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Aortic Valve Repair and Replacement 

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aortic valve illustrationWhat is the Aortic Heart Valve?
The aortic valve is located in the heart deep inside the body. It regulates the main supply of blood to the body's major vessels. Two of the most common ailments of the aortic valves occur with:

aortic stenosis, or narrowing of the aorta, which inhibits the forward flow of blood, and

aortic insufficiency, when the valve controlling blood flow doesn't close tightly, allowing blood to leak back toward the heart.

Both of these conditions must be treated to prevent even more serious problems surrounding the heart and weakening the heart muscle. Most often, aortic valve disease calls for replacement of the aortic valve, but in a few cases, it can be repaired.

Steps in Aortic Valve Repair and Replacement
Patient is sedated by the cardiovascular anesthesiologist.
Cardiothoracic surgeon begins by making a 3-4-inch incision, or keyhole incision, below the collarbone at the top of the ribcage on the right side. A 2-inch incision will be made in the groin to place the patient on the heart-lung machine.
Conventional techniques are then used to replace to aortic valve.

Causes of Aortic Valve Disorders
Aortic valve stenosis (thickening or narrowing of the blood vessels) and aortic valve insufficiency (where the valve does not close tightly and blood leaks back into the heart chamber) are primarily caused by one of three conditions:

Rheumatic fever: One of the most serious side effects of rheumatic fever is its damage to the heart, specifically, the aortic valves. Although rheumatic fever rarely occurs in these post-immunization days, it still affects more than 1 million Americans and causes 6,000 American deaths per year. An adult who had rheumatic fever as a child was left with scar tissue on the heart valves. Over time, the scar tissue interferes with the proper action of the valve. The scars harden the leaflets, flaps of skin that form the door of the valve, preventing them from opening and closing properly. This makes the heart work harder to pump the necessary volume of blood, yet narrows the opening through which blood flows. The scar tissue also attracts calcium deposits, which cling to the leaflet surface, further restricting blood flow.

Calcium buildup: Age is the biggest cause of this valve disorder. Blood contains calcium, a mineral, which over time, accumulates in hard deposits within the blood vessels and valves. The anatomy of the valve also makes it susceptible to calcium deposits. A three-leaflet valve is the ideal shape for aortic valves, to open and close as blood flows through. Some people, mostly men, have a bicuspid valve, which has two leaflets. These seem especially prone to collect calcium, which eventually interferes with the valve efficiency.

Heart defect from birth: A congenital defect, in which the valve has two leaflets, vs. three, makes the heart more at-risk for aortic valve stenosis (see above). Also, a baby may be born with smaller valve openings. In this case, the surgeon may attempt a balloon valvuloplasty to enlarge the aortic valve opening. A thin tube is threaded through a blood vessel into the heart valve. It is then inflated, into a balloon shape, to stretch the opening. Once the surgeon is satisfied, it is collapsed and removed from the infant.

On average, patients who have had minimally invasive heart surgery with no complications are in the hospital for four days. In comparison, the average stay after a full, open-chest surgery is 5-7 days. 

The process of healing from even small incisions may make you uncomfortable at first. Talk to your doctor or nurses if you think medication will be helpful. They can also recommend alternative pain relief remedies, such as warm compresses.
*Image from The Society of Thoracic Surgeons

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