Open heart surgery involves opening the chest wall and directly operating on the heart muscles, valves or arteries. It requires a heart-lung machine. Closed heart surgery works on structures outside the heart without a heart-lung machine. Common valvular heart surgeries discussed include mitral valve stenosis and regurgitation repairs/replacements, aortic valve stenosis and regurgitation repairs/replacements, and tricuspid valve regurgitation repairs/replacements. Signs, causes, evaluations and treatments are provided for each procedure.

1. VALVULAR
SURGERIES
BY,
REVATHY.A

2. Open Heart Surgery and Closed Heart
Surgery
 Open heart surgery deals with the structures inside the
heart, whereas close heart surgery deals with the structures
outside the heart. In an open heart surgery, a heart-lung
machine is required.

3. Open heart surgery

4. Open heart surgery
 Open heart surgery refers to a type of
surgery in which the chest wall is
surgically opened and heart is
exposed.
 This surgery is performed on the
muscles, valves, or arteries of the
heart.
 Required
 Usually on the centre on the chest
 Comparatively shorter
 Comparatively shorter
Closed heart surgery
 Closed heart surgery refers to the type
of surgery in which heart lung
machine or bypass machine is not
used.
 The surgeons’ works on the structures
located in the exterior area of the
heart.
Heart lung machine
 Not Required
Location of the scars
 Usually on the side of the chest
Time Spent in Hospital
 Comparatively shorter
Time to recover
 Comparatively shorter

5. Surgeries for,
 Patent Ductus Arteriosus – PDA is
about the open vessel that allow
the flow of blood between the
aorta and the pulmonary artery.
 Contraction of the Aorta - the
aorta is narrowedS
 Blalock-Taussig Shunt - a BT shunt
is used to increase the blood flow
to the lungs. A gore tex tube is
placed by opening the chest
through a left or a right
thoracotomy approach.
 On-pump surgery – It uses a heart
lung machine to take over the
heart’s job of pumping blood to
the organs and tissues.
 Beating heart or off-pump surgery
– Heart rate is slowed with
medication or a device
 Robot assisted surgery – It allows
a surgeon to use a special
computer to control robotic arms
that are capable of performing the
surgery.

7. Valvular Heart Disease
 Definition:
Valvular heart disease is characterized by damage to or a
defect in one of the four heart valves, the mitral, aortic, tricuspid, or
pulmonary.

8. INTRODUCTION
 Four valves in heart.
 Valves are strong thin flap of
tissues called leaflets
 A heart valve normally
allows blood to flow in only one
direction through the heart.
 The mitral valve and the aortic
valve are in the left heart; the
tricuspid valve and the
pulmonary valve are in the right
heart.

9.  leaflets or cusps, which are pushed
open to allow blood flow and which
then close together to seal and
prevent backflow.
 The mitral valve has two cusps,
whereas the others have three.
There are nodules at the tips of the
cusps that make the seal tighter.
 The papillary muscles are muscles
located in the ventricles of the
heart. They attach to the cusps of
the atrioventricular valves via
the chordae tendineae and contract
to prevent inversion or prolapse of
these valves on systole

10.  The chordae tendineae
(tendinous cords), colloquially
known as the heart strings,
are tendon-resembling fibrous
cords of connective tissue that
connect the papillary muscles to
the tricuspid valve and
the bicuspid valve in the heart.
 The closure of the AV valves is
heard as lub, the first heart
sound (S1). The closure of the SL
valves is heard as dub, the second
heart sound (S2)

11. TYPES OF VHD
1. Valvular stenosis
2. Valvular regurgitation

12. 1. Valvular stenosis 2. Valvular regurgitation
 The tissue forming the valvular
leaflet become stiffer and
narrowing the valve opening.
 It reduces the blood that can flow
through it.
 Eg; mitral valve stenosis,
pulmonary stenosis, aortic
stenosis
 Occurs when the valve not
completely closed.
 It causes the backward flow of
blood
 AKA insufficiency, leaky valve and
incompetence
 Eg; mitral regurgitation, tricuspid
regurgitation, aortic regurgitation

