Pulmonary valve operation: indicators and their interpretation

What is the pulmonary valve and where is it located?

Pulmonary (PV) or pulmonary valve (PA) is an anatomical structure that separates the cavity of the right ventricle from the pulmonary trunk. The latter takes part in the formation of the pulmonary circulation, delivering venous blood to the lungs through a system of small arteries and capillaries.
In relation to external landmarks, the pulmonary valve is located in the area of ​​attachment of the cartilage of the 3rd rib to the sternum on the left (auscultation point of the PC).

Structural components:

• 3 semilunar valves (flaps): anterior, left, right;
• 3 sinuses (“sinuses”);
• fibrous ring, the main function of which is the supporting frame for the valves.

The flaps are shaped like pockets attached to the fibrous ring, the free edges of which are directed towards the lumen of the vessel. The closure lines of the valves are called commissures. Thickenings in the central part of the valve are Morgagni's nodes.

The valves are formed by three layers:

• ventricular (ventricular);
• median (spongy);
• sinus (fibrous).

The valves are thickest at the point of attachment to the fibrous ring, tapering in the central direction. The valve structures are supplied with blood through separate arteries arising from the pulmonary trunk.

The histological structure of the fibrous ring and leaflets is similar to the structures of the endocardium - the inner connective tissue membrane of the heart. The top layer is represented by a thin epithelium, which protects the surface of the PC from the formation of blood clots. Elastic and collagen fibers of the lower layer provide density and extensibility.

Sinuses (or sinuses) are the space between the valves and the wall of the vessel, the name of each corresponds to the forming valve. The section of the artery wall that forms the sinus has a developed middle layer of smooth muscle cells and connective tissue elements. The latter becomes thinner towards the base of the sinus due to a decrease in the number of myocytes.

The fibrous ring is a triangular strand of dense connective tissue, which consists of collagen (the main component), elastin and a small amount of cartilaginous elements. The structures of the ring continue into the middle layer of the valves.

During embryogenesis, the PC develops from the mesenchyme, being part of the “ventricular outflow tract”.

Hemodynamics

The main function of the pulmonary valve of the heart is to ensure one-way blood flow in the pulmonary circulation system and prevent return (regurgitation) from the pulmonary trunk to the right ventricle.

During systole (the moment the heart contracts), the pressure in the pancreas exceeds that in the arteries, so the valve is in the open state, the valves are pressed against the wall of the vessel. When diastole (relaxation) occurs, blood rushes in the opposite direction, flows into the sinuses, as a result of which the valves close.

The human heart is a muscular organ shaped like an irregular cone and consisting of 4 chambers: two atria and two ventricles. At the beginning of the 2nd week of the intrauterine period of development, 2 vesicles appear from the germinal mesenchymal tissue in the neck area, merging into the heart tube, from the layers of the wall of which a single-chamber (3rd week of development) is first formed, then a two-chamber (beginning of the 4th week of development) and in at the end of the 5th week four-chamber. Gradually the heart moves to the chest area. The heart is located between the lungs, in the mediastinum. It lies asymmetrically: 1/3 of it is to the right of the median plane, 2/3 is to the left. Depending on the shape of the chest, the heart can occupy a vertical, oblique and transverse position. Vertical - for thin, narrow-chested people; transverse - in persons with a wide and short chest and oblique - in transitional forms of the chest. The heart has a base and an apex. The base is facing up. Back and right, top down, forward and left. The borders of the heart are projected onto the anterior chest as follows: the upper border is at the level of the upper edge of the cartilages of the 3rd ribs, the right one protrudes in the form of a convex line 1-2 cm beyond the right edge of the sternum at the level of the 3rd to 5th ribs, the lower one goes obliquely from the 5th right rib, the left one goes obliquely from the junction of the 3rd left costal cartilage with the bony part of the rib to the apex of the heart. The apex of the heart is projected in the 5th left intercostal space 1 cm medial from the midclavicular line.

