After valve replacement surgery. Heart valve replacement surgery and possible indications. Unstented artificial aortic valves

Often, patients develop such pathologies mitral valve which lead to the fact that he loses his ability to perform the functions assigned to him.

If the diagnosis is made too late, there is a need for an operation such as mitral valve replacement.

Reasons for this operation

The tricuspid is located between the right atrium and the right ventricle. The bicuspid is located between the right ventricles and the atria. This bicuspid valve is called the mitral valve.

As a result of certain reasons, physiological and functional changes in the mitral valve occur. This leads to the fact that its valves do not close completely and part of the blood returns.

Or the valves close too tightly, and the blood does not have the opportunity to fully pump into the atria.

All these processes entail heart rhythm disturbances, and subsequently to the development of heart failure.

If the disease is found in early stages its development, experts recommend patients a medical method of treatment. Otherwise, surgery on the mitral valve is indispensable.

Variety of operations

Operations on the mitral valve are divided into several types:

1. Plastic. In one case, the essence of the operation is to replace that part of the organ on which there is a pathology. In the second case, cutting the adhesions that formed on the walls of the MC. Plastic surgery is not aimed at replacing the old organ with a new one, but at preserving the old one.

Plastic has two subspecies:

• valvuloplasty is the process of suturing the valve leaflets. This type of surgical intervention is resorted to if the distance between the valves is too large and part of the blood returns back to the atrium. To stabilize and strengthen the stable distance, a support ring is inserted between them;
• commissurotomy - a procedure for dissecting adhesions that have formed between the valves. As a result, the distance between the halves of the MC on the heart becomes too small to pass the necessary volume of blood from the atrium to the ventricle. This type of operation can be performed without opening the patient's sternum (in a closed way) or with opening chest(open way).
• Prosthetics. The operation to replace the mitral valve is carried out if the old one can no longer be saved. It is much more difficult and dangerous than plastic. The diseased organ is removed and an artificial one is implanted in its place. In some cases, specialists resort to valve transplantation of another person.

In the event that experts believe that the old MC of a person with pathology is no longer subject to treatment, they stop at such a type of treatment as mitral valve replacement surgery.

Classification of prostheses

Valve replacement surgery involves removing the old valve and replacing it with an artificial prosthesis. All prostheses can be divided into several types:

Mechanical. Non-biological materials and mechanical working elements are used for its manufacture. Thanks to this, such an artificial prosthesis is very rare cases rejected by the patient. This type of prosthesis has a long service life. But do not forget that the introduction of mechanical prostheses increases the risk of blood clots several times. Therefore, people with such prostheses have to take medications that interfere with the thrombosis process.

Biological. Distinctive feature Such a prosthesis is that it is made from human or animal tissue, such as pig or cow. The possibility of using some mechanical elements is not excluded. I have been working with biological prostheses for about 9–18 years. After this time, it becomes necessary to re-conduct mitral valve replacement surgery. Patients with a biological valve installed do not need to take anticoagulant drugs.

Allograft. This type of prosthesis is used extremely rarely, but it is characterized by the maximum degree of engraftment. Its peculiarity lies in the fact that it is transplanted from one another person.

When choosing any one type of artificial valves, specialists take into account factors such as the age of the patient, his state of health, the presence of chronic or other diseases, etc.

Recovery period

In most cases, after the introduction of an artificial valve, patients may experience the following symptoms:

• blurred vision;
• fast fatiguability;
• lack of appetite;
• drowsiness;
• irritability;
• edema lower extremities.

Do not despair and panic. These symptoms will last for 2-3 weeks.

After this period, the patient undergoes a period of rehabilitation. The essence of this process is to perform a course of physical exercises aimed at restoring all body functions.

A prerequisite for rehabilitation is diet and a healthy lifestyle.

After the operation was performed, the further condition of the patient depends entirely on himself, on his desire to return to active and healthy life. Be healthy!

The operation, which consists in replacing one or more heart valves with prostheses, is called a heart valve replacement. Such an operation becomes necessary in case of severe, irreversible congenital or acquired changes (malformations) of the heart valves.

These pathologies are characterized by the occurrence against their background of the impossibility of normal operation of the heart valves, as a result of which, when the heart contracts, part of the blood is ejected in the wrong direction or, conversely, passes through the affected valves in insufficient volume, which leads to heart failure.

Depending on the localization of the affected valve, left and right heart failure is distinguished. Defects can be divided into two types:

• valve insufficiency - blood can move in the opposite direction, even when the valve is closed;
• narrowing (stenosis), calcium deposits (calcification), or overgrowth connective tissue(sclerosis) of valves - conditions in which blood cannot pass through the lumen of the valve in a normal volume, even when the valve is open.

Symptoms of heart disease:

• swelling in the legs, abdomen, genitals;
• dizziness and loss of consciousness during exercise;
• difficulty breathing, shortness of breath;
• chest pain;
• feeling of pressure in the chest;
• cardiac arrhythmias.

Types of prosthetic heart valves and their characteristics

Biological prosthetic heart valves are a prosthesis consisting in part of a bovine pericardium or porcine aortic valve, chemically treated to make it biologically inert, and an external stent to secure it in the valve lumen. Require anticoagulants only in the first three months after surgery. They have low durability in comparison with mechanical valves, are least suitable for implantation in the mitral position, as they wear out most quickly. The introduction of such a prosthesis is possible with any surgical technique.

Mechanical prostheses - there are many designs of such prostheses, but the most advanced and used are butterfly valves with a locking element in the form of two symmetrically located semicircular hinged doors. They have a high durability, operate relatively quietly, and when the mitral valve is replaced, the wear rate practically does not change. Mounted only by operation on open heart. They create the need to take anticoagulants throughout life.

Advice: it is worth noting that any valve can be replaced, which has been successfully and has been done for more than a year, this the best option with damage, for example, to the aortic valve, but this is not always the case with respect to the mitral valve. For mitral valve more shown recovery operations that should be taken into account and consult a doctor about the possibility of such.

Operation technique

In modern medicine, operations on the heart valves, as well as many others, can be performed using several different techniques:

open heart surgery- is carried out by introducing the patient into anesthesia, a full longitudinal sternotomy (cut along the sternum), the use of a heart-lung machine and cold cardioplegia (measures aimed at cardiac arrest and minimizing pernicious effect hypoxia on it, by irrigation with chilled saline). Further, depending on which valve needs to be replaced, the corresponding cavity of the heart is opened by a longitudinal incision. After that, the affected valve is removed, and a prosthesis is installed in its place. The dissected wall of the heart is sutured and launched by turning off the heart-lung machine. If necessary, a direct heart massage or electrical impulse is used to start the heart. After the restoration of the work of the heart, the blood that has entered it is removed from the chest cavity, and the surgical wound is closed. To connect the sternum, wire, screws or plates are used, soft tissues connected with seams. This method of carrying out the operation is characterized by high trauma with the resulting significant risks and a long period of rehabilitation.

