Pulmonary Valve Repair and Replacement Procedure
Overview
The pulmonary valve sits between the right ventricle and the pulmonary artery. Its main role is to help control how blood moves from the heart’s right side into the lungs. This valve has small flaps called cusps that let blood pass through in one direction when they open and stop blood from going back when they close.
If the pulmonary valve is damaged, it may not open or close as it should. This can make it hard for blood to move from the right ventricle to the lungs. Pulmonary valve repair and pulmonary valve replacement are two procedures that help restore healthy blood flow and improve symptoms linked to valve problems.
| Valve Location | Role in Blood Flow | Valve Structure |
|---|---|---|
| Between right ventricle and pulmonary artery | Sends blood to lungs for oxygen | Made of movable cusps |
Main Methods
Annuloplasty is a procedure that uses a ring to tighten or reshape the valve opening. This can help the mitral, tricuspid, or aortic valves work better. Valvuloplasty involves using a balloon to stretch a stiff or narrowed valve. This method is often used for the mitral and aortic valves.
| Valve Type | Annuloplasty | Valvuloplasty |
|---|---|---|
| Mitral | Yes | Yes |
| Tricuspid | Yes | Sometimes |
| Aortic | Sometimes | Yes |
Reasons for the Procedure
Surgeons perform pulmonary valve repair or replacement when the pulmonary valve does not work as it should. This usually happens due to certain conditions that affect the valve’s ability to manage blood flow between the heart and lungs. Here are some main reasons for the procedure:
- Pulmonary Valve Regurgitation: The valve fails to close all the way, causing blood to flow backward into the heart.
- Pulmonary Valve Stenosis: The valve becomes too stiff or thick, making it hard for blood to pass through. The heart then has to work much harder.
- Pulmonary Atresia: There is no proper valve, and tissue blocks blood flow from moving between parts of the heart.
People with heart valve disease, pulmonary hypertension, or congenital issues like tetralogy of Fallot may be more likely to need this surgery. Symptoms such as chest pain, shortness of breath, or fatigue often lead doctors to suggest an intervention. Doctors look at several factors before planning surgery:
| Factor | Description |
|---|---|
| Disease severity | How advanced the valve problem is. |
| Patient symptoms | Signs like shortness of breath and tiredness. |
| Age and health | The patient’s overall fitness and other issues. |
| Need for other repairs | If additional heart surgery is needed. |
Having this surgery at a center with experience in heart valve operations can improve success rates. Both children and adults with certain types of heart disease may benefit from early or combined treatment.
Potential Complications
Pulmonary valve repair and replacement can have several risks. Some common issues include bleeding, blood clots, and infection. Patients may also experience chest pain, irregular heartbeats (arrhythmias), fluid buildup, or stroke.
Other possible problems are valve failure, valve stenosis, valve insufficiency, regurgitation, or the need for a pacemaker. In rare cases, pulmonary regurgitation or infective endocarditis can develop.
Getting Ready for the Procedure
What to Know About Eating and Taking Medicine
Before going to the hospital, inform the care team at Healthnile about all medications currently being used. Make a list of every prescription, over-the-counter drug, vitamin, and supplement. Include known allergies or any past reactions to medicine so the team is well informed.
Ask when to stop eating or drinking before the procedure. There may be specific instructions, such as not eating or drinking after midnight on the night before surgery. Always follow these directions closely to help reduce medical risks.
What to Pack and What Not to Wear
Bring a written list of medications with dosages. Also, gather personal items like eyeglasses, hearing aids, or dentures. A small bag with everyday items—such as a hairbrush, toothbrush, and shaving supplies—should be packed. Wear loose, comfortable clothing for the hospital stay.
- Include an advance directive if you have one, so the care team knows your care preferences.
- Bring something enjoyable, like a book or music, to help relax during recovery.
Do not bring or wear jewelry, nail polish, contact lenses, or anything valuable. Leave these at home. For safety, avoid wearing dentures and glasses during the procedure, but bring them to use afterward.
| Bring | Leave at Home |
|---|---|
| Medicine list | Jewelry |
| Personal items | Contact lenses |
| Loose clothes | Nail polish |
| Advance directive | Dentures during surgery |
What You Can Expect
Before surgery, a healthcare provider will insert an IV line into the arm or hand to give fluids and medicine. The surgical team often shaves the area where the surgery will be done and cleans the skin with special soap to lower the chance of infection. These steps prepare the body for the operation and keep the site as clean as possible.
What Happens During Surgery
During the operation, the medical team gives medicine to help the patient sleep and feel no pain, a state called general anesthesia. The team connects the patient to a machine that takes over the work of the heart and lungs. This heart-lung machine keeps blood moving through the body and supplies oxygen while the heart is stopped for the surgery.
