Prosthetic cardiac valves
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This document discusses the history and types of prosthetic heart valves. It notes that the first successful open heart surgery using cardiopulmonary bypass was in 1953, while the first mechanical replacement valve was implanted in 1960. There are two main types of prosthetic valves - mechanical valves and bioprosthetic valves. Mechanical valves last longer but require lifelong anticoagulation, while bioprosthetic valves do not require anticoagulation but are less durable. Both valve types can lead to complications like thrombosis, bleeding, and structural deterioration over time.
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Prosthetic valves the past present and future i tammi raju
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
PROSTHETIC HEART VALVES
This document discusses various valve surgeries and prosthetic heart valves. It begins with an overview of common valve interventions like balloon mitral valvuloplasty and transcatheter aortic valve implantation. It then presents two case studies of patients requiring mitral valve surgery. The document compares medical versus surgical management and repair versus replacement. It also reviews considerations for different valve surgeries and types of prosthetic valves, including mechanical and bioprosthetic options. Post-operative care and potential complications are discussed. The document concludes by revisiting the case studies to outline treatment plans.
Prosthetic Heart Valves
Mechanical and bioprosthetic heart valves have evolved significantly since the first prosthetic valve implantation in 1952. Modern bileaflet mechanical valves provide improved central blood flow compared to older caged ball designs. Tissue valves like porcine and pericardial valves do not require lifelong anticoagulation but have limited durability. Prosthetic heart valves are prone to complications like thrombosis, structural deterioration, endocarditis, and paravalvular leak. Careful monitoring and treatment is needed to optimize outcomes.
Prosthetic heart valves types physiology
This document provides a history and overview of prosthetic heart valves. It discusses the timeline of key prosthetic valve designs from 1954 to present day. The main types of prosthetic valves covered are mechanical valves (ball & cage, tilting disc, bileaflet) and bioprosthetic/tissue valves (homograft, heterograft such as porcine). Newer technologies like stentless, percutaneous, and sutureless valves are also summarized. Valve characteristics like durability, thrombogenicity, and hemodynamics are compared for different valve types.
Mechanical valves
classification of mechanical valves, types of caged ball valve, single leaflet valve , tilting disc valve, bileaflet valve, ttk chitra valve,ST jude valve, ATS ap valve, On x valve ,carbomedics,
prosthetic heart valve evalaution
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Heart valves
This document discusses the design and evolution of prosthetic heart valves. It describes the two main types as mechanical and bioprosthetic valves. Mechanical valves have improved over time from early ball valve designs to modern bileaflet valves, but still require patients to take blood thinners. Bioprosthetic valves use animal or human tissue and have advantages like similar design to natural valves and not requiring blood thinners, but are susceptible to calcification over 10-15 years. The document outlines the anatomy and diseases of natural heart valves to provide context on why prosthetic valves are needed.
Extracorporeal circulation - CPB, ECMO
This document discusses extracorporeal circulation, specifically cardiopulmonary bypass (CPB) used during open heart surgery. It describes the basic CPB circuit including components like the venous cannula, reservoir, pump, heat exchanger, oxygenator, and arterial cannula. It outlines the steps of CPB including priming, anticoagulation, cannulation, initiating bypass, maintenance on bypass, weaning from bypass, and potential complications. CPB temporarily takes over the functions of the heart and lungs to provide a still, bloodless field for cardiac surgery using mechanical devices placed outside the body.
Recommended
Prosthetic valves the past present and future i tammi raju
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
PROSTHETIC HEART VALVES
This document discusses various valve surgeries and prosthetic heart valves. It begins with an overview of common valve interventions like balloon mitral valvuloplasty and transcatheter aortic valve implantation. It then presents two case studies of patients requiring mitral valve surgery. The document compares medical versus surgical management and repair versus replacement. It also reviews considerations for different valve surgeries and types of prosthetic valves, including mechanical and bioprosthetic options. Post-operative care and potential complications are discussed. The document concludes by revisiting the case studies to outline treatment plans.