Endovascular valve replacement- performed under local anesthesia by inserting an endovascular catheter through a vein or artery (depending on which valve is affected) on the thigh.

After the introduction of the catheter into the lumen of the valve, it is destroyed (torn) by a balloon filled with air. After that, a biological prosthesis with a stent is inserted into the valve opening, which opens, fixing the valve. The catheter is then withdrawn from the heart and blood vessels. The endovascular method gives very nice results, is less traumatic, allows you to do without the use of artificial circulation, is applicable for severe concomitant diseases, has a short rehabilitation period, and you can be discharged from the hospital within 2-4 days after the operation. And it is also possible simultaneously with endovascular prosthetics.

Method of mini-access through the apex (apical) of the heart– the prosthesis installation technique is similar to that used in endovascular prosthetics. This method differs from the previous one in that the catheter is inserted into the cavity of the heart through an incision in the chest 2-2.5 cm long and a puncture in the apex of the organ.

Advice: the most expensive of the proposed methods is endovascular prosthetics, but if you have the opportunity, you should agree only to it. The advantage in choosing this technique can be explained by the most positive ratio of efficiency and safety, as well as a very short recovery period and the period of necessary stay in the hospital of a medical institution.

The most common are: surgery to replace the aortic valve, as well as the mitral valve, due to the highest prevalence of their pathology.

It is worth noting that prosthetic heart valves in severe pathology is the last alternative measure.

Video

Attention! The information on the site is provided by experts, but is for informational purposes and cannot be used for self-treatment. Be sure to consult a doctor!

Treatment for heart valve stenosis often depends on the symptoms present in the patient. With such a disease, the valve is replaced with a prosthesis. Regardless of the fact that medical scientists are constantly improving the skill of heart valve transplantation (biological, mechanical), as well as work on the progression of artificial prostheses, while heart valve replacement in the postoperative period can have a number of complications.

Basic moments

The heart valve is an element of the internal heart frame, which represents the folds of the connective tissue. The work of the valves is aimed at delimiting the amount of blood in the ventricles, atria, which allows the chambers to take turns resting after the blood has been expelled during contraction.

If by various reasons the valve does not cope with its function, there is a violation of intracardiac hemodynamics. Therefore, in stages, the heart muscle ages, cardiac inferiority occurs. In addition, blood cannot circulate normally throughout the body, due to a violation of the pumping work of the heart, due to which the blood in the organs stagnates. This applies to the kidneys, liver, brain.

Not treating stagnant manifestations contributes to the development of the disease of all human organs eventually to death. Based on this, valvular pathology is a very dangerous problem that requires cardio surgical operation.

There are the following types of surgical intervention:

• plastic;
• valve replacement.

Plastic consists in restoring the valve on the support ring. Surgery is used for heart valve insufficiency.

Prosthetics involves the complete replacement of the valve. Often replace mitral and aortic heart valve.

When is the operation done?

The operation is prescribed in case of severe damage to the valve with the development of heart disease, which has a significant impact on hemodynamics.

The development of valve defects occurs due to rheumatism. It belongs to one of the forms streptococcal infection and is characterized by damage to the heart and joints. Rheumatism often occurs after frequent illnesses angina, chronic tonsillitis.

Valve replacement occurs based on the degree of heart failure, data provided by echocardioscopy.

The operation is assigned in the following cases:

• aortic valve stenosis, which is represented by symptoms such as fainting, chest pain, shortness of breath;
• clinical manifestation of aortic stenosis in patients who underwent aotro-coronary bypass grafting;
• heart failure of a severe form of development, characterized by shortness of breath with little activity or at rest, severe swelling of the limbs, facial region, body, moderate, pronounced mitral valve stenosis;
• symptoms of heart failure at the initial stage of development - shortness of breath during strong physical exertion, impaired heartbeat in patients with mild mitral valve stenosis;
• endocarditis is one of the factors of valve damage.

Can't do surgery

The operation is contraindicated due to a number of diseases:

• acute myocardial infarction;
• blood flow disorders in the brain acute form(stroke);
• infectious diseases, fever;
• exacerbation and worsening of chronic diseases bronchial asthma, diabetes);
• severe form of heart failure, ejection fraction, which in mitral stenosis is less than 20%.

Stages of prosthetics

The operation is under general anesthesia often with an open mind. Surgery takes an average of 6 hours.

Operation stages.

1. The surgeon makes a large incision in the chest (median stenotomy).
2. The patient is connected to a heart-lung machine.
3. There is a process of cooling the heart, the heartbeat slows down to a minimum.
4. The doctor removes the mitral valve that has been damaged.
5. The implant is installed. The mechanical prosthesis is durable and does not require replacement. It has a drawback - it increases the prothrombin rate in circulatory system contribute to the formation of blood clots. The biological valve must be replaced after 10 - 15 years due to wear.
6. The seams are being adjusted.
7. Gradual disconnection of the patient from the device.

This operation is common in the treatment of cardiac stenosis. If the surgical intervention is successful and the patient recovers without complications, then in the near future the patient will be able to forget about the heart problem.

The only reminder after heart surgery will be a scar.

Recovery postoperative period

After completion of the operation, the patient stays in the intensive care unit. After coming out of anesthesia, the patient is removed breathing tube from the lungs. The tube can be left for a while to get out excess fluid from the lungs.

The day after the operation, the patient can eat solid food. After 2 days, you are allowed to get up and walk. For a while, you may feel pain in your chest. Based on the general condition of the patient, the discharge occurs for 4-5 days.

Possible consequences after valve replacement

Heart surgery is a complex surgical procedure that can lead to complications and cause unexpected problems.

1. Growth of scar tissue.
2. Bleeding after taking anticoagulants.
3. Thromboembolism.
4. Replaced valve infection.
5. hemolytic anemia.

In some patients, a rapid growth of fibrous scar tissue occurs at the site of the prosthesis. This process occurs as a result of a seated biological or transplanted mechanical valve. This complication contributes to the formation of implant thrombosis and requires an urgent reoperation.

