Aortic Valve Replacement

Aortic valve disease:

It can cause in dysfunction of one of four valves in heart, Aortic valve disease occur mostly in 50 plus people, Aortic valve control the clean blood flow in heart.

If the valve is narrow then there will be a lot of sophistications but if the valve doesn’t close at right time then there can be backward leakage.

Diagnosis of disease:

There should be a physical examination in order to diagnose the Aortic Valve Disease, A heart specialist can do a chest x-ray or an echo cardiogram.

Sometimes, there can be a cardiac catheterization in order to improve the heart valve functioning.

Treatment of Aortic Valve Disease:

Cardiologist should prescribes some kind of medicines in order to control Blood pressure and patient has to measure his blood pressure 3 times a day and he should right down the variations and he should the discus these variations with his doctor, it will really help to cure the disease. Patient shouldn’t lift the heavy things.

In any serious case, there can be a surgery to repair or to replace the defected valve.

Semi means half and lunar means moon and the name shows that their shape is just like a half moon that’s why called as semilunar valves. Semilunar valves are present at the lower end of pulmonary artery and the aorta and both of these arteries are used for the supply of blood away from the ventricles. The function of these valves is to pump the blood into these arteries and keep the blood from flowing back into the ventricles. The chordate tendineae are absent in these valves and their shape and structure resembles more to the valves present in vein rather then those present in atriovascular valves.

There are two types of semilunar valves which are:
1. Aortic semilunar valve
2. Pulmonary semilunar valve

Both of these are present in between the truncus and conus and they are made up of immigrated neural crest cells. In addition to these two semilunar valves a new valve at the ventral position is formed which is called truncus pulmonalis and except this valve an extra folding is formed at the dorsal side which in near future develops into dorsal semilunar valve of the aorta.

Aortic semilunar valve:

The semilunar aortic valve is the valve present in between the left ventricle and the aorta and it resembles a half moon in shape and appearance. It has three leaflets of the shape of half moon and they control the flow of blood from the left ventricle towards the aorta. When there is ventricle systole the pressure in the left ventricle gets elevated and as this pressure surpasses the pressure in the aorta this leads to opening of the semilunar aortic valve. As the semilunar aortic valve opens the blood present in the left ventricle gets the permission to flow in the aorta and it start moving down the aorta.

When all the blood goes down the left ventricle into the aorta the pressure in the left ventricle drops with the termination of the ventricular systole and the pressure now raise in the aorta and this pressure forces the semilunar aortic valve to close again. The closing of the semilunar aortic valve results in the hearing of the component of the second heart sound S2 which is A2.

Above of all the most apparent inborn disorder of the heart is the presence of bicuspid aortic valve whereas the normal aortic valve has three cusps. Normally a healthy person posses a three leaflet aortic valve whereas with bicuspid disorder the patient has only two leaflets of the semilunar aortic valve. This kind of disorder remained hidden from diagnosis for years until some other disorder like calcified aortic stenosis attacks the heart. The people with bicuspid aortic valve get their calcified aortic stenosis in their 40s or 50s while others with normal tricuspid aortic valve get this disorder in their late 60s which is on an average 10 years later then former patients.

Mechanical aortic valve is implanted in human body as a result of aortic valve replacement.They are made from metal and plastic and may last the rest of the recipient’s life. The disadvantage of mechanical aortic valve replacements is that the recipient will have to take Coumadin the rest of his or her life to prevent blood clots.If you tke coumadin then you have to give up contact sports,skiing and any occupation requiring physical activity.Coumadin decreases the ability of the body to clot its blood,so the risk of bleeding in other parts is elevated.Patients on Coumadin can also bleed without trauma.The advantage of a mechanical valve is that it will last for approximately 20 to 30 years.Replacement valves that are taken from infection-free animal hearts may not require the recipient to take medication, but they have short durability time of 10 to 15 years.

