JAKAYA KIKWETE CARDIAC INSTITUTE (JKCI)

Cardiovascular Surgeries

Our Heart is divided into two upper and two lower chambers. The top two chambers are called the right and left atria. While, the two lower chambers are called the right and left ventricles. As blood leaves each heart chambers, it passes through a valve.

Heart Valves are thin membranes attached to the heart wall, and constantly open and close to regulate blood flow (causing the sound of a heartbeat). Heart valve surgery is done to repair or replace diseased heart valves leading to inadequate blood flow or leaking back of blood into the heart.

There are 4 valves within the heart:

Aortic

Mitral

Tricuspid

Pulmonic Valve

Two are located between the atria and the ventricles. These are called the Tricuspid valve and the Mitral valve. Two valves lie between the ventricles and the major arteries arising from them. These are called the Pulmonic and Aortic valves.

Normal heart valves are made of thin pieces of tissue called leaflets. The valve's leaflets are attached and supported by a ring of tough fibrous tissue known as annulus. The annulus helps to maintain the proper shape of the valve. We can compare valve leaflets to opening and closing of doors, while the annulus functions with the door frame.

The mitral valve is the most common valve to be repaired. The aortic valve is the most common valve to be replaced because it cannot be repaired. The tricuspid valve or the pulmonic valve are rarely repaired or replaced. During repair, the surgeon does trimming, and shapes, or rebuilds one or more of the leaflets of the valve. While during replacement, the surgeon, removes diseased valve and puts a new one in place.

Normal Functioning Of the Heart Valves

Let's take a look at how our heart valves work

Blood flows from our right atrium into our right ventricle through the open tricuspid valve. Simultaneously, blood flows from our left atrium into our left ventricle through the open mitral valve.

When the ventricles are full, the mitral and tricuspid valves close up. This stops blood from flowing backward into the atria whilst the ventricles contract (squeeze).

As the ventricles begin to contract, the aortic and pulmonic valves are forced open. Blood is then pumped out of the right ventricle through the pulmonary artery toward the lungs. At the same time, blood is pumped out of the left ventricle through the aortic valve into the aorta and out to the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves prevent blood from moving back into the ventricles.

As this pattern is repeated over and over, blood circulates continuously across the heart, the lungs and body. The four normally working heart valves make sure that blood always flows freely in a forward direction and that there is no leakage in the backward direction.

Valve Disease

Valve disease occurs when the heart's valves do not work correctly either due to valvular stenosis or valvular insufficiency.

Valvular stenosis is a narrowing of the valve opening that is caused by stiff, inflexible or used leaflets. This limits the forward flow of blood as it is forced through an opening that is smaller than normal. For example, the normal valve opening is about the size of a ring for thumb or larger. In contrast, valve leaflets that are stenotic and causing problems may reduce the opening to the size of a ring for little finger or even smaller.

Valvular insufficiency, also called regurgitation, incompetence, or "leaky valve", occurs when valves do not close tightly. If the valves are not sealed, some of the blood will leak backward across the insufficient valve. This lessens the forward flow of the blood. As a result, the heart muscle is required to work harder to circulate the right amount of blood through the body. Sometime people are born with valvular stenosis and insufficiency (congenital) or acquire them.

Acquired defects are problems that develop with valves that were once normal. They may be caused by rheumatics' heart disease, infection or other changes in the structure of heart valve.

Types Of Valve Surgery

Valve disease can occur in one or more of the four heart valves. Before surgery, the cardiologist performs a careful medical exam and diagnostic tests to help identify the location, type and extent of valve disease. Then, during surgery, the surgeon either repairs or replaces the diseased valve or valves.

Valve Repairs

If a valve is repaired, the surgeon may:

Separate fused valve leaflets.

Sew leaflets that were torn.

Reshape other parts of valve (such as chordae tendineae or papillary muscles)

Reshape or tighten the annulus of valve to provide increased support. This can be done with stitches alone or sturdy ring structure may be sewn to the valve's annulus.

Valve Replacement

If the surgeon decides to replace heart valve, the old valve is removed and a new valve is sewn to the annulus of the old valve. The new valve can be either mechanical or biological. Mechanical valves are made up of totally of mechanical parts. They include the ball and cage, tilting disc, or bileaflet valves.

Biological Valves

(also called tissue or bioprosthetic valves) - are made of tissues. But, they may have some artificial parts to give the valve support and help sew it in place. They can be made from pig tissue (porcine), cow tissue (bovine) or human tissue (homograft).