Prosthetic Heart Valves
Mechanical and bioprosthetic heart valves have evolved significantly since the first prosthetic valve implantation in 1952. Modern bileaflet mechanical valves provide improved central blood flow compared to older caged ball designs. Tissue valves like porcine and pericardial valves do not require lifelong anticoagulation but have limited durability. Prosthetic heart valves are prone to complications like thrombosis, structural deterioration, endocarditis, and paravalvular leak. Careful monitoring and treatment is needed to optimize outcomes.
Prosthetic heart valves types physiology
This document provides a history and overview of prosthetic heart valves. It discusses the timeline of key prosthetic valve designs from 1954 to present day. The main types of prosthetic valves covered are mechanical valves (ball & cage, tilting disc, bileaflet) and bioprosthetic/tissue valves (homograft, heterograft such as porcine). Newer technologies like stentless, percutaneous, and sutureless valves are also summarized. Valve characteristics like durability, thrombogenicity, and hemodynamics are compared for different valve types.
Mechanical valves
classification of mechanical valves, types of caged ball valve, single leaflet valve , tilting disc valve, bileaflet valve, ttk chitra valve,ST jude valve, ATS ap valve, On x valve ,carbomedics,
prosthetic heart valve evalaution
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Heart valves
This document discusses the design and evolution of prosthetic heart valves. It describes the two main types as mechanical and bioprosthetic valves. Mechanical valves have improved over time from early ball valve designs to modern bileaflet valves, but still require patients to take blood thinners. Bioprosthetic valves use animal or human tissue and have advantages like similar design to natural valves and not requiring blood thinners, but are susceptible to calcification over 10-15 years. The document outlines the anatomy and diseases of natural heart valves to provide context on why prosthetic valves are needed.
Extracorporeal circulation - CPB, ECMO
This document discusses extracorporeal circulation, specifically cardiopulmonary bypass (CPB) used during open heart surgery. It describes the basic CPB circuit including components like the venous cannula, reservoir, pump, heat exchanger, oxygenator, and arterial cannula. It outlines the steps of CPB including priming, anticoagulation, cannulation, initiating bypass, maintenance on bypass, weaning from bypass, and potential complications. CPB temporarily takes over the functions of the heart and lungs to provide a still, bloodless field for cardiac surgery using mechanical devices placed outside the body.
Heart valve selection
A 50-year-old man with no comorbidities requires aortic valve replacement. Either a mechanical or bioprosthetic valve could be used. A mechanical valve would require lifelong anticoagulation therapy. It would have a low risk of structural deterioration but higher risks of bleeding, thromboembolism, and reoperation. A bioprosthetic valve would avoid anticoagulation but have a higher risk of structural deterioration requiring reoperation. Long-term outcomes must be considered based on the patient's age, lifestyle, and risk tolerance for anticoagulation versus structural failure.
Mechanical Heart Valves
The document discusses different types of mechanical heart valves that have been developed over time to replace dysfunctional natural heart valves. It begins by describing the function of natural heart valves and reasons for their replacement. Early mechanical designs like the ball-and-cage valve and tilting disk valves are outlined, followed by modern bileaflet valves. The materials used in heart valves and modes of failure are also covered. Overall the document provides a history of mechanical heart valve design and materials as well as considerations for evaluating prosthetic heart valves.
Oxygenators
The document discusses the history and components of cardiopulmonary bypass (CPB) and extracorporeal life support (ECLS). It describes the evolution of heart-lung machines from early models that combined pumping and oxygenation functions to separate pump and oxygenator units. The key components of modern CPB circuits are described including roller pumps, centrifugal pumps, membrane oxygenators, heat exchangers, and cannulae. The document also reviews priming solutions, temperature regulation, and applications of CPB beyond cardiac surgery such as ECLS and ventricular assist devices.
Evaluation of prosthetic valve function and clinical utility.
Many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.
Ventricular Assist Device
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
Lvad
A ventricular assist device (VAD) is a mechanical pump that helps the ventricles pump blood through the body. VADs are used to treat heart failure and cardiogenic shock. They can partially or completely replace the function of a failing heart. VADs are designed to assist the right ventricle, left ventricle, or both ventricles. Common uses of VADs include bridging patients to transplant, bridging to recovery or decision, and destination therapy for patients who are not eligible for transplant. Complications of VAD therapy include bleeding, infection, thromboembolism, device malfunction, and right heart failure.