The thickness of the wall of the right and left ventricles, as well as the atria, is different, it depends on the functions of different parts. Diagram 1 shows the fetal heart before (A) and after birth (B).

Scheme 1. Heart chambers and large vessels. Diagram of blood circulation.

Right atrium. The superior vena cava, inferior vena cava, coronary sinus, which collects blood from the wall of the heart, as well as small veins of the heart flow into it. The fossa ovale is located in the septum between the right and left atria. In this place, the fetus has an oval opening through which blood from the right atrium, bypassing the lungs, enters the left atrium. The foramen ovale closes in the first year of life, but in 1/3 of cases it remains throughout life (one of the forms of congenital heart disease). Contraction of the heart wall is called systole, and relaxation is called diastole. During systole of the right atrium, blood from it flows through the right atrioventricular orifice into the right ventricle. This opening is closed by the right atrioventricular valve (tricuspid), which prevents blood from flowing back during ventricular systole (see Fig. 1).

Figure 1. Heart valves.
Right ventricle. The inner surface of the right ventricle has numerous bars and cone-shaped projections called papillary muscles. Tendon strings stretch from the top of the papillary muscles to the free edge of the tricuspid valve, preventing it from everting towards the atrium during ventricular systole (see Fig. 2). The pulmonary trunk emerges from the right ventricle, through which venous blood flows to the lungs. Its opening during diastole of the right ventricle is closed by the pulmonary valve, consisting of three semilunar valves in the form of pockets. This valve prevents blood from flowing back from the pulmonary trunk into the right ventricle.

Figure 2. Structure of the myocardium. Papillary muscles and chords.

Left atrium. Four pulmonary veins flow into it, through which arterial blood flows from the lungs. The left atrium, like the right, has an additional cavity - the left appendage, and communicates with the left ventricle through the atrioventricular orifice. It is closed by the bicuspid left atrioventricular valve, also called the mitral valve. Left ventricle. The structure of the left ventricle is similar to the structure of the right ventricle; it also contains crossbars and papillary muscles, from which tendinous strings extend to the bicuspid valve. The aorta emerges from the left ventricle. The hole in it is closed by the aortic valve, which has the same structure as the pulmonary valve. The heart wall consists of 3 layers: the inner - endocardium, the middle - myocardium and the outer - epicardium. The endocardium is a thin membrane that lines the cavity of the heart. It consists of connective tissue containing collagen, elastic and smooth muscle fibers, blood vessels and nerves. On the side of the heart cavities, the endocardium is covered with epithelium. The myocardium is the thickest layer of the heart wall, consisting of striated cardiac muscle tissue. The thickness of the myocardium in the atria is 2-3 mm, in the right ventricle – 5-8 mm, in the left – 1-1.5 cm. The difference in the thickness of the muscle layer of the heart cavities is explained by the nature of the work performed: the atria push blood only into the ventricles, the right ventricle into the lungs, and the left ventricle throughout the body. The muscles of the atria are separate from the muscles of the ventricles. The muscle fibers of both the atria and ventricles begin independently from the fibrous rings surrounding the atrioventricular openings. The fibrous rings are like the skeleton of the heart. The musculature of the atria consists of two layers: a superficial, circular layer, common to both atria, and a deep, longitudinal layer, which does not pass from one atrium to another. The musculature of the ventricles consists of 3 layers: outer, middle and inner. The outer longitudinal layer of one ventricle in the region of the apex of the heart passes into the inner longitudinal layer of the other ventricle; between the outer and inner layers there is a middle circular (circular) layer, separate for each ventricle.

Article section: Afofkis section “Heart”

Normal performance

To study the functioning of the CPA at the primary stage, a general clinical examination of the patient is used. Characteristic signs of violations:

• dyspnea;
• pulsation of the neck veins;
• pallor or cyanosis of the upper part of the body;
• during auscultation – additional noise at the point of valve projection.

Making a final diagnosis and choosing adequate treatment tactics depends on the results of instrumental methods that objectively assess the condition of this structure. The most common tests are electrocardiography (ECG) and echocardiography (echoCG).