Anticoagulants are drugs that thin the blood. They do not make the blood liquid, but do not allow the formation of blood clots, increase the time of blood clotting. Therefore, the work of anticoagulants is aimed at removing the formed blood clot from the valve until it is transformed into a blood clot.

There are cases that when taking anticoagulants in patients, bleeding opens in other organs, often in the stomach. Based on this, patients are advised to control the color of urine and excrement. In the presence of bleeding, the color changes to dark. Experiencing any signs of an unfavorable condition of the stomach, it is worth contacting a specialist.

Serious postoperative complication is thromboembolism, which causes thrombosis. Symptoms of thrombosis include:

• shortness of breath
• dizziness;
• clouding of mind;
• loss of sight, hearing;
• weakness, numbness of the whole body.

If any of the symptoms occur, seek immediate medical attention.

By placing any foreign sterile object in the human body, it may become infected. Therefore, in the case of an increase in temperature, long respiratory diseases you need to visit a doctor. Based on the tests performed, the cause of the corresponding symptoms will be determined. Or an infection of an artificial prosthesis has occurred, or this is another factor.

People with artificial prosthesis when visiting a dentist, undergoing colonoscopy, gastroscopy, angiography, in order to avoid infection of the prosthesis, it is necessary to tell doctors about the presence of an artificial heart valve. In addition, avoid infection of the skin in the presence of wounds, cuts, blisters, abrasions.

Quite rarely occurs hemolytic anemia. With anemia, a person feels weak, fatigue does not go away. Symptoms are very similar when taking anticoagulants, with complications in this case appear and develop differently.

sosudinfo.com

If you are experiencing symptoms of aortic valve stenosis, your doctor will recommend valve replacement surgery, except in conditions where surgery is risky. Symptoms such as chest pain, fainting, and shortness of breath indicate a significant narrowing of the aortic valve. Without valve replacement surgery, life expectancy is greatly reduced. In rare cases, sudden death may occur.

Heart valve replacement surgery is an advanced surgical procedure With a high percentage efficacy and low complication rates.

Aortic valve replacement

Aortic valve replacement surgery is a open type, which can also be performed using the minimally invasive surgery method. During the procedure, the damaged valve is removed and replaced with an artificial one (mechanical or biological)*. There are several types of artificial valves.

In some cases, one of the other heart valves may be used as a prosthetic aortic valve. For this, as a rule, a pulmonary valve is used, located between the right lower chamber of the heart and the opening pulmonary artery. The pulmonary valve is replaced with an artificial one. This type of valve is suitable for people under the age of 25, for whom this complex operation is most acceptable. The pulmonary valve is more durable, grows with the person, and the risk of infectious disease is lower.

Aortic valve replacement surgery can be risky due to conditions such as a weak left ventricle, ischemic disease heart or previous heart attack.

Recently, the expediency of aortic valve replacement in the absence of symptoms of stenosis has been questioned. Despite the lack of research data confirming the effectiveness of this approach, according to some experts, aortic valve repair or replacement surgery should be performed immediately after detection severe symptoms stenosis due to the risk of sudden death.

According to other experts, surgery is necessary only in case of progression of symptoms of stenosis, since the risk of sudden death is lower compared to the risk of surgery. If the operation is delayed, regular examination (including cardiogram) is necessary to monitor changes in the structure of the valve and the work of the heart. These tests will help determine the timing of the operation.

As a rule, in the presence of severe symptoms of stenosis, it will be more risky to postpone the operation than the operation itself. Without aortic valve replacement, most people with severe stenosis die within 2.5 years.

Left ventricular dysfunction and low local ejection fraction limit surgery in people with severe aortic valve stenosis.

However, according to the results of one study, for people who were at risk, aortic valve replacement surgery gave positive results. Valve replacement surgery also poses a risk for people with coronary heart disease and those who have had a heart attack.

Before your valve replacement surgery, your doctor may order a coronary angiogram or a coronary catheterization. This test can show the presence of blockage in the coronary arteries (indicative of coronary artery disease). If the blockage is severe, the doctor may prescribe surgery. bypass surgery at the same time as heart valve replacement surgery.

Other types of aortic valve replacement surgery

A surgical procedure such as balloon valvuloplasty can be the best option for young people with aortic valve stenosis. During the procedure, instead of replacing the heart valve, an expansion of the lumen of the artery is performed.

How is heart valve replacement surgery performed?

Heart valve replacement surgery is an open surgery performed in a hospital operating room. The operation can also be performed using the method of minimally invasive surgery.

Despite the complexity of the prosthetic heart valve procedure, this operation performed quite often. The operation is carried out using the latest technologies, has a high percentage of effectiveness and a low percentage of risk. The operation is performed by a cardiac surgeon - a specialist in the field of heart surgery with many years of experience in performing such operations. The operation also involves a team of nurses, an anesthesiologist, and possibly a resident doctor.

Valve replacement surgery (open heart surgery) has eight steps:

Step 1: Preparing for surgery

Valve replacement surgery requires the same preparations as other major surgeries. You will not be required to eat for 12 hours before surgery to prevent vomiting during anesthesia. You will also need to temporarily stop taking certain medications.

During surgery, you will be connected to heart monitors, including a cardiograph, to monitor heart function and other important vital signs. The nurse will also put you on a drip to give you fluids and necessary medicines. Finally, the nurse will cover the surgical field with sterile drapes and, if necessary, shave your chest to ensure the sterility of the operated area.

During the operation, you will breathe with a respirator - a tube will be placed in your lungs through your throat. The tube may cause discomfort, however most time you will be in a state of anesthesia.

The anesthesiologist will put you in a state general anesthesia, and during the operation you will not see or feel anything. During anesthesia, a transesophageal study of the conduction system of the heart is performed (transesophageal cardiogram, in which an ultrasound device is inserted into the esophagus, which transmits an image of the heart during surgery).

Step 2: Opening the chest

Your doctor will use a marker to mark the location of the incision on your chest. To access the heart, the doctor makes an incision along the chest, from the top of the chest to the navel. The incision passes through the sternum or sternum. Recently, some surgeons have begun to use the minimally invasive surgery method, in which the incision is one-third of the usual incision.

Step 3: Cardiopulmonary bypass

Once your heart is visible, the surgeon will put you on a heart-lung machine, which will perform the function of the heart and lungs during the operation, supplying the body with oxygenated blood. To connect you to a heart-lung machine, the surgeon will insert a tube into your right atrium into which oxygenated blood enters. Instead of going to the lungs to be enriched with oxygen, the blood goes to a heart-lung machine to exchange carbon dioxide for oxygen. Then the blood through the tube returns to the aorta, from which begins big circle circulation.