14. INDICATIONS
 Mitral valve stenosis
 Mitral valve regurgitation
 Aortic valve stenosis
 Aortic valve regurgitation
 Tricuspid valve regurgitation

15. 1. Mitral valve stenosis
 Mitral stenosis is a valvular heart
disease characterized by the narrowing
of the orifice of the mitral valve of
the heart.
 Improper filling of right ventricle.
CAUSES
i. Rheumatic fever is the common cause
ii. Other causes are
 Calcification
 mitral annular calcification,
Stenosis of mitral valve

16.  endomyocardial fibroelastosis,
 malignant carcinoid syndrome,
 systemic lupus erythematosus (SLE)
 whipple disease,
 fabry disease, and
 rheumatoid arthritis

17. PATHOPHYSIOLOGY

19. C/M
 Signs and symptoms of mitral stenosis include the following:
 Heart failure symptoms, such as dyspnea on
exertion, orthopnea and paroxysmal nocturnal dyspnea (PND)
 Palpitations
 Chest pain
 Hemoptysis
 Thromboembolism in later stages when the left atrial volume is increased
(i.e., dilation). The latter leads to increase risk of atrial fibrillation, which
increases the risk of blood stasis (motionless). This increases the risk of
coagulation.
 Ascites and edema and hepatomegaly (if right-side heart
 Fatigue and weakness increase with exercise and pregnancy

20. D/E
 Physical examination
 Echocardiography:
left atrial enlargement, thick and calcified mitral valve with narrow and "fish- mouth"-
shaped orifice and signs of right ventricular failure in advanced disease
 Doppler echocardiography:
is the gold standard in the evaluation of the severity of mitral stenosis.
 Cardiac chamber catheterization
 Chest X-ray:
showing left atrial enlargement.

21.  Electrocardiography
Treatment
MEDICAL tREAtMEnt
 Treatment is not necessary in asymptomatic patients
 Any angina is treated with short-acting nitrovasodilators, beta-
blockers and/or calcium blockers
 Any hypertension is treated aggressively, but caution must be taken in
administering beta-blockers
 Any heart failure is treated with digoxin, diuretics, nitrovasodilators and, if not
contraindicated, cautious inpatient administration of ACE inhibitors

23. 2. MITRAL VALVE REGURGITATION
 is a disorder of the heart in
which the mitral valve does
not close properly when the
heart pumps out blood.
 It is the abnormal leaking
of blood backwards from
the left ventricle, through
the mitral valve, into the left
atrium, when the left
ventricle contracts

24. CAUSES
 Mitral valve prolapse. In this condition, the mitral valve's leaflets bulge back into
the left atrium during the heart's contraction. This common heart defect can
prevent the mitral valve from closing tightly and lead to regurgitation.
 Damaged tissue cords. Over time, the tissue cords that anchor the flaps of the
mitral valve to the heart wall may stretch or tear, especially in people with mitral
valve prolapse. A tear can cause leakage through the mitral valve suddenly and
may require repair by heart surgery. Trauma to the chest also can rupture the
cords.
 Rheumatic fever. Rheumatic fever — a complication of untreated strep throat —
can damage the mitral valve, leading to mitral valve regurgitation early or later
life.

25.  Heart attack. A heart attack can damage the area of the heart muscle that
supports the mitral valve, affecting the function of the valve. If the damage is
extensive enough, a heart attack can cause sudden and severe mitral valve
regurgitation.
 Abnormality of the heart muscle (cardiomyopathy). Over time, certain
conditions, such as high blood pressure, can cause your heart to work harder,
gradually enlarging your heart's left ventricle. This can stretch the tissue
around your mitral valve, which can lead to leakage.
 Trauma. Experiencing trauma, such as in a car accident, can lead to mitral
valve regurgitation.
 Congenital heart defects. Some babies are born with defects in their hearts,
including damaged heart valves.

26.  Certain drugs. Prolonged use of certain medications can cause mitral valve
regurgitation, such as those containing ergotamine (Cafergot, Migergot) that
are used to treat migraines and other conditions.
 Radiation therapy. In rare cases, radiation therapy for cancer that is focused
on the chest area can lead to mitral valve regurgitation.
 Atrial fibrillation. Atrial fibrillation is a common heart rhythm problem that can
be a potential cause of mitral valve regurgitation
 Endocarditis. The mitral valve may be damaged by an infection of the lining of
the heart (endocarditis) that can involve heart valves.