Roller pump
This document provides an overview of roller pumps used for cardiopulmonary bypass. It discusses the ideal characteristics of blood pumps, the history and evolution of roller pump designs, how roller pumps work by compressing tubing between rollers and a backing plate, different types of tubing materials used, principles of operation and flow determinants, occlusion adjustment, advantages and disadvantages, and alternative pump designs like nonocclusive roller pumps.
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This document discusses balloon aortic valvuloplasty (BAV) as a treatment for aortic stenosis. It can be performed via either a retrograde or antegrade approach. The retrograde approach involves crossing the aortic valve from the femoral artery, while the antegrade approach involves transseptal catheterization from the femoral vein. Key steps for both approaches include rapid ventricular pacing to stabilize the heart during balloon inflation. The goals of BAV are to increase the aortic valve area and reduce pressure gradients. Complications can include hypotension, aortic regurgitation, and embolization of calcium deposits. BAV provides symptomatic relief but is usually not curative, as restenosis may occur.
Cardiopulmonary bypass
This document provides information on cardiopulmonary bypass, including:
1. The history of cardiopulmonary bypass, beginning with the first operation using bypass in 1951 and the first successful open heart procedure using bypass in 1953.
2. The basic components of a bypass system, including how blood is drained, oxygenated, and returned to the body via cannulas in major veins and arteries.
3. Additional details on venous and arterial cannulation techniques and potential complications. Venting of the heart is also discussed to prevent ventricular distension during bypass.
Atherectomy devices
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Bioprosthetic valve thrombosis
Bioprosthetic valve thrombosis is more common than previously thought and can occur on both surgically and transcatheter implanted valves. While its true incidence is difficult to determine, risk factors include atrial fibrillation, subtherapeutic anticoagulation, obesity, and diabetes. Clinically, it most often presents as worsening dyspnea but can also cause thromboembolism or cardiogenic shock. Echocardiography is key to diagnosis but features like increased gradients, thickened leaflets, and reduced mobility must be considered in the context of the patient's history and risk factors. Treatment involves resumption of effective anticoagulation.
Echo in prosthetic valve evaluation
Echocardiography is the main tool for evaluating prosthetic heart valves. Transthoracic echocardiography (TTE) is generally used to assess normal valve function and identify dysfunction like stenosis or regurgitation. Transesophageal echocardiography (TEE) provides better imaging of valve structure and is helpful for evaluating regurgitation and complications like endocarditis. Echocardiograms establish a baseline after valve implantation and monitor for issues like pannus, thrombus, infection or degeneration over time. TTE and TEE are complementary, with TEE used when TTE is inadequate or clinical suspicion remains after a TTE.
Pumps, oxygenators and priming solution
Pumps, oxygenators, and priming solutions are essential components of cardiopulmonary bypass. There are two main types of pumps - roller pumps and centrifugal pumps. Roller pumps work by rolling blood through tubing while centrifugal pumps use centrifugal force to move blood. Membrane oxygenators allow for gas exchange through a semi-permeable barrier, separating blood from gas, and eliminating the damage caused by bubble oxygenators. Proper selection of the components depends on factors such as flow needs, biocompatibility and minimizing trauma to blood during bypass.
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
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Deep hypothermic circulatory arrest (DHCA) involves stopping blood circulation during deep hypothermia to provide a bloodless surgical field for complex pediatric cardiac surgery. It requires cooling the patient to 15-22°C using cardiopulmonary bypass before arresting circulation. The duration of DHCA is limited to 30-60 minutes for brain protection. Neurological outcomes can be improved through careful management of factors like temperature, hematocrit levels, acid-base balance, and neuroprotective drugs during DHCA and cardiac bypass. Monitoring tools like EEG, TCD and SjVO2 help guide cerebral protection during these procedures.
Evolution of valves, Identification & Key Features | IACTS SCORE 2020
This presentation is a guide to the historical evolution, modifications and lessons learned in the development of heart valves. It clearly depicts how clinical indications for valve surgery has changed over the years and illustrates the identification of prosthesis and analysis of key features in images, at a time when patients present with malfunctioning valves for reoperations.