During the time you are on the heart-lung machine, your aorta will be clamped against the valve to prevent bleeding. To temporarily stop your heart, the surgeon will flush it with cold, salt water or medicine. The surgeon will then dip the heart into the solution to keep it alive during the temporary interruption of the blood supply.

This procedure is a necessary condition for the operation, which allows you to temporarily stop the heart, while your body continues to receive blood enriched with oxygen. The procedure also reduces the risk of serious bleeding (hemorrhage).

Step 4: Removal of the affected valve

Once the heart-lung machine is activated, the surgeon makes an incision in the aorta to remove the aortic valve. The surgeon will examine the aorta and aortic valve to determine the severity of the disease. If the valve is damaged, the surgeon will remove the valve septum. If the aorta is also affected, the surgeon will remove part of the aorta and replace it with a graft.

Step 5: Attaching the new valve

After removing the affected valve, the surgeon special device will measure the size of the valve opening to determine the appropriate size of the prosthetic valve. As a rule, the valve of the maximum allowable large sizes for full blood flow. The surgeon then checks that the size of the valve matches the size of the hole, and then sews the valve.

Step 6: Disconnect from the heart-lung machine

After the new valve is implanted, the surgeon will test its function to identify possible bleeding. The surgeon then sutures the aorta, removes air bubbles from your heart, and restores circulation. Once blood flow to the heart resumes, the heart will begin to beat again. In the event of an irregular heartbeat (fibrillation), the surgeon uses an electric shock to restore a normal heartbeat.

Step 7: Closing the chest

After the heart beat is restored, the surgeon will close your chest by suturing the bones of the sternum (sternum) with heavy-gauge steel wire. The surgeon will then place a stitch to close the incision in the chest. In most cases, a visible surgical scar remains on the chest. The operation lasts an average of 2 to 5 hours.

Step 8: Postoperative Recovery

After the operation, you will be transferred to the intensive care unit. As soon as you come out of anesthesia, the breathing tube will be removed. The tube may be left in place for several days to remove excess fluid from your lungs. You will be able to eat solid food 24 hours after the operation, after 48 hours you will be able to stand up and walk around a bit. Your chest will be sore for a while. Depending on your general condition, you will be discharged from the hospital 4 to 5 days after the operation, but your hospital stay may be extended up to 9 days.

Efficacy of aortic valve replacement surgery

The effectiveness of aortic valve replacement surgery in the treatment of aortic valve stenosis depends on symptomatic picture diseases and a number of other factors:

The following are explanations of how each of these factors affects the outcome of valve replacement surgery.

Heart failure

A narrowed aortic valve causes an excessive increase in pressure within the left ventricle. As a result, cardiac muscle hypertrophy develops due to more intense contractions in an effort to push blood through the narrowed valve opening to meet the body's need for blood. High blood pressure gradually destroys the valve, reducing its throughput, as a result of which heart failure develops. Replacing a narrowed aortic valve with a new one that allows free flow during valve contractions will significantly reduce pressure in the left ventricle.

In the absence of heart failure, valve replacement surgery can prevent serious damage to the heart muscle caused by excessive pressure, and can stop myocardial hypertrophy that develops due to increased stress on the heart in time.

In the presence of heart failure, the success of valve replacement surgery will depend on the causes and severity of the heart failure.

Causes of heart failure

If heart failure consists of left ventricular overload caused solely by aortic valve stenosis, valve replacement in most cases provides relief from the symptoms of heart failure. The effectiveness of the operation depends on the degree of damage to the heart muscle due to prolonged overload of the left ventricle.

If your heart failure is partially or wholly caused by coronary artery disease (CHD) or another condition, valve replacement will also relieve pressure in the left ventricle, but the valve's ability to push blood may not fully recover. In most cases, another condition must be treated to achieve significant improvement in cardiac function. For example, when coronary artery disease operation coronary artery bypass surgery, performed in conjunction with valve replacement surgery, will significantly improve the functioning of the heart. As with heart failure due to aortic valve stenosis, general degree recovery will depend on the degree of damage to the heart.

Long-term heart damage

The degree of damage to the heart is determined mainly by factors affecting the contractility of the heart. Damage to the heart due to aortic valve stenosis develops as a result of an increase in the load on the left ventricle. The ventricle is able to work in this mode long time. Due to the constant overcoming of stress, the walls of the ventricle thicken (hypertrophy), and eventually the ventricle expands (dilation). If the expansion of the ventricle exceeds the limits, the contractility of the heart is impaired. This process underlies heart failure. Heart valve replacement surgery can provide pressure relief in the left ventricle, however, due to excessive dilatation normal work heart may not recover.

A number of other conditions can cause cardiac dysfunction and limit the effectiveness of heart valve replacement. In particular, serious damage to the heart can be caused by a heart attack (myocardial damage) - a blockage in one of the coronary arteries that supplies the heart with oxygenated blood. If a heart attack has damaged the muscles of the left ventricle, valve replacement will not be able to fully restore these muscles.

Other heart conditions

The effectiveness of valve replacement surgery may be reduced due to coronary artery disease and previous heart attack, as mentioned above. For people with aortic valve stenosis, complications such as aortic or mitral regurgitation(violation of the density of the aortic or mitral valve), which can also affect the outcome of the operation, especially if more than one valve needs to be replaced.

Aortic valve replacement surgery is more risky than usual if you have had a heart attack, lung disease, kidney failure or atherosclerosis of the peripheral arteries.

Success rate of aortic valve replacement surgery

The doctor will evaluate the degree of recovery after surgery based on the following basic indicators:

Is it possible to complete cure aortic stenosis after valve replacement?

Even if aortic valve replacement surgery restores the previous functioning of the heart, it will not completely cure the stenosis due to a number of reasons:

Efficiency of balloon valvuloplasty

Balloon valvuloplasty or valvotomy is a procedure in which a thin tube is inserted into the aortic valve and inflated at the end to widen the opening of the valve (aortic valve stenosis).

During the procedure, you will be awake, but you will be given local anesthesia at the site of the catheter and intravenous pain medication and sedation to help you relax. The procedure is usually performed in a hospital outpatient department and you can go home the same day. Before you leave, you will spend several hours in the recovery room.

Valvuloplasty is an effective treatment for aortic valve stenosis in adolescents and young adults, but its effectiveness is limited when applied to older people. Most older people experience re-narrowing of the valve within 6 to 12 months after the procedure.

