Our Summary

This paper describes the case of a 68-year-old man who was having difficulty breathing and was found to have a problem with one of the valves in his heart, specifically the pulmonary valve. This patient had previously undergone two heart surgeries, so the doctors decided to do a less invasive surgery by using an endoscope (a thin tube with a light and camera on the end) to replace the faulty valve.

The patient was positioned on his side and his body temperature was slightly lowered to help protect his heart during the surgery. The doctors used a technique that allowed the heart to keep beating during the procedure. They inserted the endoscope and surgical tools through small cuts between the patient’s 3rd and 4th ribs on the left side.

After making a cut in the pulmonary artery, the flawed parts of the valve were removed. A new heart valve from St Jude Medical was then put in place. The doctors also removed a part of the heart called the left atrial appendage.

The patient was able to leave the hospital without any complications. The doctors believe this is the first time a pulmonary valve replacement has been done entirely using an endoscope.

FAQs

  1. How was the pulmonary valve replacement procedure performed in this case?
  2. What is the significance of the endoscopic pulmonary valve replacement procedure in this case?
  3. What were the outcomes of the pulmonary valve replacement surgery for the patient?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pulmonary valve replacement is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and engaging in recommended physical therapy or rehabilitation exercises to aid in recovery and improve long-term outcomes. It is also important to maintain a healthy lifestyle, including regular exercise, a balanced diet, and avoiding tobacco use, to support overall heart health.

Suitable For

Patients who are typically recommended for pulmonary valve replacement include those with severe pulmonary valve regurgitation, congenital heart defects such as tetralogy of Fallot, patients with previous cardiac surgeries who require redo procedures, and those who are experiencing symptoms such as dyspnea and exercise intolerance. These patients may benefit from minimally invasive approaches to surgery, such as endoscopic pulmonary valve replacement, to reduce the risk of complications and improve recovery outcomes.

Timeline

Before the pulmonary valve replacement:

  • Patient presents with dyspnea
  • Transthoracic echocardiography reveals severe pulmonary valve regurgitation
  • Patient has a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement
  • Patient undergoes cardiac surgery twice, through median sternotomy and right thoracotomy

After the pulmonary valve replacement:

  • Patient is placed in a modified right lateral decubitus position
  • Surgery is performed using a mild hypothermic cardiopulmonary bypass
  • On-pump beating-heart technique is used during surgery
  • 3D endoscopic system and trocars for surgical instruments are inserted through the left 3rd and 4th intercostal spaces
  • Pulmonary cusps are resected and a 27-mm St Jude Medical Epic heart valve is implanted in the intra-annular position
  • Left atrial appendage is resected
  • Patient is discharged without complications

What to Ask Your Doctor

  1. What are the risks and benefits of pulmonary valve replacement in my specific case?
  2. Are there any alternative treatment options for my severe pulmonary valve regurgitation?
  3. How long is the recovery process after pulmonary valve replacement surgery?
  4. Will I need to take medication long-term after the surgery?
  5. How often will I need follow-up appointments or tests after the surgery?
  6. Are there any lifestyle changes I should make after pulmonary valve replacement surgery?
  7. What is the success rate of pulmonary valve replacement surgery in patients with a history of previous cardiac surgeries?
  8. What should I expect during the surgery and how long will it take?
  9. Are there any specific complications or risks associated with endoscopic pulmonary valve replacement?
  10. How soon after the surgery can I expect to see an improvement in my symptoms of dyspnea?

Reference

Authors: Wada T, Nagashima R, Kizu K, Takayama T, Miyamoto S, Sako H. Journal: Minim Invasive Ther Allied Technol. 2023 Dec;32(6):345-347. doi: 10.1080/13645706.2023.2250422. Epub 2023 Dec 18. PMID: 37729442