Valve reconstruction is a surgical technique used to repair defects in heart valves. It provides an alternative to valve replacement. In the US, about 99,000 heart valve operations are performed each year, most commonly to repair or replace the mitral or aortic valves which are on the left side of the heart. Valve repair techniques include commissurotomy to open narrowed valves, annuloplasty to provide support with a ring, and reshaping, patching or shortening valve leaflets. Conditions requiring surgery include severe valve damage or complications from issues like infection.

2. 
Valve reconstruction has proved to be an effective,
reproducible and durable treatment for life-threatening
Cardiac diseases.In the United States, surgeons
perform about 99,000 heart valve operations each
year. Nearly all of these operations are done to repair
or replace the mitral or aortic valves. These valves are
on the left side of the heart, which works harder than
the right. They control the flow of oxygen-rich blood
from the lungs to the rest of the body.If valve damage is
mild, doctors may be able to treat it with medicines. If
damage to the valve is severe, surgery to repair or
replace the valve may be needed.
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4. 
Heart valve repair is a surgical technique
used to fix defects in heart valves in valvular
heart diseases, and provides an alternative to
valve replacement.
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5. 

COMMISSUROTOMY
For narrowed valves, where the leaflets are
thickened and perhaps stuck together. The
surgeon opens the valve by cutting the points
where the leaflets meet.
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8. VALVULOPLASTY

Valvuloplasty is the widening of a stenotic
valve using a balloon catheter
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9. 

RING ANNULOPLASTY
When a valve loses its shape and strength, it's
unable to close tightly. An annuloplasty gives
the leaflets support through ring-like devices
that your surgeon attaches around the outside
of the valve opening.
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10. 





RESHAPING
The surgeon cuts out a section of a leaflet.
Once the leaflet is sewn back together, the
valve can close properly.
DECALCIFICATION
Decalcification removes calcium buildup
from the leaflets. Once the calcium is
removed, the leaflets can close properly.
REPAIR OF STRUCTURAL SUPPORT
which replaces or shortens the cords that give
the valves support (these cords are called the
chordae tendineae and the papillary muscles).
When the cords are the right length, the valve
can close properly.
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12. 

PATCHING
The surgeon covers holes or tears in the
leaflets with a tissue patch.
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13. 
Mitral valve repair

Aortic valve repair

Tricuspid valve repair

Pulmonary valve repair
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15. 
Mitral valve repair is a cardiac surgery
procedure
performed
by
cardiac
surgeons to treat stenosis (narrowing)
or regurgitation (leakage) of the mitral
valve. The mitral valve is the "inflow
valve" for the left side of the heart.
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16. 
In 1923 Dr. Elliott Cutler of the Peter Bent
Brigham Hospital performed the world’s first
successful heart valve surgery - a mitral valve
repair. The patient was a 12-year-old girl with
rheumatic mitral stenosis.

Replacement of the mitral valve with an
artificial valve in the 1960s
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17. 



ANNULOPLASTY
Inserting a cloth-covered ring around the
valve to bring the leaflets into contact with
each other
QUADRANGULAR RESECTION
removal of redundant/loose segments of the
leaflets
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19. 
RE-SUSPENSION of the leaflets with artificial
(Gore-Tex) cords.
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20. 
Bacterial endocarditis

Mitral regurgitation may also occur as a result of
ischemic heart disease (coronary artery disease) or nonischemic heart disease (dilated cardiomyopathy).

Surgery for MR is recommended when Patient have
symptoms of heart failure, or when ejection fraction
drops below 55%
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21. 

Examples of serious damage or complicated
conditions that might lead to mitral valve replacement
include:
Extensive ballooning of the mitral valve (rather than a
single flap that puffs up).

Severe hardening (calcification) of the valve.

Prolapse (bulging) of the valve at an unusual location.

Damage to the valve from infection (endocarditis)
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23. 



During valve surgery, patient is given general
anesthesia.
Surgeon makes a large incision in patient chest.
Patient placed on a heart-lung machine during
the surgery.
Blood is circulated outside of the body and
oxygen is added to it using a heart-lung
(cardiopulmonary bypass) machine.
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26. 
TO PROTECT THE HEART MUSCLE FROM DAMAGE DURING
SURGERY TO REPLACE THE HEART VALVE, THE HEART MAY BE
COOLED.