Aortic valve replacement is a surgery used to remove a diseased or defective aortic valve and replace it with another valve.Symptoms of defect in aortic valve are Shortness of breath, Fainting, Fatigue and Swelling in the legs.
Aortic valve problems are of 2 types: Aortic stenosis and aortic insufficiency.
Aortic stenosis is the narrowing of the valve. In this case,the heart has to push harder to get blood through the smaller opening and due to this less blood circulates through the heart and rest of the body. Aortic stenosis may be caused by calcium that get deposited on the valve. This deposition hardens the valve, which can hinder its ability to open and close properly.
Aortic insufficiency or leakage occur when a valve does not close properly allowing the blood to flow in the direction away from its original path. This happens because of weak or worn out valve.

Cause of aortic valve disease is having a bicuspid valve instead of tricuspid valve. As time passes the bicuspid valve become weak and may leak or become narrow. One more cause of aortic valve disease is an infection known as rheumatic fever. It can damage the valve by scarring and then make the valve function improperly.

Reasons for aortic valve replacement are patient’s past history, current symptoms, physical exam and special tests.A defective aortic valve may also effect lungs, kidneys or even liver.The purpose of an aortic valve replacement is to remove this diseased or defective aortic valve and replace it with another valve.

Instruments Used for Aortic Valve Replacement are the heart-lung bypass machine and the new aortic valve. “Heart-lung” bypass machine or cardiopulmonary bypass machine is used to replace the functions of your heart and lungs while your heart surgery is in progress. Its adds oxygen to the blood like lungs and pumps blood to the body like heart. Aortic valve is either a man-made mechanical valve, made of metal and plastic or a valve that is taken from an infection-free animal heart.

Minor aortic valve replacement complications are Nausea and vomiting, Infections at the site of the IVs, wires, or tubes, Minor bleeding or bruising, Abnormal or painful scar formation, Allergic skin reaction, Skin numbness and Atrial fibrillation.

Major aortic valve replacement complications are Infection, Bleeding, Heart attack, Stroke,Valve replacement failure, Loss of life and Heart or lung problems, includes Irregular heart rhythms, Temporary or permanent damage to your heart’s electrical system, Pneumonia, Lung or heart failure,Rupture of the heart wall, Kidney failure, Allergic reaction to medication, Nerve or organ damage, Transmission of disease from blood products.

Irregular heart rhythms are observed after aortic valve replacement surgery due to disorganized electrical signals.Atrial Fibrillation ia an irregular heart rhythm that does create symptoms.Its symptoms are rapid heart rate or a pounding in your chest.

Aortic valve failure after aortic valve replacement occurs in less than 1 out of 100 patients. It may be caused by clot formation or development of a leak around the sutures that hold it in place. This can be the result of the valve tissue weakening or due to an infection. It can be treated by surgery.

Mechanical valves are made totally of mechanical parts that are tolerated well by the body. Mechanical valves are made of metal or carbon and are designed to perform the functions of the patient’s native valve. The bi-leaflet valve is the most common type of mechanical valve and consists of two carbon leaflets in a ring covered with polyester knit fabric.

A normal Aortic valve consist of three functional leaflets called tricuspid valve which means that it has three paths to supply blood to heart. Bicuspid valve is a condition of aortic valve which has just two leaflets called bicuspid aortic valve, having just two paths rather than three. Mostly this problem arises in children in the womb of mother when aortic valve due to any reason could not develop properly (the term is known as congenital deformity) and is inherited problem. If a baby is not suffering from this deformity at the time of birth, it may arise in the coming life mostly in thirties and forties.

Round about two percent of the whole population suffer from such deformity of aortic valve in which abundance of patients consist of males.

Parts of the Bicuspid Valve:

(1)Two leaflets
(2)Raphe

Both have different sizes. The bigger leaflet is termed as conjoined leaflet. Bicuspid valve has two commissures which are sometimes partly fused and in some cases not, the commissure which is partly fused is known as high raphe and the other is known as low raphe.

Function of Bicuspid Aortic Valve:

A typical aortic valve allow forward flow of blood and stops the backward flow whereas if bicuspid valve is thickened it creates hurdles for blood to flow smoothly across the valve, this problem is known as aortic valve regurgitation, aortic valve leakage or aortic stenosis. If this valve does not open completely it may create severe problem for heart to work properly. As blood can not flow freely, it creates a sound which we call it murmur. Some bicuspid valve doesn’t create such kind of sound but they still have problem with opening and closing of valves and this sound is the first sign of abnormality of the aortic valve. In the latter case surgery is essential.