Aortic Valve Surgery (AVR):

Aortic valve surgery is performed by cardiac surgeons to treat most commonly aortic valve stenosis and aortic valve regurgitation.

During the surgery, aortic valve shall be repaired or replaced. The results of patient's diagnostic investigations, the structure of heart, age, and also the presence of other medical conditions and other factors are considered to decide whether aortic valve repair or replacement is the most suitable treatment approach for patient.

Aortic valve surgery can be performed using either traditional heart valve surgery or minimally invasive technique, depending upon patient's condition.

Traditional Aortic Valve Surgery

During traditional aortic valve surgery, the cardiac surgeon makes a 6- to 8-inch incision down the center of patient's sternum, and part or all of the sternum (breastbone) is divided to provide direct access to the heart. The surgeon then repairs or replaces the diseased heart valve or valves.

Minimally Invasive Aortic Valve Surgery

This is a type of aortic valve repair surgery that is performed through smaller, 2- to 4-inch incisions without opening patient's whole chest. This is usually done with a "J" incision and reduces blood loss, pain, length of hospital stay and also speeds up recovery.

On the basis of the results of diagnostic investigations, the treating doctor determines if the patient is a suitable candidate for this type of surgery.

Mitral Valve Surgery (MVR)

Mitral Valve Surgery is a surgery that is performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of our heart and it has two flaps or leaflets. Earlier surgical intervention of the diseased mitral valve may prevent irreversible damage to the heart.

Mitral valve surgery can be performed using either traditional heart valve surgery or minimally invasive technique, depending upon patient's condition.

During the traditional surgical technique, here also the cardiac surgeon makes a 6- to 8-inch incision down the center of patient's sternum, and part or all of the sternum (breastbone) is divided to provide direct access to the heart. The cardiac surgeon then repairs or replaces the diseased mitral valve.

Whereas, Minimally invasive mitral valve surgery is done through 2-inch to 3-inch-long cut in the right part of chest near the sternum (breastbone). Muscles in the area get divided and this lets the surgeon reach the heart. A small cut is then made in the left side of heart so that the mitral valve can be repaired or replaced.

The surgery cal also be done through robotically-assisted technique. Here, the surgeon utilizes a special computer to control robotic arms at the time of surgery. A 3D view of the mitral valve and the heart at large are displayed on a computer screen in the operating room. This method is very accurate.

Tricuspid Valve Surgery (TVR)

The tricuspid valve that is located on the right side of the heart makes sure blood flows the right way through the heart's chambers from the right atrium down to the right ventricle. The most common forms of tricuspid valve disease are: tricuspid stenosis; and tricuspid regurgitation.

TVR can also be done either through traditional surgical technique with 6 to 8 inches incision in the chest or through Minimally Invasive and Robotically assisted valve surgery technique.

The cardiac surgeon will evaluate patient's overall medical condition, heart's anatomy and function, and the severity and extent of valve disease to determine what technique of surgery would be suitable for the patient.

Double Valve Surgery (DVR)

DVR is performed on patients who have both aortic and mitral valve , or aortic and tricuspid valve disease. The surgical correction of valvular stenosis or regurgitation typically comprises of the repair or replacement of all the affected valves .

Both traditional as well as minimally invasive approach are feasible for this type of valve abnormality correction. Decision regarding the same is taken by treating doctor, based on patient's medical condition, age and results of diagnostic investigations.

Diet and Nutrition after Valve Surgery

Healthy Diet and Nutrition

Apart from exercise, eating healthy shall speed up recovery and healing process. If patient's appetite is poor, try to give him/her smaller but more frequent meals. Depending on his/her condition, the doctor or dietician may put him/her on a special dietary plan. For example, patients with heart failure must follow a low-sodium diet. Diabetic patients are advised to follow a low-fat, low-sugar diet.

Tips to healthy eating

Try eating different varieties of healthy foods.

Select foods low in fat and cholesterol.

Consume less salt or sodium.

Cut down on sugar and sweets.

Eat more carbohydrates (potatoes, rice, pasta, vegetables) and fiber ("roughage").

In place of frying foods, try to bake, boil, or steam when preparing foods.

Vegetable fats: Soybean oil, sunflower oil, Olive oil, sesame oil and corn oil are most suitable.

Consult with doctor or dietician before using salt or salt substitutes.

Patient Testimonials

The smiles on their faces show appreciation after successfully surgeries

Happy kids after successfully surgeries

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