This is courtesy of Dr. Vinayak Shukla, MS, MCh, FIACS. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Christian Medical College and Hospital, Vellore - home to one among the first implants in Asia.
This presentation is part of a video which belongs to the lecture series of IACTS SCORE 2020 held at the Sri Sathya Sai Institute of Higher Medical Sciences Whitefield, Bengaluru between 7th and 8th March, 2020.
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Vascular closure devices were developed in the 1990s as alternatives to manual compression for achieving hemostasis after a cardiac catheterization procedure. There are two main types - passive devices that enhance clotting without achieving prompt hemostasis, and active devices that achieve hemostasis more quickly through mechanical or chemical means. Examples of active devices discussed include the Angio-Seal device which uses an absorbable anchor and collagen plug, and the Perclose device which uses an automated suturing mechanism. Studies have shown that active devices can reduce time to hemostasis, ambulation, and discharge compared to manual compression, though they may increase risks of infection and limb ischemia in some cases. Complications associated with vascular closure include bleeding
prostheticvalvesthepastpresentandfuture-itammiraju-140413095625-phpapp01 (1).pdf
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
HEART VALVE
The document summarizes the history and types of artificial heart valves. It discusses the four heart valves in the human body and how they work to prevent backflow of blood. Early artificial heart valves included the caged-ball and tilting-disc designs. The modern bileaflet valve provides central flow like a natural valve without damaging blood cells. Artificial valves can be either mechanical versions of these designs or tissue valves derived from animal organs like pig or cow valves. Both valve types have advantages and disadvantages related to durability, risk of clotting, and need for anticoagulant drugs.
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Heart valve selection
A 50-year-old man with no comorbidities requires aortic valve replacement. Either a mechanical or bioprosthetic valve could be used. A mechanical valve would require lifelong anticoagulation therapy. It would have a low risk of structural deterioration but higher risks of bleeding, thromboembolism, and reoperation. A bioprosthetic valve would avoid anticoagulation but have a higher risk of structural deterioration requiring reoperation. Long-term outcomes must be considered based on the patient's age, lifestyle, and risk tolerance for anticoagulation versus structural failure.
Mechanical Heart Valves
The document discusses different types of mechanical heart valves that have been developed over time to replace dysfunctional natural heart valves. It begins by describing the function of natural heart valves and reasons for their replacement. Early mechanical designs like the ball-and-cage valve and tilting disk valves are outlined, followed by modern bileaflet valves. The materials used in heart valves and modes of failure are also covered. Overall the document provides a history of mechanical heart valve design and materials as well as considerations for evaluating prosthetic heart valves.
Oxygenators
The document discusses the history and components of cardiopulmonary bypass (CPB) and extracorporeal life support (ECLS). It describes the evolution of heart-lung machines from early models that combined pumping and oxygenation functions to separate pump and oxygenator units. The key components of modern CPB circuits are described including roller pumps, centrifugal pumps, membrane oxygenators, heat exchangers, and cannulae. The document also reviews priming solutions, temperature regulation, and applications of CPB beyond cardiac surgery such as ECLS and ventricular assist devices.
Evaluation of prosthetic valve function and clinical utility.
Many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.
Ventricular Assist Device
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
Lvad
A ventricular assist device (VAD) is a mechanical pump that helps the ventricles pump blood through the body. VADs are used to treat heart failure and cardiogenic shock. They can partially or completely replace the function of a failing heart. VADs are designed to assist the right ventricle, left ventricle, or both ventricles. Common uses of VADs include bridging patients to transplant, bridging to recovery or decision, and destination therapy for patients who are not eligible for transplant. Complications of VAD therapy include bleeding, infection, thromboembolism, device malfunction, and right heart failure.
Roller pump
This document provides an overview of roller pumps used for cardiopulmonary bypass. It discusses the ideal characteristics of blood pumps, the history and evolution of roller pump designs, how roller pumps work by compressing tubing between rollers and a backing plate, different types of tubing materials used, principles of operation and flow determinants, occlusion adjustment, advantages and disadvantages, and alternative pump designs like nonocclusive roller pumps.
