This document provides tips and instructions for using a PowerPoint presentation on valvular heart disease and cardiac surgery. The presentation contains blank slides to engage students by asking questions. It is intended for active learning sessions and self-study. The presentation covers topics like indications for surgery, surgical procedures for different heart valves, choices between repair and replacement, and potential complications. QR codes and links are provided to access the presentation on mobile devices.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Introduction & History.

3. Introduction & History.
• In patients with valvular heart disease,
cardiac surgery aims to restore
normal valve function through either repair or
replacement of the diseased valve.
• Surgery of valvular heart disease started more than
50 years ago .
• Techniques became standardized for most types
of repair and replacement procedures,
• surgical management of valvular heart disease still
continues to evolve to respond to the changing
profile of patients.

4. Introduction & History.
• Reconstructive valvular surgery is the
preferred surgical procedure, especially for
the diseased mitral valve.
• Valve replacement is the standard procedure
for the diseased aortic valve.
• Age and cardiac rhythm are the main
determinants for choosing between a
mechanical and a biologic artificial valve.

5. Extracorporeal Circulation

6. Extracorporeal Circulation
• prerequisite for open heart interventions
because it permits arrest of the heart and
cessation of ventilation.
• Venous blood is drained through cannulas
placed in the right atrium or in the venae
cavae.
• Blood is oxygenated by a membrane
oxygenator.
• returned to the patient with the aid of a
roller pump through a cannula in the
ascending aorta.

7. Extracorporeal Circulation
• Extracorporeal circulation requires
anticoagulation with heparin, which is
neutralized after separation from
cardiopulmonary bypass with an
appropriate dose of protamine.

8. Myocardial protection

9. Myocardial protection
• Accomplished by injection of a cold (4°C)
cardioplegic solution, derived from the
extracorporeal circuit and cooled by the
heat exchange system.
• Diastolic arrest of the heart occurs as a
result of the drop in temperature and the
addition of potassium chloride (20 mmol/L)
to the cardioplegic solution.

10. The heart has 4 valves:

11. The heart has 4 valves:
• The mitral valve and tricuspid valve, which
control blood flow from the atria to the
ventricles.
• The aortic valve and pulmonary valve,
which control blood flow out of the
ventricles.

12. Indications

13. Indications
• Stenosis.
• Insufficiency –Regurgitation.
• Stenosis+Regurgitation

14. Position

15. Position
• Supine

16. Anesthesia

17. Anesthesia
• Endotracheal controlled inhalational
anesthesia.

18. Intraoperative
Transesophageal Echography

19. Intraoperative
Transesophageal Echography
• All patients undergoing a valve repair
undergo intraoperative assessment of the
result by transesophageal echography
• Any persistent valve dysfunction is
immediately treated.

20. Incision:

21. Incision:
• A median sternotomy is the operative
approach of choice for most valvular
procedures.
– the entire heart becomes accessible,
– does not alter the respiratory function
– rapid healing with a very low rate of scar
infection
• Reoperation/ Cosmetic
– mini-sternotomy
– thoracotomy

22. Valvular Reconstructive Surgery

23. Valvular Reconstructive Surgery
• Valvular reconstruction is especially
relevant for procedures involving the mitral
and the tricuspid valves.

24. Mitral Valve Repair

25. Mitral Valve Repair
• Rheumatic Valve Disease
• Myxomatous degeneration of the mitral
valve, so-called Barlow’s disease
• Fibroelastic deficiency
• Infectious Endocarditis
• Ischemic Mitral Insufficiency
• papillary muscle dysfunction
• End-stage dilated cardiomyopathy

26. Mitral Valve Repair
• Leaflet Reconstruction.
• The remodeling ring annuloplasty
• Correction of papillary muscles.
• Mitral valve repair, when it is technically
feasible, offers better long-term results than
mitral valve replacement with either
bioprosthetic or mechanical prostheses.

27. Tricuspid Valve Repair

28. Tricuspid Valve Repair
• Functional Tricuspid Insufficiency
• Organic Tricuspid Insufficiency
• Rheumatic fever
• Infectious endocarditis
• In carcinoid syndrome
• traumatic papillary muscle or chordal rupture as
well as tricuspid leaflet tearing is occasionally
encountered after blunt trauma to the chest;
 Repair of the tricuspid valve comprises
commissurotomy and ring annuloplasty.

29. Aortic Valve Repair

30. Aortic Valve Repair
• Replacement is the standard treatment of a
diseased aortic valve. On occasion, reconstructive
surgery of the aortic valve can be performed.

31. Valve Replacement

32. Valve Replacement
• The diseased valve is removed together with
eventual fragments of calcium adherent to the
annulus
• Any prosthetic valve consists of two elements:
– a sewing ring for fixation to the valvular orifice,
generally made of Dacron and occasionally reinforced
with silicone;
– a mobile section that allows opening and closure of the
orifice during the cardiac cycle.

33. Valve Replacement
• According to the nature of the mobile
component, artificial valves are divided into
two categories-
– mechanical and
– biologic.
• Age and cardiac rhythm are among the main
determinants for choosing a specific
artificial valve

34. Mechanical Prosthetic Valves

35. Mechanical Prosthetic Valves
• The most important risk linked to the use of
a mechanical valve is valvular thrombosis.
• Need lifelong systemic anticoagulation.

36. Biologic Valves

37. Biologic Valves
• Biologic valves are separated into three
groups on the basis of the origin of the
biologic material:
– heterografts (animal origin),
– homografts (human donor),
– autografts (tissues derived from the patient).
• bioprosthetic valves are subjected to
degeneration.

38. Autograft Valves

39. Autograft Valves
• The use of autograft valves is limited to
transfer of the pulmonary valve to the aortic
position, known as the Ross procedure.
• A pulmonary homograft is subsequently
implanted into the vacated position.
• dysfunction is usually well tolerated in the
pulmonary position .

40. choice

41. choice
• The choice of an artificial valve must first take
into account the age of the patient.
• In children -The Ross procedure is the operation
of choice for aortic valve replacement.
• Adults younger than 70 years -mechanical
prosthesis.
• If life expectancy does not exceed 10 years a
bioprosthesis .
• In Patients Older than 70 Years-bioprosthesis

42. Closed Mitral Valvotomy

43. Closed Mitral Valvotomy
• Historically, surgical commissurotomy was
the standard treatment for relief of mitral
stenosis.
• Percutaneous mitral balloon valvuloplasty
(PMBV) has since become the treatment of
choice for mitral stenosis.
• Catheter inserted from femoral vein > Rt.
Atrium > puncture the septum > Mitral
valve > Inflate balloon.

44. • Transcatheter aortic-valve implantation.

45. Complications

46. Complications
• Thromboembolism.
• Degeneration.
• Failure
• Paravalvular leak

47. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

48. Get this ppt in mobile

49. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
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• https://www.facebook.com/doctorpradeeppa
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