ECG

There are no specific electrocardiographic signs of PC defects. Changes in the ECG occur when symptoms of heart failure due to a valve defect appear.

With regurgitation or stenosis of the pulmonary valve, hypertrophy of the right ventricle develops, which is established on the ECG in comparison with the state of the left sections.

Severe pancreatic hypertrophy (mass larger than left):

• the ventricular QRS complex is represented by qR or simply R in precordial lead V1;
• in V6 the QRS complex is deformed in rS, RS (occasionally – Rs);
• the degree of hypertrophy is reflected by the height of the R wave in V1 and the depth of S in V6 - the greater the difference between them, the more significant the increase in the myocardium;
• the ST segment in V1 is under the isoline, the T wave is negative;
• in V6 ST is located above the isoline, T-positive.

Moderate hypertrophy (the mass of the pancreas is less than the left one, but impulse conduction is slow):

• The QRS complex in V1 is observed as rsR or rSR;
• V6 deformation in qRS.

Moderate hypertrophy is represented by deformation of the QRS complex:

• in V1 – rS, RS, Rs;
• in V6 – qR;
• the amplitude of the R wave in V1 is increased;
• the S waves in V1 and R waves in V6 are reduced.

A shift of the electrical axis of the heart to the right is noted at each stage of hypertrophy.

ECHO

Ultrasound examination of the heart is considered the gold standard for diagnosing PC defects. The method allows you to study the anatomical features and functional state of the valves. To visualize internal hemodynamics, Doppler echocardiography is used.

The pulmonary valve on ECHO is depicted in the form of a three-lamellar formation, the elements of which bend into the lumen of the vessel during RV systole.

Standard PC indicators:

• structure – normoechoic, homogeneous;
• peak blood flow velocity – 0.5-1.0 m/s;
• average pressure gradient – ​​up to 9 mm Hg. Art.;
• lumen diameter – 11-22 mm.

During ultrasound, the structure of the coronary artery and the presence of pathological formations are studied. The main changes for various defects are presented in the table.

Aortic valve disease: features of its course and treatment

According to statistics, disorders of the cardiovascular system have become increasingly observed in people over 30 years of age. There are many reasons that provoke pathologies. If some diseases are treatable and, by removing provoking factors, one can achieve normalization of health, then others accompany the patient throughout his life and can significantly shorten his life.

Aortic valve disease is a serious pathology. More often requires surgical intervention. It can be congenital or acquired. Appears as a result of narrowing of the aortic mouth or incomplete closure of its valve.

Causes and symptoms

There are no exact statistics on the prevalence of the disease by age group and gender, but cardiologists note that it is detected several times more often in women than in men. The peak number of patients is observed among people of older retirement age. The main reasons may be:

• leaflet calcification;
• progression of rheumatism;
• idiopathic dilatation of the aorta;
• arterial hypertension and endocarditis;
• aneurysm;
• congenital defect of the aortic valve.

Chest trauma, arthritis, syphilis and some pathologies that develop in a person over a long period of time can also give impetus to the appearance or progression of disruption of the normal functioning of the organ.

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Degrees

The risk to the patient's health and the need for surgery depends on the degree of aortic regurgitation.

Depending on the degree, the valves are deformed and the quantitative volume of blood entering the heart through the aorta changes. The initial, first stage of the disease is virtually impossible to determine. The patient’s symptoms are completely absent or feel like side effects of other diseases. This occurs because the heart adjusts to the change in volume and compensates for it.

Symptoms

As the pathology develops, the organ ceases to cope with its functions, and symptoms characteristic of aortic valve disease appear:

• tinnitus and dizziness when moving or changing position;
• increased heartbeat, pronounced pulsation in the blood vessels;
• shortness of breath, fatigue, fainting and pre-fainting states, nausea;
• a pressing feeling of heaviness in the right hypochondrium, as well as swelling of the lower extremities;
• coughing attacks when lying down, standing, feeling of constant weakness.