28. C/M
Some people with mitral valve disease might not experience symptoms for
years
 Abnormal heart sound (heart murmur)
 Shortness of breath (dyspnea)
 Fatigue
 Heart palpitations

29. Swollen feet or ankles
D/E
Common tests to diagnose mitral valve regurgitation include:
 Echocardiogram.
 Electrocardiogram (ECG).
 Chest X-ray.
 Cardiac MRI.
 Cardiac CT.

30.  Exercise tests or stress tests.
 Cardiac catheterization.
TREATMENT
 MEDIACL MANAGEMENT
The goal of treatment is to improve heart's function and avoiding future
complications
Medications may include:
 Diuretics.

31.  Blood thinners.
 High blood pressure medications.
 SURGICAL MANAGEMENT
 Mitral valve repair.
 Mitral valve replacement

32. 3. AORTIC VALVE STENOSIS
 The narrowing of the exit of
the left ventricle of
the heart (where
the aorta begins), such that
problems result.
 It may occur at the aortic
valve as well as above and
below this level.

33. CAUSES
 Congenital heart defect.
 Calcium buildup on the valve.
 Rheumatic fever.
RISK FACTORS
 Older age
 Bicuspid aortic valve

34.  Having cardiovascular risk factors, such as diabetes, high cholesterol
and high blood pressure
 Chronic kidney disease
 History of radiation therapy to the chest
 History of infections that can affect the heart

37. C/M
 Aortic valve stenosis ranges from mild to severe.
 Aortic valve stenosis signs and symptoms generally develop when
of the valve is severe.
 Some people with aortic valve stenosis may not experience symptoms for
many years.
Signs and symptoms of aortic valve stenosis may include:
 Abnormal heart sound (heart murmur) heard through a stethoscope
 Chest pain (angina) or tightness with activity
 Feeling faint or dizzy or fainting with activity

38.  Shortness of breath, especially when you have been active
 Fatigue, especially during times of increased activity
 Heart palpitations — sensations of a rapid, fluttering heartbeat
 Not eating enough (mainly in children with aortic valve stenosis)
 Not gaining enough weight (mainly in children with aortic valve stenosis)
The heart-weakening effects of aortic valve stenosis may lead to heart failure.
Heart failure signs and symptoms include fatigue, shortness of breath, and
swollen ankles and feet.

39. D/E
 Echocardiogram.
 Electrocardiogram (ECG).
 Chest X-ray.
 Exercise tests or stress tests.
 Cardiac computerized tomography (CT) scan.
 Cardiac catheterization.

40. TREATMENT
Treatment for aortic valve stenosis depends on the severity of your condition.
o Duretics
o Aortic valve repair
o Aortic valve replacement

41. 4.AORTIC VALVE REGURGITATION
 a condition that occurs
when heart's aortic valve
doesn't close tightly
 The leakage may prevent
heart from efficiently
pumping blood to the rest
of body.

42. CAUSES
 Congenital heart valve disease.
 Age-related changes to the heart.
 Endocarditis.
 Rheumatic fever.
 Other diseases.
Marfan syndrome, a connective tissue disease. Some
conditions, such as lupus,
 Trauma.

44. C/M
• Fatigue and weakness
• Shortness of breath with exercise
• Swollen ankles and feet
• Chest pain (angina), discomfort or tightness, often increasing during exercise
• Light-headedness or fainting

45. • Irregular pulse (arrhythmia)
• Heart murmur
• Sensations of a rapid, fluttering heartbeat (palpitations)
D/E
 Echocardiogram.
 Electrocardiogram (ECG).