Some bicuspid valve don’t create such kind of sound but they still have problem with opening and closing of valves and this sound is the first sign of abnormality of the aortic valve.

Symptoms:

The mass of the heart may enlarged
Heartbeat may be irregular (sometimes slow and sometimes very fast)
If the pulse is not strong in body specially of ankles and wrists
Patient feels tiresome
Problem in breathing
A sound of blood flow called murmur
In severe condition patient may get unconsciousness

Tests:

There are different tests through which this heart problem can be diagnosed
Ultrasound of heart (ECG: Electrocardiogram)
Magnetic resonance imaging of the heart (MRI)
If the problem is not diagnosed by mentioned tests, doctor may prescribe the following essential tests:
X-Ray for the whole Chest
Angiography which includes the x-ray of the blood vessels

Different medical solutions are adopted for different kind of patients:
If a baby is suffering from aortic valve leakage or is too much narrow and is unable to control through medications then in this sever condition to save the life of child there is only one solution which is surgery. This narrow valve needs a surgical solution and is inevitable.

This contracted valve can be widened and opened through cardiac catheterization. Catheter is tube which is passed into the heart and then into the contracted valve when this tube gets to the contracted part of the valve the attached balloon is overblown and the diameter of valve is opened to extent of other normal valves.

What is an Aortic Valve?

First off, we need to identify the aortic valve and its location. Every person’s heart contains four valves: pulmonic, aortic, tricuspid, and the mitral valve. Hence the name, the aortic valve is placed between the aorta (the person’s largest artery) and the left ventricle (the bottom heart chamber).

Aortic Valve Surgery

Aortic valve disease, aortic valve regurgitation, and aortic valve stenosis are the three primary reasons that a person would have aortic valve surgery. Below is information to help you understand the conditions that would be treated with aortic valve surgery. I will try to be clear and concise about why aortic valve surgery would be necessary for such conditions.

Treatment of aortic valve surgery depends upon its nature. If it is of mild nature, nothing is refrained from doctors. But when it comes in ‘moderate category’, antibiotics are prescribed. It is advised to avoid fatiguing work like sprinting or weight lifting.

If once it’s status falls in ‘serious category’, Aortic valve surgery is recommended by doctors.
There are two types of procedures in which surgery is performed: aortic valve repair and aortic valve replacement.

Aortic Valve Repair

Congenital defects are usually repaired. Although following six types of procedures are used by the surgeons depending upon the nature of defect:

Commisurotomy: When the leaflets become too wide, aortic valve befalls narrow, so surgeon cuts the leaflets from them which are wider.

Valvuloplast: When leaflet becomes weaker, ring type device is installed outside the aortic valve for support.

Reshaping: Misshapen aortic valves are reshaped by cutting and then stitching.

Decalcification: Calcium on the aortic valve leaflets is removed to prevent the possible aortic valve leakage.

Repair of structural support: Strings supporting the aortic valve are shaped, so they can close properly.

Patching: Holes in aortic valve leaflets causing leakage of aortic valves are patched.

Aortic Valve Replacement

There are two types of aortic valve replacements: biological aortic valve replacement and mechanical aortic valve replacement, having their own advantages and disadvantages.

Mechanical aortic valve replacement:
Valves made of Plastic, carbon or metal materials are often used as they are long-lasting, but after the replacement, patients have to take blood thinning anticoagulants for the rest of their lives to prevent blood clotting on the parts.

Biological aortic valve replacements
Biological materials such as animal tissues or human donated heart tissues are used. There is no fear of blood clotting as biological materials are used. It’s life time is 10 years, after which it has to be replaced again.

In children and young ones, biological aortic valve breaks down quicker, so biological valve replacement is often used in elderly patients.

Aortic valve surgery – what is the risk?

Unfortunately any time you undergo anesthesia there will be some form of risk, as is, when you drive your car down the road or even if you are sitting at home in your recliner. There is still some element of risk of death. However, you may be pleased to know that doctors have improved technology significantly in the last ten years for aortic valve surgeries. Considering most people who undergo surgery are at a very severe risk of having a heart attack or death, the risk is well worth it. Generally over 98.2% of the people who undergo such surgeries will have a good recovery. The recovery of such a procedure is usually several months before they get back to where they once were. However, there have been numerous patients that have lived long and healthy lives for years afterwords.