Due to a lack of oxygen, a person’s complexion becomes pale gray, a bluish tint to the lips is observed, and typical circles appear under the eyes. Also, when examining a patient, the cardiologist examines the presence and severity of symptoms:

• the difference between the upper and lower blood pressure readings;
• pulsation on the carotid arteries, uvula and tonsils;
• reaction of the pupils to heart contractions, heart murmurs;
• changes in the size of the organ, protrusion in the chest area.

Diagnostics

Accurate diagnosis of the disease can only be made on the basis of objective data, a complete cardiac examination, biochemical blood test and a number of other tests.

Based on the presence of clinical symptoms, the severity of the defect, and the severity of aortic insufficiency, a decision about surgery is made. In elderly patients, due to the low contractility of the organ, the functional impairment is almost invisible. The severity of the pathology can be determined after studying the area of ​​the hole in relation to the blood flow. Arterial insufficiency is determined by the indicator of reverse blood flow.

By listening, a cardiologist can determine the onset of development of bicuspid aortic valve disease:

• with stenosis, a systolic murmur is characteristic with a weakening of the 2nd tone in the aorta;
• Insufficiency is indicated by a murmur during diastole.

It is necessary to study the functioning of the heart by:

• ECG;
• X-ray examination;
• MRI to exclude coronary insufficiency and other pathologies.

However, the basis for choosing treatment is echocardiography.

When diagnosing, an accurate description of the patient’s feelings is of great importance, so before the appointment, you can write down all the complaints and let the doctor read them.

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Treatment at different stages

Depending on the cause, extent, stage of aortic valve disease and other factors, different treatment methods may be used. The patient must be regularly observed by a specialist and undergo the examinations prescribed by him. In the absence of obvious symptoms:

• mild defect – once every 3 years;
• moderate form – once every 24 months;
• severe degree - annually, sometimes more often.

The following medications are prescribed:

• rheumatic nature of the disease - antibiotics;
• arterial hypertension - to normalize blood pressure.

Surgical intervention is not required, only constant monitoring by the attending physician is required.

If clinical complaints appear, to alleviate the patient’s condition in the preoperative period or if surgery is impossible, the following is prescribed:

• inhibitors, diuretics, nitrates;
• vasodilators and beta blockers;
• drugs that improve blood circulation.

A timely operation can help completely get rid of aortic valve disease. When blood reflux in an amount not exceeding 30% and slight deformation of the valves, intra-aortic balloon counterpulsation is recommended. In case of severe structural changes that allow more than 30% blood flow, implantation is required.

Surgery

In a person with heart disease, the bicuspid aortic valve requires replacement or replacement in several cases.

Surgical intervention is mainly performed after 30-35 years, but with the accelerated development of the disease it can take place at any time. The number of contraindications to prosthetics is minimal. They are:

• decompensated diabetes;
• oncological diseases;
• post-stroke condition;
• exhaustion and anemia.

For each patient, his condition is predicted at the time of the operation and during the rehabilitation period. Depending on this, a conclusion is given about the possibility of returning to normal life.

Forecast

The construction of treatment plans for the disease and the choice of methods occurs after diagnosis and identification of the severity of the aortic valve defect.

Mild hypertrophy with strong obstruction of blood flow leads to a decrease in the number of heart contractions and, accordingly, gradually reduces the therapeutic effect of surgery.

The process of hypertrophy allows, at a certain stage of the disease, to stabilize the functioning of the heart, but at the same time it can cause the development of angina pectoris and increase the likelihood of a heart attack.

If aortic heart valve disease developed asymptomatically, and then its rapid progression began, then the subsequent life expectancy of a person is no more than 3 years.

Risk factors and disease prevention

Aortic valve defects can be divided into 2 groups.

There are no preventive measures that guarantee complete protection against the disease, but the following help reduce the risk:

• timely treatment of streptococcal infections;
• if you have rheumatism, constant monitoring by a specialist;
• taking certain groups of antibiotics and other drugs prescribed by a cardiologist;
• complete exclusion of alcohol, drugs and smoking;
• engaging in acceptable forms of exercise.