Valvuloplasty is more effective for people in young age due to differences in the causes of aortic valve stenosis in young people and older people. The cause of stenosis in young people is usually a congenital mitral aortic valve that has two septa instead of three. In older people, stenosis develops over time due to the gradual accumulation of calcium in the valve, a process called aortic sclerosis, similar to atherosclerosis, in which hard plates form inside the arteries.

In certain cases, valvuloplasty may be a transitional step before valve replacement surgery in pregnant women and in people with serious health problems that greatly increase the risk associated with the operation.

Determination of the timing of valve replacement surgery

Currently, experts are investigating ways to predict the progression of aortic valve stenosis based on the results of diagnostic tests. The main task research is the possibility of using such a diagnostic method as an echocardiogram to predict the time when the stenosis reaches the stage at which it will be necessary to perform an operation. In the absence of a reliable method for predicting the development of the disease, the only way out is to wait for the onset of symptoms.

How effective is early surgery?

In most cases, the reason for the operation is an exacerbation of the symptoms of aortic valve stenosis, however, according to some clinical research, there are exceptions. According to experts, for some people the best option would be early holding surgery whether they experience symptoms or not, especially if the risk of sudden death is taken into account. Sudden death in the absence of symptoms is very rare, but the possibility remains.

Is it necessary to perform coronary artery bypass surgery and aortic valve replacement surgery at the same time?

Another reason for discussion is the advisability of performing aortic valve replacement surgery in the absence of symptoms of stenosis in case of need for coronary artery bypass surgery for the treatment of coronary heart disease (CHD). Because coronary artery bypass surgery is an open procedure, most physicians consider it appropriate to perform valve replacement surgery at the same time in people who have severe aortic valve stenosis. Some doctors also recommend performing valve replacement surgery with coronary artery bypass surgery in people with moderate aortic stenosis.

Aortic valve replacement surgery using minimally invasive surgery

During heart surgery, cardiac surgeons also use the method of minimally invasive surgery. In traditional open heart surgery, the surgeon makes a 12-inch incision from the beginning of the sternum to the belly button, then widens the ribs to access the heart (sternotomy).

In minimally invasive surgery, a heart surgeon makes a one-third (less than 4 inches) incision in the sternum of a conventional incision. Since the aortic valve is located near the anterior wall of the sternum, surgeons came to the conclusion that aortic valve replacement surgery could be successfully performed through this small opening.

This procedure is performed using the following techniques:

Other than these variations, the technique for performing aortic valve replacement surgery using minimally invasive surgery is similar to traditional surgery in all other respects.

Performing an operation using a heart-lung machine

One of the techniques in the method of minimally invasive surgery is the use of a heart-lung machine. The machine is usually connected to one of the veins and to an artery in the chest. During several procedures, surgeons examined various ways connection to a heart-lung machine. One way involves using the femoral artery, which is located at the top of the thigh in inguinal region. When using this method, you may experience pain at the point where the tube enters the artery. However, most surgeons connect to a heart-lung machine using the arteries and veins of the sternum.

What are the potential benefits of valve replacement surgery using minimally invasive surgery?

Valve replacement surgery using minimally invasive surgery may be more effective than traditional approach. Benefits may include:

Discussions regarding the benefits of minimally invasive surgery

Specialists continue to study the results of operations performed using the method of minimally invasive surgery in order to determine whether these advantages are merit of this method. While some studies support the effectiveness of the minimally invasive surgical method, other studies have shown little difference between the minimally invasive and traditional methods.

Minimally invasive surgery can be a safe and effective way to perform aortic valve replacement surgery. The initial disadvantage of this method is the complexity of the operation, which also often takes more time. However, the additional time required for the operation, as it turned out, does not affect the outcome of the operation. Finally, the only guaranteed benefit of minimally invasive surgery is less extensive scarring due to a small incision. The present research focuses on other significant potential benefits of minimally invasive surgery.

Should I consider valve replacement surgery using minimally invasive surgery?

Doctors continue to work on improving the technique of minimally invasive surgery. Gaining experience with this technique is likely to shorten the time required for the operation and increase its efficiency. Ask your doctor about the number of valve replacements performed using minimally invasive surgery.

If this method is acceptable to you, your decision to have surgery will be based on your doctor's arguments about the possible benefits and potential risks operations, which in turn should be based on the practical experience of the doctor and medical periodicals. You should also ask your doctor about the results of his minimally invasive surgery, as well as the latest research data.

Your choice of minimally invasive surgery will depend on a number of factors:

The use of minimally invasive surgery is undesirable if valve replacement surgery and coronary artery bypass surgery are required at the same time, since this method does not provide sufficient access to the coronary arteries.

Unstented artificial aortic valves

Complicating the durability of prosthetic valves is the fact that the leaflets of most biological prosthetic heart valves used in the treatment of aortic valve stenosis are fixed on a special stent. The stent is an important part of valve design, but it can also restrict blood flow, particularly in people who require smaller valves.

To overcome this problem, the researchers developed a type of porcine tissue valve without the use of a stent. The valve is attached to a portion of the aorta (aortic root).

The valve is chemically treated to protect the valve and maintain tissue strength. To strengthen the valve, its part is fixed with a polyester rim.

Of all the varieties of artificial valves, non-stented biological prosthetic valves are the most similar to natural heart valves. The exclusion of the stent suggests an improvement in blood flow. To prolong the life of non-stented heart valves, the valve tissue is specially processed.

At the moment, the study of non-stented heart valves is being carried out in order to determine the disadvantages and advantages of this type of valve.

Benefits of Unstented heart valves

The main advantage of non-stented heart valves is the wider orifice, allowing for freer blood flow, as is the case with a normal, healthy valve. improved throughput valve reduces the pressure inside the left ventricle.

Service life of unstented heart valves

Unstented heart valves have not been in use long enough to determine their effectiveness after 10 to 15 years. Because longevity is an important property of artificial valves, non-stented heart valves are likely to remain an area of ​​active development until researchers can explore their maximum lifespan.

www.eurolab.ua

When one or more valves of the heart muscle malfunction, serious violations blood supply, namely the heart begins to pump blood in an enhanced mode. It is necessary to ensure circulation the right amount blood in the body. This condition can be triggered by the development of valvular stenosis or valvular insufficiency.

If no action is taken to timely treatment, this pathology can cause a significant deterioration in well-being, and even become a real threat to the life of the patient. To get rid of the disease, repair or surgical replacement of the heart valve is performed. This allows the heart muscle to work normally and the patient returns to his usual way of life.