It is recommended that if you feel you suffer from aortic valve disease that you should see your doctor as soon as possible. There are potentially other better alternatives to aortic valve surgery available.

The abnormal narrowing of the aortic valve which may be congenital or acquired is called aortic valve stenosis. It can also be defined as pathological narrowing of the aortic valve orifice. It is a type of a valvular heart disease which is characterized by the abnormal narrowing of the aortic valve.
Aortic valve is a tricuspid valve as it has three leaflets and it controls the flow of blood from the left ventricle into the left aorta and the rest of the body when there is ventricle systole.
The human heart is a four chamebered organ. The upper two chambers are right and left atria which are thin walled chambers. The lower two chambers are called right and left ventricles which receive blood from the atria through the tricuspid and mitral valves. The ventricles are the thick walled chambres. The valves are the leaflets of thin tissues which controls the opening and closing of the heart chambers during each heart beat cycle. The main function of the valves is the prevention of the backward flow of the blood. When the flow of blood to the arteries is impaired, aortic stenosis exist and it can lead to heart failure. The ratio of aortic stenosis in men is three times more than women.
Three conditions appeaer to be the cause of aortic stenosis in adults which are the progressive wear and tear of the bicuspid valve. This condition is congenital. The second condition is the wear and tear of the valve in elderly age. Scarring of the aortic valve due to rheumatic valve is also one of the most common causes of aortic valve stenosis.
About 2% of the people are born with a bicuspid aortic valve while aortic valve is a tricuspid valve and in young patients it doers not support the proper flow of blood and hence due to this the flow of blood is turbulent and it causes more wear and tear of the valve and with the passage of time this wear and tear leads to calcification, scarring and less mobility of the valve leaflets. 10% of the bicuspid valves become narrow leading to aortic valve stenosis. In the patients of age 65 or more the common cause of aortic valve stenosis is senile calcific aortic stenosis. With the increasing age the protein collagen of the leaf lets is destroyed and due to this calcium start depositing on them and it reduses the mobility of the leaflets.
Rheumatic fever is caused by the untreated infection of the group A streptococcal bacteria and aortic valve stenosis due to rheumatic fever causes increased turbulence which cause more damage. The aortic valve stenosis due to rheumatic fever the narrowing of the valves is due to the fusion of the leaflets.
Symptoms of the aortic valve stenosis depends on the degree of the narrowing of the aortic valve. Patients with mild narrowing don’t have any symptoms but if the narrowing exceed 50% then the patient start feeling an increased pressure in the left ventricle. The major symptoms of aortic valve stenosis are syncope means fainting, chest pain and shortness of breath. 4% patients of aortic valve stenosis die suddenly because of strenuous exertion. Chest pain is the most common symptoms of valve stenosis as iot occurs in one half of the patients. Fainting usually occurs because of exertion or excitement and these conditions vasodilation occurs which causes lowering of the blood pressure. Fainting can also occur due to arrhythmia which is the decreased cardiac output because of irregular heart beat. Shortness of breath is the most ominous sign. It is caused by increased pressure in the blood vessels of the lung which is due to the increased pressure required to fill the left ventricle. At early stages the shortness of breath occurs during any activity but with the progress in disease it also occurs at rest.
The arteries which carry blood to the brain are called carotid arteries which can be felt at neck. Patients having significant aortic valve stenosis have a delayed upstroke and lower intensity of the carotid pulse which shows the severity of the narrowing. A loud murmur is heard because of turbulence to the flow of blood. The intensity of the murmur doesn’t show the intensity of the disease.
EKG can be used for the diagnosis of aortic valve stenosis as it shows abnormal patterns which reflects the thickened heart muscles. EKG is the recording of the heart’s electrical activity.
Chest x-ray can also be used for this purpose. It shows a normal heart shadow but if heart failure is present than a fluid in the lung tissue and larger blood vessels in the upper lung regions are often seen.
Ultrasound waves are used in echocardiography to obtain the images of heart chambers, valves, and surrounding structures. It is a non-invasive tool for the diagnosis of aortic valve stenosis. An echocardiogram shows a thickened, calcified aortic valve which opens poorly in addition to the size and functioning of the heart chambers. Doppler technique is used in this process.
Cardiac catheterization is a very expensive process used for the diagnosis of the aortic valve stenosis. In this process small hollow tubes made of plastic are advanced in the aortic valve and left ventricle. This technique measures the pressure on both sides of the aortic valve, rate of flow of blood through the aortic valve as well as the area of the aortic valve. The normal size of aortic valve is 3 square centimeters and the symptoms occurs when the size is reduced to 1 square centimeter whiloe the situation becomes critical when this reduction exceeds upto 0.7 square centimeter.
The patients without any symptoms are observed until the symptoms occur. Mild aortic stenosics don’t need any treatment or restriction of activity while moderate stenotics with the valve area of 1.5 to 1.0 square centimeters are advised to avoid strenuous activities. The patients of endocarditis are given antiboitics before any process as this very serious aortic valve problem. In this process the bacteria are introduced into the blood stream. The antiboitics used are Amoxil, erythromycin, ampicillin, gentamicin and vancomycin.
Once the symptoms of aortic valve stenosis occur then use of antiboitics is useless as the use of diuretics to reduce high lung pressures and remove lung fluid can provide only temporary relief of symptoms. Such patients are treated with cardiac catheterization or some more severe cases undergo aortic valve replacement.