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This document discusses different designs of coronary stents. It begins by providing background on the development of coronary stents and their approval for use. It then describes some of the earliest stent designs, including the Gianturco-Roubin coil stent and the Palmaz-Schatz slotted tube stent. The document goes on to discuss various aspects of stent design that can impact performance, such as the geometric configuration, materials used, coatings, and drug-eluting capabilities. Key design considerations like strut thickness, number of struts, and mechanical properties are also reviewed.
TTK CHITRA VALVE A REVIEW
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Cardiopulmonary bypass
This document provides information on cardiopulmonary bypass, including:
1. The history of cardiopulmonary bypass, beginning with the first operation using bypass in 1951 and the first successful open heart procedure using bypass in 1953.
2. The basic components of a bypass system, including how blood is drained, oxygenated, and returned to the body via cannulas in major veins and arteries.
3. Additional details on venous and arterial cannulation techniques and potential complications. Venting of the heart is also discussed to prevent ventricular distension during bypass.
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Bioprosthetic valve thrombosis
Bioprosthetic valve thrombosis is more common than previously thought and can occur on both surgically and transcatheter implanted valves. While its true incidence is difficult to determine, risk factors include atrial fibrillation, subtherapeutic anticoagulation, obesity, and diabetes. Clinically, it most often presents as worsening dyspnea but can also cause thromboembolism or cardiogenic shock. Echocardiography is key to diagnosis but features like increased gradients, thickened leaflets, and reduced mobility must be considered in the context of the patient's history and risk factors. Treatment involves resumption of effective anticoagulation.
Echo in prosthetic valve evaluation
Echocardiography is the main tool for evaluating prosthetic heart valves. Transthoracic echocardiography (TTE) is generally used to assess normal valve function and identify dysfunction like stenosis or regurgitation. Transesophageal echocardiography (TEE) provides better imaging of valve structure and is helpful for evaluating regurgitation and complications like endocarditis. Echocardiograms establish a baseline after valve implantation and monitor for issues like pannus, thrombus, infection or degeneration over time. TTE and TEE are complementary, with TEE used when TTE is inadequate or clinical suspicion remains after a TTE.
Pumps, oxygenators and priming solution
Pumps, oxygenators, and priming solutions are essential components of cardiopulmonary bypass. There are two main types of pumps - roller pumps and centrifugal pumps. Roller pumps work by rolling blood through tubing while centrifugal pumps use centrifugal force to move blood. Membrane oxygenators allow for gas exchange through a semi-permeable barrier, separating blood from gas, and eliminating the damage caused by bubble oxygenators. Proper selection of the components depends on factors such as flow needs, biocompatibility and minimizing trauma to blood during bypass.
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
Deep hypothermic circulatory arrest in pediatric cardiac sur
Deep hypothermic circulatory arrest (DHCA) involves stopping blood circulation during deep hypothermia to provide a bloodless surgical field for complex pediatric cardiac surgery. It requires cooling the patient to 15-22°C using cardiopulmonary bypass before arresting circulation. The duration of DHCA is limited to 30-60 minutes for brain protection. Neurological outcomes can be improved through careful management of factors like temperature, hematocrit levels, acid-base balance, and neuroprotective drugs during DHCA and cardiac bypass. Monitoring tools like EEG, TCD and SjVO2 help guide cerebral protection during these procedures.
Evolution of valves, Identification & Key Features | IACTS SCORE 2020
This presentation is a guide to the historical evolution, modifications and lessons learned in the development of heart valves. It clearly depicts how clinical indications for valve surgery has changed over the years and illustrates the identification of prosthesis and analysis of key features in images, at a time when patients present with malfunctioning valves for reoperations.
This is courtesy of Dr. Vinayak Shukla, MS, MCh, FIACS. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Christian Medical College and Hospital, Vellore - home to one among the first implants in Asia.
This presentation is part of a video which belongs to the lecture series of IACTS SCORE 2020 held at the Sri Sathya Sai Institute of Higher Medical Sciences Whitefield, Bengaluru between 7th and 8th March, 2020.