Replacing a damaged valve

During the surgical operation, the doctor removes the damaged one and installs a mechanical or biological valve, which is sewn to the "native" valve ring. You need to know that any such replacement is biocompatible, so rejection immune system the implant does not occur.

Surgical replacement is almost always performed when valve repair is no longer possible. The aortic valve is often replaced, although in some cases it can be successfully repaired. In any case, you will discuss all treatment options in detail with your doctor and choose the one that you need.

Need to know what important aspect in the matter of replacement, is the constant intake of anticoagulants or blood thinners. These are drugs that delay blood clotting. Their use minimizes the formation of blood clots on the replaced valves, which significantly reduces the risk of possible development heart attacks and strokes.

The most commonly used drugs include, for example, Warfarin (Coumadin). The choice of the drug you need depends on the replacement method used.

In addition, all patients taking these drugs need to have regular blood tests. Based on its results, the doctor will determine the indicator of the so-called "prothrombin time". This indicator is necessary to analyze the body's response to the medication being taken and to determine the desired dosage.

Implants that can replace natural, natural valves vary. Let's look at them in more detail:

biological transplants

They are also called "tissue", "bioprostheses". They are made from the living tissue of an animal, most often a cow or a pig. They can also be made from human tissue. These include an allograft or a homograft. However, they may also contain artificial components that provide support and placement.

In most cases, patients with an implanted biological valve do not need lifelong anticoagulant therapy.

Allografts

This is a natural valve that was taken from a donor after his death. It is frozen in special conditions, and then transplanted to the recipient. These grafts are used to replace a damaged aortic or pulmonary valve. They take root very well and are tolerated by patients, since allograft tissues are closest in nature to the patient's own tissues. Most patients who have received an allograft do not need regular and permanent reception anticoagulants.

Mechanical valves

These devices are made of completely mechanical elements, which are designed for many years of full-fledged work. The material from which they are made is well tolerated by the body. Usually they are made of metal or carbon.

Most often they replace the bicuspid valve. The implant consists of two carbon flaps in a ring, which is covered with a polyester fabric.

The installation of a mechanical valve implies the constant taking of anticoagulants by patients.

In some cases, patients implanted with a mechanical valve notice that it sometimes clicks. This is the sound of doors opening and closing.

Recovery period

After a heart valve replacement, the patient goes through a recovery period, which takes an average of 2-3 months. After about six months, a person can resume driving a car. In general, all instructions and advice on lifestyle during the recovery period will be given to you by your doctor. He will tell you how to care for the part of the body where the operation was performed. The doctor will explain the general points of maintaining health, give advice and recommendations hygiene procedures in postoperative period.

For example, to keep the cardiovascular system in good shape, you should take the recommended drugs. In addition, you must categorically give up smoking and lower your blood cholesterol levels. It is useful to do physical exercise regularly, maintain normal, healthy weight eat good quality and healthy food.

In addition, you will have to regularly attend consultations and be examined by a cardiologist. Diagnosis, such as an echocardiogram, will need to be repeated at regular intervals. Be healthy!

Svetlana, www.rasteniya-lecarstvennie.ru
Google

www.rasteniya-drugsvennie.ru

Heart valve replacement

The first valve implantation operations began in 1970. To replace the human, valves taken from the heart of pigs were used. They can also be called bioprostheses.

The use of porcine heart valves made it possible not to use medications that affect blood clotting (anticoagulants), since there were practically no blood clots after the operation. Due to the great similarity with the human heart, pig implants grow very quickly. True, these bioprostheses also have a drawback - a limited service life. They wear out within 7-10 years, but despite this, they are widely used today.

For plastics, other organic means are used. It is possible to transplant a human valve, but due to the lack of donors, such cases are very few.

If for some reason the above methods are not suitable for the patient, then it is possible that autoplasty is used. In this case, the patient's tissue is transplanted, from which the valve is created.

Mechanical prostheses have also been created. The service life of such implants is much longer than organic ones, but their use requires mandatory intake of anticoagulants.

This valve is made from special kind steel and a plastic or ceramic ball is placed inside. The material of the implant is stronger than natural, because of this, during its operation, a characteristic, audible sound is emitted. As long as the sound is present, the valve is working well, and this indicates that it is working.

Operation

This procedure is performed under general anesthesia. The patient is connected to a heart-lung machine. It provides artificial blood circulation and oxygen supply to the body, removes carbon dioxide from blood.

Next, the pericardial sac and the heart itself are opened. For manipulations, the work of the heart is stopped. The defective valve is then removed and implanted. When the heart is ready to function again, an electrical impulse is sent, which starts its work.

Such an operation, according to doctors, is already a standard procedure. In large cardiac surgery centers and hospitals, several such operations can be performed per day. Thanks to modern methods, the procedure has a high level of safety. The threat can occur only if the heart had a large degree of damage before it began.

If there are concomitant diseases, then intervention is not always possible. So, surgical replacement of the aortic valve is contraindicated if there is any other heart disease or there is thickening and calcification of the aortic walls. In such cases, resort to other methods of treatment.

Life after surgery

Heart valve replacement obliges a person to change the preoperative lifestyle. Most people feel better after surgery. This is because normal heart function resumes. Within a few months, patients feel practically healthy. To restore the body after such cardiac surgery, a special physical education program and diet are indicated.

The first month and a half, during the rehabilitation period, some individual manifestations may be observed. Some patients develop high spirits, others may experience a depressive state that lasts for several days, less often weeks. May occur short-term disturbances on the part of vision, loss of appetite, sleep disturbance, swelling of the lower extremities. All this will normalize after a while.

You need to visit your doctor regularly for a checkup. The first visit occurs 3-4 weeks after discharge. In addition to the examination, you need to donate blood and urine, do echocardiography and x-rays of the chest. Based on the results of the examination and the course of the recovery period, a further schedule of visits to the doctor is determined. If there are no complications after rehabilitation and general well-being is normal, then trips to the cardiologist are reduced to once a year.

After a heart valve replacement, drugs may be prescribed for permanent or temporary use. It is strictly forbidden to change their dosage or stop taking them on your own. also in without fail tell other doctors about it surgical intervention before any procedure.

People who have been given a biological valve are prohibited from using drugs and foods rich in calcium. This is necessary to extend its life.

Life after heart surgery valve replacement Why does the heart press

Indicated for malformations leading to the appearance of heart failure or stenosis.

