Posts Tagged ‘pulmonary valve’

Moving Your Valves Around

September 29, 2009

Don’t be surprised to hear about more CHDers having the Ross Procedure to repair a damaged Aortic Valve. Invented by British surgeon Donald Ross in 1967, the Ross procedure is performed on roughly 1500 patients each year.

During the Ross Procedure, both the Aorta and the Pulmonary Artery are clamped and cut near the junction with the heart. The damaged Aortic Valve is then removed and discarded. The Pulmonary Valve is then removed and sewn into the Aortic Valve’s place. A frozen Pulmonary Valve (previously removed from a cadaver) is then reanimated and sewn into the opening left by the original Pulmonary Valve. In the final step, the Aorta and the Pulmonary artery are then sewn back into place. If this is a little confusing, here’s a helpful diagram.

It does seem a little strange – if you recall our memory trick for remembering the proper order of the valves, it’s “Three People Might Agree” – blood flows normally through the Tricuspid Valve, then the Pulmonary Valve, out to the lungs and back to the heart; through the Mitral Valve, and finally through the Aortic Valve and out to the body. T – P – M – A, or Three People Might Agree. If you follow the route after a Ross Procedure, you go through the Tricuspid, Pulmonary, Mitral, and another Pulmonary… Three People Might People! That makes no sense! But it works.

New research has shown that the Ross Procedure has a high survival rate, and the cadaver valve works well – after 20 years, 80% of Ross patients did not need replacement of either Pulmonary Valve. The operation also has the advantage of growing with the patient (great for children!) and no need for anticoagulation… Goodness knows, I wish I didn’t have to have an INR test ever few weeks!

New valve, no surgery!

August 18, 2009

So you need a new heart valve. Oh, boy. I bet you are just looking forward to the prospects of open heart surgery: having your chest split open, the pain when you cough (and if you think coughing hurts, just wait until your first post surgical sneeze!) and spending two to three months recovering. Or maybe you are like me… after all the problems with the scar tissue tearing and nearly bleeding out during my last operation, the docs aren’t going to go back in my chest any time soon. So what now?

The answer used to be “Just do the best you can,” because there were no other options. But now inserting a heart valve via catheterization is becoming more and more common – New York’s Presbyterian Hospital has implanted its 100th heart valve – and they never split anyone’s chest!

Before you pick up the phone and call the hospital, there is one problem – all 100 were done as part of a clinical trial. Most likely, they’ll have to turn you down, because these are tests of new valves carried out under controlled conditions. But every time they implant a valve, hopefully they learn something new. Presbyterian is replacing Aortic valves; a Pulmonary valve replacement was introduced a few weeks ago. It’s new to us, but they have been using it in Europe for some time.

So perhaps one day – not too far into the future – valve replacement by catheter will be the way things are done!