Aortic Valve Leakage -  What is it?

The aortic valve is one of the four valves of heart located between left ventricle and aorta. It may have two or three flaps called bicuspid or tricuspid aortic valve which work like one way gate. When the heart pumps, the pressure in aorta increases than the pressure of left ventricle, the aortic valve is opened. The oxygenated blood moves from left ventricle to aorta and thus to the body. When the pressure in the left ventricle drops, due to aortic pressure the aortic valve closes down and thus it stops the blood flowing backward to ventricle. If the aortic valve doesn’t close properly, it causes aortic valve leakage. Bloods moves back in wrong direction from aorta to the left ventricle. Body doesn’t get the required amount of blood. In order to make up the aortic valve inefficiency, the heart has to work harder as heart has to pump more blood for the body.

Aortic Valve Leakage – What are Causes?

There can be many cause of aortic valve damage which results in aortic valve leakage.
Congenital structure: It can be due to the congenital structure. People with bicuspid aortic valve often face the problem, it there is more pressure on the valve.
Aging: Aging is other possible cause, with age the leaflets of valve become weak and problem can arise.
Aorta size: Due to high blood pressure or hardening of arteries, the aorta becomes large and thus the pressure on the aortic valve increases.
Others: There can be many other reasons of aorta valve damage like Infection, rheumatic fever, trauma etc.

Aortic Valve Leakage – What are Symptoms?

There are very rare chances that this problem appears suddenly and it becomes acute. It takes many years to develop the symptoms. All it depends upon the amount of blood leakages. In beginning heart make up the inefficiency by pumping more blood. But with time it starts growing large in size and the symptoms start to appear. If it is not fixed, it can result in Heart failure, abnormal heart beats or even heart damage. Aortic valve surgery is recommended which involves aortic valve repair or aortic valve replacement depending upon the nature of aortic valve damage.

Following symptoms are seen in patients of aortic valve leakage.
Weakness, shortness of breath, chest pain, uneven heart beats, fainting etc.

The most common problem in old age is aortic valve disorder. Aortic valve controls the blood pumped out of heart from left ventricle into aorta. It holds an important function, malfunctioning of it creates disorder.

This disorder can possibly arise in two ways. If valve becomes abnormally narrow (aortic valve stenosis) heart has to work hard to pump the sufficient amount of blood.

If the valve doesn’t close properly, blood being pumped out by the valve leaks in backward direction into the left ventricle which may lead to aortic regurgitation. In both cases the valve is narrow or it doesn’t close properly, muscular wall of left artricle becomes thicken and its size becomes large. This condition is called hypertrophy.
There is risk of disorder for the people who are born with bicuspid aortic valve. As bicuspid valve doesn’t open as openly as tricuspid valve, it causes pressure on the aortic valve leaflets. It results in aortic valve stenosis due to increase wear and tear over time. Almost 10% of bicuspid aortic valves become narrowed leading to aortic vlalve disorder.