Aortic valve disease needs to be treated using scientific methods of therapy. Traditional methods do not have the desired effect and can lead to missed deadlines when the disease can be cured. Therefore, in case of any deviations, medical attention is needed.

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Acquired heart disease - symptoms and treatment

There is no medicine that can reverse the process and restore the valve to its original state. With the help of medication, it is only possible to influence the cardiovascular system and reduce the risk of complications. In severe cases, surgical treatment methods are used.

Drug treatment

The goal of therapy is to eliminate the causes of circulatory failure, improve the functional state of the myocardium, restore normal blood circulation, microcirculation (transport of blood cells and substances to and from tissues) and prevent recurrent circulatory disorders. Treatment for chronic circulatory failure includes a complete balanced diet and drug therapy.

The main groups of drugs used for valve dysfunction:

1. ACE inhibitors (angiotensin-converting enzyme) - enalapril, lisinopril, ramipril, perindopril, fosinopril. The drugs block the conversion of the hormone angiotensin I to angiotensin II. Angiotensin II has a vasoconstrictor effect and causes a rapid increase in blood pressure. ACE inhibitors are used to treat hypertension and treat or prevent heart failure.

2. Beta blockers - carvedilol, bisoprolol, metoprolol. These drugs lower blood pressure and normalize heart rate. The action is caused by blocking beta-adrenergic receptors, which are responsible for the body's response to stress.

3. Mineralocorticoid receptor antagonists - spironolactone, eplerenone. The drugs lower blood pressure and have a diuretic effect, reducing fluid content in tissues.

There are different types of heart defects, and different combinations of drugs are used to treat each of them. Concomitant pathologies and individual characteristics of the patient are also taken into account.

For example, when congestion predominates, diuretics (furosemide, torsemide) are additionally prescribed, which reduce the volume of circulating blood, reducing congestion in the pulmonary and systemic circulation. If blood clots are present or there is a high risk of their occurrence, anticoagulants are used - drugs that reduce blood clotting (warfarin, rivaroxaban, dabigatran, apixaban).

Relatively recently, a new class of drugs was developed - angiotensin-neprilysin receptor inhibitors (sacubitril). Their main effect is to increase the amount of peptides cleaved by neprilysin. The drugs increase diuresis (urine volume), natriuresis (sodium excretion in the urine), cause relaxation of the myocardium and prevent processes of disruption of the structure and function of the heart.

If it is impossible to use beta blockers, it is recommended to replace them with If channel inhibitors (ivabradine), which also reduce the heart rate. If it is impossible to use ACE inhibitors, angiotensin receptor blockers (losartan, valsartan, candesartan, telmisartan, irbesartan, olmesartan) are used. They have properties similar to ACE inhibitors, but do not reduce the synthesis of angiotensin II, but block angiotensin receptors [6].

Surgery

If there are indications, the effectiveness of drug treatment is insufficient and there are no contraindications, surgical methods are used. Many patients are afraid of the need for heart surgery. In some cases, surgical methods do carry some risk, but there are fairly safe operations that are not open heart and without large incisions. Such operations include balloon commissurotomy for mitral valve stenosis. The method consists of widening the valve using a catheter passed through the artery.

Before surgery, the necessary laboratory and instrumental studies are carried out and the patient’s condition is stabilized with medications. When preparing for surgery, it is important to reduce shortness of breath, swelling, and normalize pulse and blood pressure.

A common surgical method is artificial or biological valve replacement. There are also valve-sparing operations, which involve plastic surgery of a damaged valve.

Surgical treatment significantly improves the quality of life, however, after surgery, medication continues, but is adjusted if necessary. In addition, after certain operations, such as artificial valve replacement, anticoagulant therapy is constantly taken. The drugs are necessary because the risk of thromboembolic complications (blockage of arteries with blood clots) increases [5].