Vascular closure devices
Vascular closure devices were developed in the 1990s as alternatives to manual compression for achieving hemostasis after a cardiac catheterization procedure. There are two main types - passive devices that enhance clotting without achieving prompt hemostasis, and active devices that achieve hemostasis more quickly through mechanical or chemical means. Examples of active devices discussed include the Angio-Seal device which uses an absorbable anchor and collagen plug, and the Perclose device which uses an automated suturing mechanism. Studies have shown that active devices can reduce time to hemostasis, ambulation, and discharge compared to manual compression, though they may increase risks of infection and limb ischemia in some cases. Complications associated with vascular closure include bleeding
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Similar to Prosthetic cardiac valves
prostheticvalvesthepastpresentandfuture-itammiraju-140413095625-phpapp01 (1).pdf
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
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The document summarizes the history and types of artificial heart valves. It discusses the four heart valves in the human body and how they work to prevent backflow of blood. Early artificial heart valves included the caged-ball and tilting-disc designs. The modern bileaflet valve provides central flow like a natural valve without damaging blood cells. Artificial valves can be either mechanical versions of these designs or tissue valves derived from animal organs like pig or cow valves. Both valve types have advantages and disadvantages related to durability, risk of clotting, and need for anticoagulant drugs.
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The document discusses different types of mechanical heart valves that have been developed over time to replace dysfunctional natural heart valves. It describes early valve designs like the ball-and-cage Starr-Edwards valve and the tilting disc Bjork-Shiley valve. More modern bileaflet valves are also discussed. The key materials used in heart valves include metals for strength as well as pyrolytic carbon and polymers which are durable and promote blood compatibility. Researchers continue working to improve valve lifespan, reduce risk of blood clots, and develop less invasive implantation methods.
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This document discusses the anatomy and surgical techniques related to heart valves and cardiac surgery. It provides detailed diagrams and photographs of heart valve anatomy, different types of prosthetic heart valves including mechanical and bioprosthetic options, and surgical techniques for valve replacement and repair. Complications associated with valve replacement such as thrombosis, endocarditis, and structural valve deterioration are also examined with images.
PHV.pptx
1. The document discusses the history and evolution of prosthetic heart valves from the first mechanical valve designed in 1954 to current bioprosthetic and transcatheter valves.
2. Key events and innovators discussed include the first successful aortic valve replacement in 1960 by Dwight Harken and the development of the Starr-Edwards ball-in-cage valve in the 1960s.
3. The major types of prosthetic heart valves covered are mechanical valves (ball-in-cage, tilting disk, bileaflet), bioprosthetic valves (homograft, autograft, heterograft), and newer transcatheter valves.
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The document discusses echocardiographic recognition, function, and dysfunction of prosthetic heart valves. It begins by classifying prosthetic heart valves into mechanical valves, which are made of non-biological materials, and tissue (bioprosthetic) valves, which are made from human or animal tissue. It then describes the echocardiographic evaluation of normal functioning prosthetic heart valves and provides guidance on assessing prosthetic valves in the aortic, mitral, pulmonary, and tricuspid positions. The document concludes by discussing potential prosthetic valve dysfunction and limitations of echocardiography for assessment.
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This document discusses the history and evolution of mechanical heart valve substitutes from the 1950s to the present. It describes early ball and cage valves developed by Harken and Starr-Edwards in the 1950s-60s that helped ignite the field of prosthetic heart valves but had limitations. It then covers the development of tilting disc valves including the Bjork-Shiley valve that was later recalled due to failures, and bileaflet valves such as the St. Jude Medical valve made of durable pyrolytic carbon. The document traces the materials, designs and improvements made to mechanical heart valves over decades to increase effectiveness and safety.
Artificial heart
An artificial heart is a mechanical device that replaces a failing heart. It has several valves and chambers to propel blood through the body. Artificial hearts can temporarily assist a recovering heart or permanently replace a damaged heart until transplant. Research is ongoing to reduce artificial heart sizes and develop implantable batteries and biologically compatible materials. Artificial heart valves also help damaged valves and come in mechanical and animal tissue forms, each with advantages and disadvantages. Future areas of research include polymer and tissue engineered valves.
heart-lung-machine-pump.ppt
The heart-lung machine provides temporary circulatory and respiratory support during cardiac surgery, allowing the heart to be stopped and the lungs bypassed. It oxygenates and pumps blood, maintaining circulation while the surgery is performed. Key components include venous and arterial cannulas, pumps, an oxygenator, filters, heat exchangers, and tubing. Membranous oxygenators facilitate gas exchange without bubbles, while roller pumps propel blood flow. Advances aim to further reduce complications like microemboli and post-operative cognitive issues.
