Contents
The tricuspid valve is a movable septum between the right ventricle of the heart and the right atrium. The valve is involved in blood circulation, through it the blood flows from one part of the heart to another. Violations in this part leads to an overload of the right side of the heart, provokes a circulatory failure, worsens the quality of life of the patient, even threatens with death. An effective method of treatment is valve plastic surgery, during which its structure and mobility are restored.
Description of the procedure
The heart is divided into chambers, the blood between them circulates through the valves. There are four valves in the heart, and the failure of at least one causes severe damage to health. The tricuspid or tricuspid consists of three cusps that open and close during the heartbeat. When the valves open, blood passes through them and flows from the right ventricle into the right atrium. The leaflets close tightly to prevent the outflow of blood back.
If the valve does not open fully, it is called stenosis. In this case, the blood flow is disturbed, the ventricle is overloaded. If the leaflets do not close completely, this is called tricuspid insufficiency.
Tricuspid valve repair is intended to restore its function.
This is a rather complicated surgical intervention, which is always performed under general anesthesia, most often with the use of a heart-lung machine (AIC). Depending on the problem (stenosis or insufficiency), choose the appropriate tactics.
In case of stenosis, the leaflets can grow together or thicken, during the operation they are manually separated, sutured in the right places. If failure is diagnosed, sutures are placed around the circumference of the valve to restore the shutter.
As a result of such actions, normal blood circulation is restored, the load on the heart is reduced.
Often, for effective treatment, special rings and half rings are installed at the time of surgery. These constructs can be artificial or biological, the latter being preferable because they are more easily accepted by the body and do not require lifelong medication. Rings are sewn around the perimeter of the valve apparatus, they restore the required clearance and ensure normal closure of the leaflets.
At the same time, such a reconstruction provides a long-term result, since it does not allow the fibrous ring to re-expand. Also, plastic surgery of the tricuspid valve may involve the complete excision of its leaflets and replacement with an implant. Such measures are resorted to when it is impossible to rehabilitate native sashes.
When plastic surgery is indicated
Such manipulations are carried out in two cases: when the valves do not open well and when they do not close completely. This can happen due to acquired diseases or congenital anomalies. Congenital pathologies of the tricuspid valve are very rare. Usually, valvular disorders are caused by acquired ailments:
- heart injury;
- infectious diseases;
- systemic lupus erythematosus;
- rheumatism of the heart muscle;
- carcinoid syndrome.
Stenosis and insufficiency in the tricuspid septum are very rarely independent diseases. As a rule, these are the consequences of other pathologies. Violations in the work of the mitral valve, located on the left side of the heart, put a load on the right side.
As a result, the right atrium and ventricle cannot cope with the load, the valve is deformed. Violations in the operation of the valvular apparatus at first may not manifest themselves, but over time the patient feels:
- strong heartbeat;
- shortness of breath;
- swelling of the lower extremities;
- pain in the chest;
- bloating;
- weakness, frequent fatigue.
Also, failures in this area are accompanied by an increase in jugular veins. Even the patient himself can distinguish swollen veins in the neck. The skin becomes earthy yellow, as the liver often also suffers from impaired blood circulation.
Periodically, nausea, belching, heaviness in the abdomen may occur. The need for plastic is established only after a thorough examination and clarification of the diagnosis.
Preparing for valve repair
The first step in patient preparation is diagnosis. To clarify the diagnosis, an ultrasound of the chest, ECG, blood and urine tests are prescribed. In some modern clinics, the heart is examined on a CT scanner. Angiography of the vessels of the heart and or CT show in detail the heart muscle and blood circulation in it, during the studies, the radiologist can accurately determine tricuspid stenosis or insufficiency. After the tests, the patient undergoes a consultation with a cardiac surgeon, a neuropathologist, a therapist.
If valve disorders are accompanied by additional heart problems, they try to get rid of them before the operation. So, for example, with arrhythmias, the heart rhythm is first normalized. If the clinical picture is complicated by heart failure, a diet with the exception of sodium is prescribed. A few days before the procedure, all patients are shown a diet, you need to give up salt, too fatty, spicy, drink less water. You can’t eat 8 hours before plastic surgery. As part of the preparation of the patient, the attending physician explains to his ward how the plastic of the tricuspid valve is done. It is important that the operated person does not worry, does not overload the heart and nervous system. If you have concerns or fears, you should talk to your doctor about it.
Performing an operation
Reconstruction of the valve apparatus takes place in a hospital, in the operating room. Before this, the patient is given premedication: sedatives and hypnotics are administered intravenously. Throughout the process, the patient’s condition will be monitored by assistants using connected equipment. When sleep comes, the surgical team begins manipulations.