Acquired heart defects (AHD)

Heart valve defects

Valvular heart disease is characterized by damage or defect of one of the four heart valves: mitral, aortic, tricuspid or pulmonary.

The mitral and tricuspid valves control the flow of blood between the atria and ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve regulates the blood flow between the heart and the aorta, and therefore the blood vessels to the rest of the body. With normal heart valve function, blood flows with the proper force in the right direction at the right time.

With a heart defect, the function of the valve is impaired; it can become too narrow (stenosis), which is why it does not open completely, or expand and cannot close completely (insufficiency). A narrowed valve prevents blood from flowing out of the chamber of the heart, while when it fails, the blood flows back into the chamber from which it previously came out. Impaired valve function leads to enlargement and thickening of the heart muscle, reducing its elasticity and efficiency.

The most common defects are the mitral and aortic valves.

The severity of heart disease varies. In mild cases there may be no symptoms, but in advanced cases the defect can lead to congestive heart failure and other complications. Treatment depends on the extent of the disease.

Causes of heart valve defects

There are many reasons. Some of them are present at birth (congenital), while others can be acquired later in life:

• aging of valves: heart valve tissue can degrade with age due to atherosclerosis, lose elasticity and become hard;
• rheumatism;
• bacterial endocarditis;
• high blood pressure;
• myocardial infarction;
• heart tumors
• systemic diseases (rheumatoid arthritis, systemic lupus erythematosus, syphilis);
• radiation therapy used to treat cancer.

Symptoms that may appear due to heart valve disease

Symptoms of heart disease can occur suddenly, depending on how quickly the disease progresses. When the disease progresses slowly, your heart may adjust and you may not notice the onset of any symptoms. It is important to understand that the severity of symptoms is not equivalent to severe heart valve disease and, conversely, symptoms may be completely absent in cases of severe heart valve disease.

Symptoms of heart disease include:

• Shortness of breath during exercise, fatigue
• Swelling of the extremities, rapid weight gain due to fluid accumulation
• Palpitations or irregular heartbeat
• Chest pain
• Dizziness or fainting
• Fever (if the valve is infected)

To identify and treat heart valve diseases, correct and timely diagnosis is important.

Diagnosis of defects

Valvular heart disease can be detected by listening to characteristic sounds known as heart murmurs.

To fully diagnose the defect, you need to undergo one or more of the following studies:

1. An electrocardiogram (ECG) shows the heart's electrical activity, regularity of heartbeats, thickening (hypertrophy), and damage to the heart muscle from coronary artery disease.
2. A chest x-ray shows enlargement of the heart chambers due to dysfunction of the heart valves.
3. Echocardiogram (EchoCG) is the gold standard in modern diagnostics. In an echocardiogram, sound waves bouncing off the heart are recorded and converted into images. The scans can reveal abnormal size, shape, and movement of the heart and valve dysfunction.
4. Coronary angiography, which involves inserting a catheter into the heart to assess the condition of the vessels supplying the heart.

Mitral valve defects

There are three types of mitral valve dysfunction:

1. Mitral valve prolapse is when both valve leaflets are enlarged and bulging, preventing them from closing evenly.
2. Insufficiency is when the valve leaflets do not close tightly, causing blood to leak back into the left atrium of the heart. Deficiency can occur suddenly (acute) or, more often, gradually over time (chronic). Acute mitral valve regurgitation is often caused by damage to the heart, such as a heart attack or infective endocarditis.

There are many reasons why chronic mitral valve insufficiency can develop. Symptoms include fatigue, shortness of breath on exertion and while lying down, and irregular heartbeat.

1. Stenosis—the mitral valve leaflets thicken, become rigid, and may even fuse together. Because of this, the valve opening narrows. Among adult patients, stenosis is more common in women, and the main cause is rheumatism. Symptoms include shortness of breath on exertion, swelling of the lower extremities, and cardiac arrhythmias. In some patients, clots (thrombi) form in the left atrium. These clots can travel through blood vessels and damage the brain, spleen, or kidneys.