IN ADDITION, A CARDIOPLEGIA SOLUTION (WHICH IS A FLUID
WITH HIGH CONCENTRATIONS OF POTASSIUM AND MAGNESIUM)
IS
INTRODUCED
TO
STOP
THE
HEART
COMPLETELY.THE
DAMAGED MITRAL VALVE IS EITHER REPAIRED OR REMOVED
AND REPLACED WITH AN ARTIFICIAL (PROSTHETIC) HEART
VALVE.
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27. 
Aortic valve repair is a surgical procedure
used to correct some aortic valve disorders as
an alternative to aortic valve replacement.
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28. 
Aortic valve repair is most commonly performed
in patients with aortic regurgitation caused by;

a dilated aortic annulus

conjoined cusp prolapse in bicuspid aortic valves
(BAV)

single cusp prolapse in tricuspid aortic valves,
and

aortic valve cusp perforation from endocarditis
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31. 
There are two surgical techniques of aortic-valve
repair:

The Reimplantation-Technique (David-Procedure)

The Remodeling-Technique (Yacoub-Procedure)
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32. 


A complete median sternotomy is performed.
In patients requiring only aortic valve repair, a
complete median sternotomy is performed through
a limited 8 cm skin incision
After establishing cardiopulmonary bypass, a
transverse aortotomy is performed 2 cm above the
sinotubular junction.
For better visualization, the aorta can be
completely transected and suspended with stay
sutures positioned above the commissures to better
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34. 
1.annular dialatation
This type of AR is caused by a dilated aortic
annulus resulting in a sagging of the belly
of the cusp resulting in lack of central cusp
apposition. Reduction annuloplasty corrects
the problem by increasing the surface area
of cusp coaptation.
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36. 
Intraoperative photograph prior to repair.
Note: loss of cusp coaptation. The pledgeted
sutures are stay sutures for improved
exposure.
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37. 
Intraoperative photograph following
pledgeted commissuroplasty
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38. 
This type of AR results from the prolapse of
the conjoint cusp. The usual conjoint cusp is a
fusion of the right and left coronary cusps.
The goal of the correction is to shorten the
redundant conjoint cusp thus elevating the
free margin of the cusp to coapt with the
other non-prolapsing cusp.
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40. 
Intraoperative photograph after resection of a
central triangle of redundant prolapsing
conjoint cusp. The first interrupted suture
reapproximating the cut edges of the cusp is
being placed.
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41. 
This type of AR is caused by the prolapse of
one or more cusps. The free margin is
elongated. This can occur by rupture of a
small fenestration. The goal of this repair is to
shorten the free margin to meet the other
cusps.
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42. 
Intraoperative
photograph
demonstrating
completed repair of cusp prolapse in tricuspid
valve.
Repair
was
performed
by
plicating
prolapsed cusp and pledgeted commissuroplasty.
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43. 
This type of AR is caused by infective
endocarditis or iatrogenic perforation. The
goal of this repair is to patch the defect in the
cusp.

An autologous pericardial patch is prepared
and used to cover the defect with either
running or interrupted 6-0 polypropylene
suture
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45. 
Illustration demonstrating cusp perforation
and subsequent patch repair.
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46. 
Intraoperative
photograph
demonstrating
cusp perforation prior to repair.
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47. 
Intraoperative photograph following patch
repair of cusp perforation with non-fixed
autologous pericardium.
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48. 



Depending on the extent of valve disease, Patient need to
have the valve repaired or replaced.
To repair the valve, surgeon may
commissurotomy or implant a valve ring.
perform
a
A commissurotomy is performed for a tight valve
(stenosis). The valve leaflets are cut to loosen the valve
slightly, allowing blood to pass easily.
Another type of valve repair is a valve ring annuloplasty,
which is sewn in place when the valve is leaking
(regurgitant or insufficient). The valve leaflets are
tucked in place with the ring.
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49. 
Heart valve replacement surgery involves the
removal of the badly damaged valve. The
valve is replaced with a plastic or metal
mechanical valve, or a bioprosthetic valve,
which is usually made from pig tissue. The
damaged valve is cut out, and the new valve
is sewn into place
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50. 
Mechanical valves, which are usually made from
materials such as plastic, carbon, or metal.
Mechanical valves are strong, and they last a long
time

Biological valves : which are made from animal
tissue (called a xenograft) or taken from the
human tissue of a donated heart (called an
allograft or homograft). Sometimes, a patient's
own tissue can be used for valve replacement
(called an autograft)
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51. 
Surgery to repair or replace the mitral valve is often
required in MR. Surgery is generally done for mitral
valve prolapse (MVP) only when MR is present.

Conditions that are most likely to require surgery
include:

Sudden (acute) MR.

MR with symptoms of heart failure.

MR
with
mild-to-moderate
left
ventricular
dysfunction (ejection fraction less than 55%)
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52. 



CONDITIONS THAT MAY REQUIRE SURGERY
INCLUDE:
MR with an irregular heartbeat (atrial fibrillation)
but no symptoms and no signs of functional
damage to the left ventricle.
MR with elevated blood pressure in the lungs
(pulmonary hypertension) but no symptoms and no
signs of functional damage to the left ventricle.
MR with mild to severe left ventricular
dysfunction, no symptoms, and a high likelihood
of preserving some of the related structures of the
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53. 
People who receive a mechanical heart valve are
more likely than those who receive a bioprosthetic
heart valve to develop blood clots in the heart. The
clots may break loose, travel to the brain , and
cause a stroke. So if patient received a mechanical
heart valve to treat severe MR, patient need to take
medicine for the rest of your life to prevent clots
from forming (anticoagulant medicine).
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54. 
Most patients are admitted to the hospital the day
before surgery or, in some cases, on the morning of
surgery.