- The surgeon makes an incision in the chest. If they make their way to the heart through the intercostal space, it will not be necessary to cut the bones of the sternum. In most cases, the doctor opens the chest, then gets to the valve in layers.
- The heart is forcibly stopped, a heart-lung machine is connected. During the process, this apparatus will saturate the blood with oxygen and give it the right temperature while the heart is “off”.
- Then the actions of the surgeon will depend on the pathology itself. To restore the lumen, the leaflets can be cut and sutured, most often sutured around the circumference of the valve. There are several suturing techniques, with moderate dilatation, de Vega sutures are usually applied. If the closure of the valve is corrected, rings, half rings or a tape are most often sewn in. The implantation of such structures is called “annuloplasty”. If it is impossible to restore the functions of the tricuspid valve, its leaflets are removed, and a prosthesis is placed in their place.
- Before turning off the AIC, the doctor checks the operation of the operated or prosthetic valve. The shortcomings are corrected, the heart-lung machine is turned off.
- The place of incisions is sutured in layers, the external seams are treated with sterilizing agents. Then apply a tight bandage.
- The patient’s condition is reassessed and he is transferred to the intensive care unit. When the effect of anesthesia wears off, the patient is placed in the intensive care unit.
After the operation, the patient remains under the supervision of doctors for another week. This is necessary in order to control the results of plastic surgery and prevent complications. In the early days, bed rest, moderate drinking, and diet are indicated. After the final examination, the patient is discharged home.
Postoperative period
During discharge, the doctor gives his ward instructions on nutrition and lifestyle, sets the date for the next examination. In the postoperative period, you must follow the prescribed diet, which will exclude:
- fatty;
- roast;
- too spicy and salty.
During recovery, stress is very unfavorable, so it is important to ensure a calm and measured pace of life. If necessary, the attending physician may prescribe drugs to maintain the nervous system if the ward is too sensitive. Alcohol in the first month after valve reconstruction is completely excluded. It is also important to quit smoking. Visits to the doctor will be scheduled, at first, examinations are scheduled every month, if there are no complaints. An unscheduled visit to the doctor is worth in such cases:
- bleeding from the wound, swelling, itching in this part;
- persistent chest pain (maybe at first);
- causeless fever;
- frequent dizziness and nausea.
During the appointment, the cardiologist will listen to the heartbeat, breathing rhythm, measure pressure. Diagnosis is also periodically shown: ultrasound, ECG, tests. This is necessary in order to track the recovery process.
Physical activity should be moderate, it is recommended to walk more often in the fresh air, the step should be unhurried.
When it will be possible to return to full activity, the doctor will tell. Also, to maintain the work of the heart and the whole body, medication is prescribed. If a biological prosthesis was implanted, anticoagulants are indicated in the first three months. If an artificial prosthesis was sewn in, anticoagulants are indicated for life.
Plastic results
Symptoms of stenosis or tricuspid insufficiency disappear immediately after surgery. In the first 1-2 months after it, the patient’s condition will gradually improve if the manipulations went without complications. Negative consequences may include:
- bleeding;
- heart attack;
- the formation of blood clots and blockage of blood vessels;
- visual disturbances, appetite, sleep (is the norm, disappears within a month);
- infection;
- hemolytic anemia.
Scheduled and unscheduled inspections are scheduled to prevent such consequences. In most cases, the prognosis for plastic surgery of the tricuspid valve is positive, the work of the heart is restored, the patient returns to his usual way of life.
Complicates the postoperative period taking anticoagulants, which reduce blood clotting. Biological implants do not require constant intake of anticoagulants, but the duration of such prostheses is limited. Observations of patients show that a biological implant lasts an average of 9-10 years.
Mechanical analogues are distinguished by a long service life; they retain the work of the heart for 20-25 years. But during all this time you need to take drugs that reduce blood clotting. When the life of the implant has passed, it is replaced with the next one. If ordinary sutures were applied during the plastic surgery, reoperation may not be required. However, long-term patient survival is better with rings than with conventional sutures.
Where is tricuspid valve plasty done?
The reconstruction of the tricuspid valve is carried out in large regional centers. Such services are provided by specialized medical centers, cardiac surgery departments of clinics and hospitals. The price for such a procedure is on average 3000-3500 dollars.
The cost may be higher, it depends on the reputation of the clinic, the qualifications of the surgical team, the complexity and degree of pathology.
When choosing a clinic, it is better to give preference to proven doctors, read customer reviews, learn about the experience of the medical staff, especially the surgeon.
Tricuspid valve repair is a complex procedure designed to improve the patient’s life. Often such manipulations are needed to save the patient. The operation allows you to restore the work of the heart, get rid of the narrowing of the valve or its insufficiency. Prosthetics reduce the risk of heart attacks. Compliance with all the recommendations of the doctor will ensure a speedy recovery and return to a full life.