Aortic valve defects

Aortic valve regurgitation occurs when the valve leaflets do not close and blood flows back into the left ventricle of the heart. A patient may have significant aortic regurgitation for many years without developing significant symptoms. Signs of the disease include palpitations, shortness of breath on exertion or while lying down (there may be sudden severe shortness of breath in the middle of the night), chest pain.

Aortic valve stenosis affects men more often than women. This is a condition where the valves thicken, become stiff and fuse together, narrowing the valve and preventing the normal flow of blood from the heart to the aorta and the rest of the body. Aortic valve stenosis usually does not cause symptoms until the valve opening has narrowed to about one-third of normal size. Symptoms include shortness of breath on exertion, chest pain, and fainting.

Tricuspid valve insufficiency

This is a heart defect characterized by incomplete closure of the tricuspid valve leaflets and the reverse flow of blood from the right ventricle into the right atrium.

Damage to the tricuspid valve, like other heart valves, can be caused by rheumatism, myxomatosis, infective endocarditis, or chest trauma.

Tricuspid valve insufficiency may also not be associated with damage to the valve itself, but may arise as a result of a long course of mitral and aortic defects, in the absence or improper treatment of them.

Treatment of heart valve defects

Treatment for heart valve disease will depend on the type and severity of the condition and may include medication or surgery.

If the heart defect is significant and medications do not help, surgery is performed to repair or replace the heart valve. Currently, heart valve surgery strives to perform valve-sparing operations. Thanks to improvements in reconstructive surgery techniques, it is possible to restore the valve even with infective endocarditis. In other cases, the valve is replaced with an artificial prosthesis.

Artificial heart valves

Artificial heart valves have improved significantly since their invention, and cardiac surgeons now have prostheses that can perform the function of their own valve as closely as possible.

Depending on the composition, artificial heart valves can be mechanical or biological. Mechanical valves are made entirely of synthetic materials, their advantages are strength, durability and wear resistance. The disadvantage is the need for lifelong use of anticoagulants (blood thinners) to prevent the formation of blood clots.

Artificial heart prostheses

Biological valves are made from animal heart tissue and treated with special solutions that increase wear resistance and prevent immune rejection after implantation. The advantages of biological prostheses are that there is no need for lifelong use of anticoagulants. Disadvantage: rapid wear, limited age of the patient. Biological prostheses are recommended for patients over 70 years of age; their service life is about 10-15 years.

Heart surgery

In most cases, the surgeon makes an incision in the middle of the sternum to reach the heart, uses a heart-lung machine to circulate blood throughout the body during surgery, stops and opens the heart to reach the diseased valve, then repairs or replaces the valve.

Heart valve surgery is also performed through a small incision on the right side of the chest using video support.

Patients with aortic stenosis can undergo aortic valve replacement with a biological prosthesis through the femoral artery or the apex of the heart - without cutting the sternum and stopping the heart. This operation is performed on older patients at high risk of standard open heart surgery. In this case, only biological prostheses are implanted.

After heart surgery

The World Health Organization (WHO) has defined health as not only the absence of disease and illness, but also the presence of physical, mental and social well-being. The goal of heart surgery is not only to prolong life, but also to improve functional mobility and quality of life.

Open heart surgery is a major procedure and requires time to fully recover. It depends on the age and general health of the person, as well as the complexity of the operation.

If you seek surgical help in a timely manner, it is possible to avoid postoperative complications and go through a short recovery path in almost 100% of cases.

During the first two weeks the patient feels tired and weak, the general condition gradually recovers over the next month. During this period, you need to limit heavy physical activity and give up sports. You need to leave the house at least 2 times a day for a short walk and try to increase your load a little every day. The sternum will heal completely within two months, after which it will be possible to return to normal household activities.

For many patients, returning home after heart surgery is a great relief, but for some it can be quite frightening. Follow the recommendations of your doctor, take prescribed medications on time, the duration and quality of your life depends on this.