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Aortic Valve Replacement
Aortic valve replacement is a procedure whereby the failing aortic valve of a patient's heart is replaced with an artificial heart valve. The aortic valve may need to be replaced because: * The valve is leaky (aortic insufficiency, also known as aortic regurgitation) * The valve is narrowed and doesn't open fully (aortic stenosis) Current methods for aortic valve replacement include open-heart surgery, termed ''minimally invasive cardiac surgery (MICS)'' or ''surgical aortic valve replacement'' (SAVR) and percutaneous or transcatheter aortic valve replacement (TAVR; also PAVR, PAVI, TAVI). A competent practising cardiologist can evaluate whether a patient could benefit from heart valve repair. History During the late 1940s and early 1950s, the first surgical approaches towards treating aortic valve stenosis had limited success. The first attempts were valvotomies, (i.e. cutting the valve while the heart is pumping). A ball valve prosthesis placed on the descending thoraci ...
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