Symptoms of aortic valve disorder don’t appear in its early stage. As problem develops, breath, light-headedness, dizziness, angina (chest pain), fainting are common problems a patient suffered from.

Aortic valve disease – The Symptoms

There are a lot of people who have aortic valve disease but do not even realize it. In fact, the majority of people will never receive treatment from the complication or even see a doctor about it. This is still the case even if the stenosis (narrowing) or insufficiency of the aortic valve is at a severe state. The symptoms are fairly typical of aging or being out of shape and it often goes unnoticed until you have major problems or even death.

The initial symptoms of aortic valve disease that would require aortic valve surgery would be fatigue. You will simply feel tired from the time you get up to the time you go to bed. It is frequent that anyone with a severe aortic valve disease condition would sleep often even during the middle of the day.

Another common symptom is loss of energy. Have you got to the point where your brain tells you that you would like to go somewhere, but your body tells you something different? This is a case of a loss of energy and a sign of aortic valve disease.

One of the exterior symptoms is swelling of the ankles. Even without walking long distances or being on your feet all day, aortic valve disease causes people to build fluid up around the ankles.

If you are concerned about having aortic valve disease then another common symptom is typically found by a doctor. You will find that the heart beat is not in perfect rhythm. It may skip a beat or have extra beats in the pattern.

Obviously what makes this so hard to diagnose is that these are common symptoms of aging or being out of shape as well. Some people misdiagnose it for other less severe problems. However, if you have a very advanced stage of aortic valve disease, there are a few other symptoms you should be aware of.

Shortness of breath – Perhaps just walking to the bathroom and back has you worn out enough that it is time for a nap and you find it difficult to regain your breath after walking even short distances. This means that you are getting inadequate oxygen to the rest of your muscles and your body is telling you something is wrong and overcompensating by excessive breathing and a shortness of breath.

Chest pain – If your chest begins to have sharp pains as you breath and it is fairly consistent regardless of what you are doing, then it is a good indication you have aortic valve disease. Often times, such a severe case where you are feeling the inadequacy of your aortic valve it could potentially require aortic valve disease.

Loss of consciousness – This would be the last step of someone who is suffering from aortic valve disease. Unfortunately this loss of consciousness can often mean insufficient oxygen to the blood and potentially death if not corrected immediately. If anyone you know reaches this stage they should be taken to the hospital immediately.

Aortic valve disease – what is it?

Aortic valve disease is an appropriate name for a condition when the aortic valve is not properly functioning as it should. There are typically a couple of reasons that the function of the aortic valve becomes a problem and leads to aortic valve surgery like aortic valve repair or aortic valve replacement.

Aortic Valve Stenosis

The first is known as aortic valve stenosis. Aortic valve stenosis is when the leaflets inside of the valve become stiff, inflexible, or fused. The result is that the valve becomes clogged and blocks adequate blood flow. Calcium will build up on the valve leaflets and this limits the mobility. Stenosis can occur with a normal 3 leaflets patient or a bicuspid which is 2 leaflets. You may be surprised to find out that nearly 2% of Americans have a bicuspid aortic valve. They are more susceptible to aortic valve disease.

Aortic Valve Regurgitation

The second reason you may suffer from aortic valve disease is that you have a condition known as aortic valve regurgitation. You may also hear it simply referred to as valvular insufficiency or simply a “leaky aortic valve”. In easy to understand terms, this simply means that your valve leaflets do not close completely as they should. Blood (which carries oxygen) is supposed to be pumped through the aortic valve into the aorta. However, if the blood (along with the oxygen) is partially being pumped back into the heart, this means less blood is getting to the aorta. Your heart has to work significantly harder to get the right amount of blood needed to the aorta and throughout the rest of the body. A few reasons why your valve may be leaky is that you have an infection in the valve (endocarditis), floppy leaflets (prolapsed leaflets), or a dilatation of the aorta (aneurysm).