Repairing the Pulmonary Valve
Surgeons most often perform pulmonary valve repair as open-heart surgery. The surgeon opens the chest bone, called a sternotomy, to reach the heart. Once inside, the surgeon may:
- Separate flaps of the valve that are stuck together.
- Shape one or more new flaps using tissue from the patient’s own heart.
- Remove old patches from earlier surgeries, bringing the flaps together to help the valve work again.
- Trim or reshape tissue so the valve closes more tightly.
- Tighten or support the ring of tissue (annulus) around the valve.
The surgical team performs all these steps to restore proper valve function without needing to replace it. After the repair, the team wires the chest bone back together.
Key Points
| Task | Purpose |
|---|---|
| Separation of fused flaps | Helps valve open and close better |
| Creation of new valvular tissue | Fixes shape and function |
| Removal of old patches | Restores normal valve structure |
| Tightening support ring | Prevents leakage |
Less Invasive Valve Repair Methods
When possible, doctors may choose a less invasive way to repair the pulmonary valve, such as balloon valvuloplasty. This method uses a thin, flexible tube, called a catheter, with a balloon on the tip. The team inserts the balloon through a blood vessel in the arm or groin and guides it to the heart.
Once in place, the balloon is inflated to stretch the valve open. This can make it easier for blood to flow through the heart. Afterward, the team removes the balloon and catheter. Balloon valvuloplasty is common in babies and children with a narrowed pulmonary valve but is less effective in adults because the valve may shrink again, and more procedures may be needed later.
Benefits of Minimally Invasive Repair
- Smaller incisions
- Shorter stay in the hospital
- Faster recovery
- Less pain after surgery
- Lower chance of infection
Replacing the Pulmonary Valve
If the valve cannot be fixed, surgeons may need to replace it. Valve replacement surgery involves removing the old valve and putting in a new one. The new valve can be mechanical (made from strong materials) or from animal or human tissue (called biological valves).
People with mechanical valves usually need to take blood thinners for the rest of their lives to prevent clots. Biological valves do not last as long and may need to be replaced after several years. The choice of which type of valve to use depends on the person’s age, health, and needs.
Doctors and patients talk about these options to decide what is best. Pulmonary valve replacement can be done as open-heart surgery or by using smaller incisions with less invasive techniques.
Comparison Table: Mechanical vs. Biological Valves
| Feature | Mechanical Valve | Biological Valve |
|---|---|---|
| Longevity | Lasts long (decades) | Wears out in 10-20 years |
| Blood thinners | Needed for life | Often not required |
| Material | Metal and composites | Animal or human tissue |
Less Invasive Valve Replacement Procedures
Some people can have their valve replaced with a minimally invasive procedure. The most common method is transcatheter pulmonary valve replacement. The team places a catheter in a large blood vessel in the groin or chest and guides it to the heart.
The replacement valve travels through the catheter. A tiny balloon expands the new valve into place inside the heart. This avoids the need to open the chest and is especially helpful for those who have already had other heart surgeries.
If a replacement valve from an earlier surgery stops working, the team can often place a new valve inside the old one by this same method, known as a valve-in-valve procedure.
Advantages
- No chest opening required
- Less pain and scarring
- Faster return to normal activities
After Surgery and Recovery
After repairing or replacing a valve, most patients go to the intensive care unit. Nurses and doctors monitor the patient’s heart rate, blood pressure, and breathing closely. The team gives fluids and medicines through an IV, and other tubes may drain the bladder and remove fluid or blood from the chest.
Oxygen may be given with a mask or nasal tube. Once stable, the patient moves to a regular hospital room. The amount of time in the hospital depends on how the surgery was done and the person’s overall health.
During recovery, the care team helps manage pain, checks for infection, and encourages the patient to walk and do breathing exercises. These steps help the patient get stronger and lower the risk of problems.
Recovery Checklist
- Monitor for infection at incision sites.
- Take all medicines as directed.
- Keep track of pain or side effects.
- Gradually increase activity and walking.
- Follow wound care instructions.
Before going home, the patient receives a set of instructions on how to care for the surgery area, manage discomfort, take prescriptions, and watch for warning signs of infection.
Outcomes
Recovery after pulmonary valve repair or replacement varies, but success often depends on the skill of the healthcare team and the experience of the facility. Most individuals attend follow-up checkups to monitor valve function and heart health.
Many people benefit from a personalized cardiac rehabilitation program after surgery. This program often begins in the hospital and continues for several weeks at home. Elements of this program usually include:
- Regular physical activity
- Healthy eating habits
- Weight control
- Stress management techniques
- Quitting tobacco products
- Getting 7 to 8 hours of rest each night
A care team provides education and support to encourage patients to return gradually to daily routines like working, driving, and exercise. Advances in technology and ongoing training for medical staff contribute to improved outcomes and safer recoveries. The combination of surgical skill, patient effort, and technology supports better long-term heart health.