The work of the heart can be disrupted due to rupture, narrowing, scarring, or hardening of the heart valve (or several). Due to the fact that the heart valve is damaged and does not close completely, part of the blood instead of the aorta flows back into the ventricle. The load on the heart increases.

First, the myocardium (or heart muscle) significantly increases its parameters, gradually developing heart failure. Myocardium weakens and create normal course he can no longer bleed. This situation requires a valve replacement in the heart, otherwise a fatal outcome is possible.

Today, heart valve surgery can be done in many clinics in our country. The magnitude of the defect and its degree, the age of the patient determine the choice of one or another "spare part".

Heart valve replacement

The beginning of the era of prosthetic heart valves dates back to 1970. During the very first manipulations, the human heart valve was replaced with valves borrowed from pigs. They are also called bioprostheses. After such measures, blood clots very rarely occurred, which made it possible not to resort to the use of anticoagulants (drugs that affect blood clotting). But later it became clear that the service life of such "details" is not long (on average 7-10 years).

Then they decided to create something more perfect, which was what mechanical prostheses were. Their shelf life is much longer, but it is necessary to take medicines that affect blood clotting.

Over the past decades, many types of valves have been developed: biological, disk-mechanical, simply mechanical, ball-mechanical. Spare "shutters" of the heart are made of a special type of steel, in which a plastic or ceramic ball (plate) is placed inside.

Back to index

The principle of operation of implants

The valves open under the action of the surging blood, while the plate or ball rises up. After the ejection of blood by the ventricles and atria, it is “absorbed” new blood, the valve closes. The material of artificially made prostheses is durable. Therefore, when they work (closing-opening), a characteristic, well-audible sound is emitted. This is a signal that the valve is working and working properly. Despite the ever-increasing duration of the life of prostheses, it still has limits. Implantation of prostheses is more often performed in elderly people and if it is not possible to perform valve plastic surgery.

If you stop hearing the characteristic sound from an artificial (implanted) heart valve, the patient should be immediately sent to the hospital. You need to tell the doctor about the threat hanging over the patient's life.

Back to index

Valve repair on the heart

The plasticity of heart valves involves the use of organic products. Pig heart valves are widely used because they are more similar to the human heart and grow rapidly. In some situations, "parts" borrowed from other people are transplanted. However, such cases are rare, because. there are not enough donors.

When none of these methods can be applied to the patient, then autoplasty is performed - the patient's own tissue is transplanted, from which the valve is created.

Back to index

Valve replacement heart surgery

This procedure is performed under general anesthesia, after which the patient is connected to the heart-lung unit.

Due to the latter, oxygen is supplied, excess carbon dioxide is removed from the blood, and blood is pumped through the circles (small and large) of the blood circulation.

Then the pericardial sac and the heart itself are opened. During the procedure, the heart is stopped. First of all, the valve that has become unusable is removed, then an artificial one is implanted.

After the heart is ready to perform its duties, it is “switched on” by sending an electrical impulse.

Back to index

Danger of heart valve replacement procedure

Today, the implantation of an artificial heart valve is already a standard procedure. In some large-scale cardiac surgery centers and hospitals, several such operations are performed in one day. The operation is safe due to the improvement of the technique. The threat appears when the heart has a large degree of damage even before the start of the operation.

Back to index

Lifestyle of the operated

The postoperative period forces the patient to reconsider his entire previous lifestyle. Most patients who have undergone such cardiac surgery experience an improvement in well-being, which usually occurs as a result of gradually (over several weeks) leveling of the symptoms observed before the operation. of cardio-vascular system. The peak of favorable changes is observed in many patients after a few months after the procedure.

For rehabilitation purposes, patients are shown a program exercise and adhering to a special dietary regimen. Someone in the postoperative period will have a euphoric and high spirits. Or, conversely, visit depressive states lasting several days (or weeks). There are also short-term visual disturbances (due to swelling of the eye structures), appetite worsens (up to 1 month), disordered sleep (several weeks), swelling of the lower extremities (lasts for weeks). These phenomena are quite justified, and they pass.

It is important to understand that valve surgery does not cure completely. existing pathology hearts. It only restores the function of the damaged valve. Therefore, patients should not forget to adhere to healthy conditions life and be examined in a timely manner during dispensary observation.

The first visit to the outpatient clinic is carried out after 3-4 weeks after the patient is discharged home. In addition to a physical examination, the patient donates blood (with a coagulogram) and urine, undergoes an ECG, x-ray, echocardiography, chest x-ray. The frequency of visits to the doctor in the future is determined individually and is associated with the absence / presence of consequences, the severity of changes in the valve apparatus, the efficiency of the left ventricle, the development concomitant pathology(for example, pulmonary hypertension or heart failure), the presence of other pathologies of other internal systems and organs.

Satisfactory general health of the patient and the absence of complications gives reason to visit a cardiologist only once a year. If there are any sudden changes in the state as a whole, then the graph of it dynamic inspections is subject to correction. Then the patient is shown frequent examinations, planned according to the results of individual needs.

In the postoperative period, the patient must take a course of medicines prescribed by the doctor, following the recommendations received.

It is strictly forbidden to stop using medications or change their dosage at your own discretion. The performed surgical intervention on the heart valves must be made known to the dentist and other doctors accepting the patient. This is required because any invasive procedure to which tooth brushing, provides for the administration of antibacterial drugs in order to exclude the situation of bacteria settling on the implant, penetrating through the bloodstream, and against the occurrence of endocarditis after this.

Those patients who have had a biological (or tissue) valve installed on the heart are prohibited from taking large doses preparations containing calcium and products in which the latter is included in their composition. This is due to the fact that not to reduce the life of the implant.

If the operated person begins to complain (discomfort in the region of the heart, pain, swelling, etc.), then he should immediately consult a doctor.

A comprehensive examination is carried out in order to determine possible risks and negative factors which may affect the outcome of the operation. Frequent fainting, difficulty breathing and sharp pain in the chest, which is regular, may indicate the need for prosthetic heart valves.

It should be noted that timely aortic valve replacement can significantly prolong the patient's life, while saving him from the severe daily consequences of a protracted disease. modern medicine is able to effectively deal with possible complications, and the effectiveness of the operation makes it a good alternative to just waiting.

The essence of the operation and indications for the intervention of a cardiac surgeon

Aortic valve replacement is an open operation. It can be carried out by several methods of minimally invasive surgery. The main task facing the surgeon is to remove the diseased valve and replace it with a previously agreed mechanical or biological one. Indications for surgery are to evaluate the ejection fraction, if it is less than 55% - this becomes an indication for surgery.