The night before surgery, patient should take bathe to
reduce the amount of germs on skin.

After admitted to the hospital, the area to be operated
on will be washed, scrubbed with antiseptic, and, if
needed, shaved.
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55. 
Patient is asked not to eat or drink after midnight
the night before surgery.

An electrocardiogram (ECG or EKG) , blood tests,
urine tests, and a chest x-ray should be done.

A (mild tranquilizer) is given before taken into
the operating room.
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56. 


During valve repair or replacement surgery, the
breastbone is divided, the heart is stopped, and
blood is sent through a heart-lung machine.
Because the heart or the aorta must be opened,
heart valve surgery is open heart surgery. After
hooked up to the heart-lung machine, heart is
stopped and cooled.
Next, a cut is made into the heart or aorta,
depending on which valve is being repaired or
replaced.
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57. 

Once the surgeon has finished the repair or
replacement, the heart is then started again,
and are disconnected from the heart-lung
machine.
The surgery can take anywhere from 2 to 4
hours or more, depending on the number of
valves that need to be repaired or replaced.
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58. 


Recovery from heart valve surgery usually
involves a few days in an intensive care unit
(ICU) of a hospital. Full recovery from heart
valve surgery can take several months.
Recovery includes healing of the surgical
incision,
gradually
building
physical
endurance, and exercising.
Patient should
activities.
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59. 


Continue to monitor patient condition.
Watch out for symptoms of blood clots and
infections.
An artificial valve may need to be replaced
after a period of time. Should be informed.
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60. 



Effects from the operation itself (such as bleeding,
infection, and risks associated with anesthesia).
These risks are low.
Blood clotting caused by the new valve. Replacement
with a mechanical valve requires lifelong treatment
with medicine to prevent blood clots (anticoagulant).
Infection in the new valve. Infection is more common
with valve replacement than with valve repair.
Failure of the new valve. Valve failure is more
common with valve replacement than with valve
repair. Bioprosthetic valves last for about 8 to 15
years.
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61. 
Patient has to stay in the hospital for about a
week, including at least 1 to 3 days in the
Intensive Care Unit (ICU).

Recovery after valve surgery may take a long
time, depending on how healthy patient were
before the operation. Patient have to rest and
limit your activities.

Patient have to begin an exercise program or to
join a cardiac rehabilitation program.
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62. 



Most valve repair and replacement operations are
successful. The outcome of mitral valve replacement
depends on a person's overall health, including other
health conditions.
In some rare cases, a valve repair may fail and another
operation may be needed.
Patients with a biological valve may need to have the
valve replaced in 10 to 15 years. Mechanical valves may
also fail, so patients should alert their doctor if they are
having any symptoms of valve failure.
Patients with a mechanical valve will need to take a
blood-thinning medicine for the rest of their lives.
Because these medicines increase the risk of bleeding
within the body, patient should always wear a medical
alert bracelet and inform doctor or dentist about taking a
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63. 
Bacteria can enter the bloodstream during these
procedures. If bacteria get into a repaired or
artificial valve, it can lead to a serious condition
called bacterial endocarditis. Antibiotics can
prevent bacterial endocarditis.

Patients
with
mechanical
valves
say
they
sometimes hear a quiet clicking sound in their
chest. This is just the sound of the new valve
opening and closing, In fact, it is a sign that the
new valve is working the way it should.
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64. 
Minimally invasive heart valve surgery is a
technique that uses smaller incisions to repair
or replace heart valves. This means there is
less pain. Minimally invasive surgery also
reduces the length of the hospital stay and the
recovery time
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65. 
Minimally invasive valve surgery can only be
done in certain patients. This type of surgery
cannot be done in patients

With severe valve damage

Who need more than one valve repaired or
replaced

Who have clogged arteries (atherosclerosis)

Who are obese
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66. 
Transcatheter aortic valve implantation is a
minimally invasive procedure to repair a
damaged or diseased aortic valve. A catheter
is inserted into an artery in the groin and
threaded to the heart. A balloon at the end of
the catheter, with a replacement valve folded
around it, delivers the new valve to take the
place of the old.
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68. 
Heart valve repair or replacement surgery is a
treatment option for valvular heart disease. When
heart valves become damaged or diseased, they
may not function properly. Conditions which may
cause heart valve dysfunction are valvular stenosis
and valvular insufficiency (regurgitation).When
one (or more) valve(s) becomes stenotic (stiff), the
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