46.  Chest X-ray.
 Exercise tests or stress tests.
 Cardiac MRI.
 Cardiac catheterization.

47. TREATMENT
 Aortic valve repair
 Aortic valve replacement

48. 5. TRICUSPID STENOSIS
 Narrowing of the opning of
tricuspid valve.
 Usually occurs together
with aortic or mitral stenosis

49. CAUSES
Congenital
Calcification
Rheumatoid fever
Endocarditis
Ebstein’s anomaly
SLE

50. PATHOPHYSIOLOGY
Decreased bld flow from RA to RV
Decreased output
Decreased RV filling
Decreased CO
Increased systemic pressure

51. C/M
 Signs of RHF
• Hepatomegaly
• Peripheral edema
• JVD
• Ascites
 Fatigue
 Hypotension
 Heart murmur

52. D/E
Echocardiogram
Electrocardiogram
MANAGEMENT
If stenosis is mild, no need for treatment.
If it is severe , go for,
valve replacement
valvotomy
balloon valvuloplasty

53. 6. TRICUSPID REGURGITATION
 a type of valvular heart
disease where there is
failure of the
heart's tricuspid valve to
close properly when
the ventricles contracts.
 This defect allows the
blood to flow backwards,
reducing its efficiency.

54. CAUSES
 Ebstein's anomaly.
 Infective endocarditis.
 Carcinoid syndrome.
 Implantable device wires (leads).
 Endomyocardial biopsy.
 Blunt chest trauma.

55.  Rheumatic fever.
 Congenital heart defects.
 Marfan syndrome.
 Radiation.

56. Ebstain’s Anomaly
Ebstein anomaly is a
congenital malformation of
the heart that is
characterized by apical
displacement of the septal
and posterior tricuspid valve
leaflets, leading to
atrialization of the right
ventricle with a variable
degree of malformation and
displacement of the anterior
leaflet

58. C/M
Tricuspid valve regurgitation often doesn't cause signs or symptoms until the
condition is severe
 Fatigue
 Declining exercise capacity
 Jugular vein distention
 Abnormal heart rhythms
 Pulsing in neck

59.  Shortness of breath with activity
 ascites
 peripheral edema
 Third heart sound

60. D/E
 Echocardiogram
 Cardiac MRI
 Electrocardiogram (ECG)
 Chest X-ray
 Exercise tests or stress tests
 Cardiac catheterization

61. TREATMENT
 Medical Management
Diuretics and Angiotensin-converting enzyme inhibitors
 Surgical Management
 Heart valve repair
 Heart valve replacement.
 Catheter procedure.
 Maze procedure
 Catheter ablation

62. 7. PULMONIC VALVE STENOSIS
 Pulmonary valve stenosis is
a condition in which a
deformity on or near the
pulmonary valve narrows
the pulmonary valve
opening and slows the
blood flow
 Adults occasionally have
pulmonary valve stenosis as
a complication of another
illness

63. CAUSES
 congenital heart defects
 rheumatic fever
 carcinoid tumors

64. PATHOPHYSIOLOGY
RV work hard to pump the blood
It fails to pump forward efficiently
Pressure builds up in the RA
RHF

65. C/M
Pulmonary valve stenosis signs and symptoms may include:
 Heart murmur — an abnormal whooshing sound heard using a
caused by turbulent blood flow
 Fatigue
 Shortness of breath, especially during exertion
 Chest pain
 Loss of consciousness (fainting)

66. D/E
 Echocardiogram.
 Electrocardiogram.
 MRI and CT
 Cardiac catheterization

67. TREATMENT
 Balloon valvuloplasty.
 Open-heart surgery

68. 8. PULMONIC VALVE REGURGITATION
 Improper closure of
pulmonic valve
 A leaky pulmonary valve
allows blood to flow back
into the heart chamber
before it gets to the lungs
for oxygen.

69. CAUSES
 Pulmonary hypertension
 Infective endocarditis
 Rheumatic heart disease
 Connective tissue disorder
 Carcinoid syndrome

70.  Congenital anomalies
 Tetalogy of fallot
 Prosthetic valves

71. PATHOPHYSIOLOGY
Backward flow of blood to RV during diastole
RVH
RAH
RHF

72. C/M
1. PND
2. Fatigue
3. Dyspnea
4. Anorexia
5. Exercise intolerence
6. Ascites / Edema

73. D/E
 Echocardiogram
 Electrocardiogram
 Chest X ray

74. MANAGEMNT
 Balloon valvuloplasty
 Open heart surgery