In addition, diastolic and systolic diameters are taken into account, which, when diameters reach 75 mm and 55 mm, respectively, are also factors that determine indications for surgery. Unexpected occurrence of an acute form aortic insufficiency are also indications for heart valve replacement.

Specialists divide patients into those who have asymptomatic and chronic form diseases. Moreover, even with an asymptomatic form, if there is a decrease in tolerance with an increase in physical activity, there may also be indications for heart valve replacement.

The exile fraction is a rather complex parameter, the value of which is influenced by a large number of factors. In this regard, it is believed that this value is not absolutely predictable, and, accordingly, can be excluded by careful consideration of the medical history by the attending physician.

It is not worth delaying the operation with an understandable clinical picture. Irreversible myocardial damage begins to develop as a result of apoptosis.

Types of prostheses

There are several varieties of artificial valves. Sometimes another patient's heart valve is used as a prosthetic aortic valve. The most common pulmonary valve is located between the right lower chamber of the heart and the opening of the pulmonary artery.

This option is used in surgical intervention for patients under 25 years of age, for whom this complex operation is most acceptable. The pulmonary valve is very durable, its advantage is that it grows with the person. Survival is more effective, as the risk of infection is lower.

Complications

Sad statistics say that more than 50% of patients who use drug treatment, will die within a year, while the operation on the left ventricular valve can significantly prolong the life of the patient.

The protracted postoperative period can last up to three years. The duration of the signs of ventricular dysfunction affects the restoration of the heart's working capacity even after a complex operation.

Complications and risk factors include:

• weakness of the left ventricle;
• cardiac ischemia;
• previous heart attacks;
• exhaustion of the patient's body;
• low regenerative capacity.

In this regard, many experts agree that mitral valve replacement should be carried out only in cases of emergency and in the presence of favorable conditions that will increase the effectiveness of the measures taken. Deep calcification, mitral valve insufficiency, leaflet fibrosis can effectively overcome mitral valve replacement.

The operation is carried out with the “turning off” of the patient’s heart and the use of a heart-lung machine. Wherein diseased heart is excluded from the circulatory system, and the surgeon gains access to the site of the operation. It is most effective to perform mitral valve prosthetics on a hypothermic heart (compression as a result of slight exposure to low temperatures).

After fixing the place around the circumference of the fibrous ring with U-shaped sutures, the mitral valve is replaced in an anatomically correct position. All air is sucked from the heart chambers, all surgical incisions are sutured, and the patient begins to gradually disconnect from the artificial circulation system.

Aortic valve replacement is carried out in the same sequence, only when using a different type of valves. Sometimes, a situation may arise that requires the simultaneous replacement of several valves at once (aortic and mitral or tricuspid).

As already mentioned, the postoperative period can be up to three years. The first examination of the patient after the operation is carried out with a good clinical picture in six months. Recovery sinus rhythm, for example when atrial fibrillation, or if a very dangerous postoperative disease is detected - infective prosthetic endocarditis, increased physical activity may be prescribed. Their goal is to increase the size of the heart, increase the pumping of more blood to stabilize the condition and reduce the impact of infections.

Even with a long postoperative period, the presence of additional risks, people with acute stenosis without this operation die within 2-5 years. The main thing that stops doctors after a long examination of the patient’s condition is existing risk sudden death. stable state or preparation for surgery may result in a delay. Mitral valve replacement is performed after a thorough study of changes in the behavior of the heart, the structure and functioning of organs.

In cardiac surgery, the onset of severe symptoms is usually more dangerous state for the patient than the risks of surgery. Prosthetic heart valves are complicated by a number of diseases that affect the standing of the heart tissue, valve function, or the general condition of the patient.

The doctor prescribes a set of tests to exclude coronary heart disease, the negative impact of strokes, heart attacks. Coronogram and coronary catheterization reveals possible blockage of the arteries. More serious cases may require multiple treatments or reconstructive surgeries, including coronary bypass surgery.

Other types of operations

Valvuloplasty is most often used in the operation of young people who are more stamina. This option involves the expansion of the lumen of the artery of the native valve, without the use of artificial prostheses.

Prosthetic heart valves are performed in surgical rooms, and are open-type operations. In this case, minimally invasive surgery methods can be used. Despite these risks and possible complications, valvular heart valve replacement is a fairly common procedure that is very often performed in patients diagnosed with problems with aortic insufficiency.

The operation is carried out using the latest technologies that reduce the time for the operation, increase efficiency and reduce the percentage of risk. The direction of cardiac surgery is quite in demand, there are a large number of qualified cardiac surgeons capable of performing very complex operations, have many years of experience and a well-coordinated team of nurses and support staff.

Narrowing of the aortic valve results in increased pressure within the left ventricle. The intensity of contractions of the heart increases in order to push an increasing volume of blood through a decreasing conditional passage. Hypertrophy of the heart muscle can cause heart failure. Timely replacement of valves can stop this process, reduce pressure in the left ventricle.

Aortic valve stenosis is one of the key reasons with myocardial hypertrophy. The effectiveness of the operation depends on the area of ​​damage to the heart muscle, pressure in the left ventricle, the presence of additional factors risk, such as a previous heart attack or coronary heart disease.

Assessment of heart damage ultimately comes down to determining its contractile capacity. Even a high load on the left ventricle can be tolerated by the patient for a long time. Dilatation (expansion) of the ventricle can be observed, as a result of which the contractility of the whole heart gradually decreases. Depending on the conditions in each particular case, the patient's ability to recover, after installing a prosthetic valve and reducing the pressure inside the ventricle, the normal contractility of the heart may not be restored.

This is due to excessive dilatation and a high degree of tissue damage to the heart. Misdiagnosis, poor quality history can lead to a situation where, as a result of a heart attack, there is already damage to the myocardium. Prosthetics cannot restore these muscles, and, accordingly, at high risks, the effectiveness of the operation transferred by the patient decreases.

The task of valve prosthetics is to restore the normal state of the ventricle, contractility heart and decrease in pressure inside the ventricle. This is most often achieved by returning to the original heart size.

Conclusion

Even a successful operation, a successful postoperative period does not guarantee a complete cure for stenosis. A patient who has been fitted with a mechanical valve needs constant medication. Moreover, the service life of mechanical valves is limited, which requires reoperation, timely diagnosis of violations in its work.

Individual characteristics of the patient's heart may lead to the fact that the nominal diameter of the artificial valve may not meet the requirements of the heart. This means that the decrease in pressure inside the ventricle will remain, to one degree or another.