Tga management
1. The document outlines the history and evolution of surgical techniques for treating transposition of the great arteries (TGA).
2. Early techniques included atrial septal defect creation (Blalock-Hanlon) and atrial switch operations by Senning and Mustard using flaps or baffles.
3. The arterial switch operation was first successfully performed by Jatene in 1975 and modified by Lecompte, allowing coronary artery transfer.
4. Advances now allow arterial switch in neonates and extended to 6 months with support like ECMO.
CPB(CARDIO PULMONARY BYPASS)
- Cardiopulmonary bypass (CPB) allows for temporary taking over of the heart and lungs' functions during surgery.
- Its development began in the early 19th century with experiments in extracorporeal circulation.
- John Gibbon successfully used CPB for open-heart surgery in 1953, repairing an atrial septal defect.
- CPB relies on principles like hypothermia, hemodilution, and anticoagulation to oxygenate and circulate blood outside the body during surgery and provide organ protection. It has revolutionized cardiac surgery and allowed for repair of previously inoperable heart defects.
cardio pulmonary bypass
The document summarizes important milestones in the history of cardiac surgery from the late 19th century to modern times. It describes the first successful suturing of a heart wound by Dr. Ludwig Rehn in 1896. It then outlines key developments like the first use of cardiopulmonary bypass for open-heart surgery by John Gibbon in 1953, and the first successful repairs of congenital heart defects using heart-lung machines in the mid 1950s by surgeons including Lillehei, Kirklin, and Dennis. The document traces the evolution of technologies like mechanical pumps, membrane oxygenators, and techniques like hypothermia that enabled modern open-heart surgery.
Double Lumen Tubes
This document discusses the history and development of double lumen tubes (DLTs) for lung separation during surgery. It describes some of the key innovators in DLT design from the 1930s to 1960s, including Gale and Waters, Magill, Carlens, Bryce-Smith, and Robertshaw. Their designs improved aspects like cuff placement, tube shape and size, and ease of insertion. The document also reviews anatomical considerations for optimal placement of right and left-sided DLTs, as well as alternatives that can be used if standard DLT placement is not possible.
Heart valve surgery.pptx
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.
Prosthatic vales_.pptx
Prosthetic heart valves are used in 7-25% of infective endocarditis cases. The risk of infection is the same for mechanical and bioprosthetic valves at 5 years, but is higher for mechanical valves in the first 3 months. Infection risk cumulatively rises to 3.1% at 12 months and 5.7% at 60 months post-surgery. Infections typically present as low grade fever, new murmurs, or congestive heart failure. Echocardiography is used to evaluate prosthetic heart valves and detect complications.
Brief history of cardiac surgery
1) Cardiac surgery has evolved significantly from the late 19th century. Early operations on the pericardium took place in the early 19th century but were rarely successful.
2) A major breakthrough was the first successful open-heart surgery performed by John Gibbon in 1953 using the first heart-lung machine. This allowed for direct visualization and repair of cardiac structures.
3) The development of cardiopulmonary bypass by Lillehei in 1954 and the use of mechanical pumps by Kirklin further advanced cardiac surgery by allowing for longer, more complex procedures.
4) Milestones since then include the first coronary artery bypass by Favaloro in 1967, innovations in heart valve surgery and replacement,
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1. The history of bronchoscopy began in 1885 with direct visualization of the larynx. Key developments included the first bronchoscopy in 1907 and introduction of the flexible bronchoscope in 1967.
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Prosthetic cardiac valves
- 1. PROSTHETI C VALVES Mohamed A. Gabr CARDIOTHORACIC SURGERY SPECIALIST AT MUH MANSOURA UNIVERSITY 2019
- 2. HISTORICAL NOTE - 1801
- 3. HISTORICAL NOTE - 1916 - 1935 Heparin was discovered by Jay Mclean and William Henry in 1916, although it did not enter clinical trials until 1935 MCLEAN, J. (1 January 1959). "The Discovery of Heparin". Circulation. 19 (1): 75–78.
- 4. HISTORICAL NOTE - 1953 The first successful open heart operation using cardiopulmonary bypass was done by John Gibbon on May 6, 1953. The operation was closure of an atrial septal defect. The patient, Cecelia Bavolek, was alive and well on the 50th anniversary of that operation in May 2003.
- 5. HISTORICAL NOTE - 1954 In 1954, Charles Hufnagel and his colleagues described 23 patients with aortic insufficiency who had been treated by rapid insertion of an acrylic ball valve into the descending aorta
- 6. The first mechanical replacement valve was created and implanted by Albert Star and Lowell Edwards in America in 1960. HISTORICAL NOTE - 1961
- 7. The first valve replacement from a human patient was first performed in 1962 by Donald Ross Surgeon Alfred Gunning, from Oxford, had been using freeze-dried valves from donated corpses for his research. He gave some of these to Donald Ross HISTORICAL NOTE - 1962
- 8. Mechanical - Other mechanical valve (I) - >60 years (aortic)* - <65 years (mitral)* - Other strong indication for anticoagulation Bioprosthesis - <60 years (aortic)* - >65 years (mitral)* - Younger patients who wish to avoid (IIa) or have contraindications to anticoagulation (I) - Future pregnancy (IIb) INDICATIONS
- 9. The ideal prosthetic valve The ideal valve substitute should mimic the characteristics of a normal native valve. In particular, it should have: - excellent haemodynamics, - long durability, - low thrombogenecity, - excellent implantability - preserve surrounding tissue - unidirectional flow - cheap
- 10. UNFORTUNATELY THIS IDEAL SUBSTITUTE DOES NOT EXIST.
- 11. The ideal prosthetic valve
- 13. A- Caged Ball Valves which consist of a silastic ball with a circular sewing ring and a cage formed by 3 metal arches, are no longer implanted.
- 14. composed of a single disk secured by lateral or central metal struts. The opening angle of the disk relative to valve annulus ranges from 60° to 80°, resulting in 2 distinct orifices of different sizes. B- Tilting disc Valves
- 15. made of 2 semilunar disks attached to a rigid valve ring by small hinges. The opening angle of the leaflets relative to the annulus plane ranges from 75° to 90°, and the open valve consists of 3 orifices B- Bileaflet Valves
- 17. Porcine bioprosthetic valves: consist of 3 porcine aortic valve leaflets crosslinked with glutaraldehyde and mounted on a metallic or polymer supporting stent. Bovine Pericardial valves: fabricated from sheets of bovine pericardium mounted inside or outside a supporting stent. A- Stented Heterograft Valves
- 19. Porcine valves Bovine valves
- 20. B- Stentless Heterograft Valves developed in an effort to improve valve hemodynamics and durability. Porcine valves Bovine valves
- 21. Aortic valve homografts are harvested from human cadavers within 24 hours of death. They are treated with antibiotics and cryopreserved at −196°. C- Homograft Valves
- 22. D- Autograft Valves In Ross procedure
- 23. E- Percutaneous Bioprosthesis balloon - expandable Self - expandable The valves are usually implanted using a percutaneous trans-femoral approach or trans-apical via thoracotomy.
- 24. TAVR
- 31. Bioprosthetic valves Mechanical valves LessDurableDurability 10-15 years30 yearsLife span LessMoreThrombogenecity For 3 months onlyRequired for lifeAnticoagulation LowHighRisk of Reoperation LessMorePPM NegligibleMoreNoise Close to naturalImprovingHaemodynamics
- 32. Complications - Thrombo-embolism - Anti-coagulant related bleeding - Prosthetic valve thrombosis - Prosthetic valve endocarditis - Patient-Prosthesis Mismatch - Valve failure - Paravalvular leakage - Pannus formation - Structural valve deterioration - Haemolysis
- 33. Long-Term Management 1- ANTI-THROMBOTIC THERAPY 2- ENDOCARDITIS PROPHYLAXIS 3- ECHOCARDIOGRAPHIC FOLLOW-UP