Our Summary

A 14-year-old girl needed a new pulmonary valve, which is a part of the heart. The doctors saw that her heart was larger than usual and her pulmonary artery, a major blood vessel in the heart, had an aneurysm, which is a dangerous bulging. To fix this, the doctors decided to use a less invasive method, meaning they would not have to open up her chest completely.

They made a small cut under her left armpit and went through the space in between her ribs to reach her heart. They also made a small cut in her right thigh to connect her to a heart-lung machine, which takes over the functions of the heart and lungs during surgery. This machine was used to help her heart to pump blood, but at a lesser extent than usual, so the doctors could work on the heart while it was still beating.

They opened up the pulmonary artery and installed a new biological valve. After installing the valve, they stitched up the artery to reduce its size. The heart-lung machine was then turned off after 64 minutes and the tubes connecting the patient to the machine were removed one by one.

After the operation, the doctors looked at the heart using an ultrasound and saw that the new valve was working well and the size of the pulmonary artery was reduced. The girl was allowed to go home 12 days after the surgery and was given medication to prevent blood clots.

FAQs

  1. What is the procedure for a minimally invasive pulmonary valve replacement?
  2. How was the proper valve function and reduced pulmonary artery confirmed after the surgery?
  3. What postoperative care was provided to the patient after the pulmonary valve replacement?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pulmonary valve replacement is to follow postoperative care instructions carefully, including taking medications as prescribed, attending follow-up appointments, and following a healthy lifestyle to promote healing and prevent complications. It is important to communicate any concerning symptoms or changes in health to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for pulmonary valve replacement include those with congenital heart defects such as Tetralogy of Fallot, pulmonary atresia, or pulmonary regurgitation. These patients may experience symptoms such as shortness of breath, fatigue, chest pain, or heart palpitations due to a malfunctioning pulmonary valve. In some cases, pulmonary valve replacement may be recommended to prevent further complications such as heart failure or arrhythmias. The procedure can be performed using minimally invasive techniques, such as through a small incision in the axilla, to reduce recovery time and scarring.

Timeline

Before pulmonary valve replacement:

  • Patient is scheduled for surgery after diagnosis of an enlarged cardiac silhouette and aneurysmal pulmonary artery
  • Computed tomography scan is performed to evaluate the condition
  • Less-invasive approach through the left axilla with peripheral cannulation is chosen
  • Patient is prepared for surgery and draped in the decubitus position
  • Peripheral cannulation for cardiopulmonary bypass is achieved through right groin dissection
  • Surgical incision is made in the mid-axillary line and thorax is entered through the fourth intercostal space

After pulmonary valve replacement:

  • Pulmonary artery is opened and a biological valve is chosen for replacement
  • Valve replacement is performed with proper techniques to ensure optimal function
  • Cardiopulmonary bypass is discontinued after 64 minutes
  • Cannulas are removed sequentially
  • Echocardiography shows good results with proper valve function and reduced pulmonary artery size
  • Patient is discharged on postoperative day 12 on antiplatelet therapy

What to Ask Your Doctor

  1. What are the risks associated with pulmonary valve replacement surgery?
  2. How long is the recovery period after the surgery?
  3. What medications will I need to take after the surgery?
  4. How often will I need follow-up appointments after the surgery?
  5. Will I need any additional procedures or treatments in the future?
  6. How will the surgery affect my daily activities and exercise routine?
  7. Are there any dietary restrictions I need to follow after the surgery?
  8. What signs or symptoms should I watch for that may indicate a complication after the surgery?
  9. How long will the new pulmonary valve last before it may need to be replaced again?
  10. Are there any lifestyle changes I should consider to improve the long-term success of the surgery?

Reference

Authors: Gil-Jaurena JM, Pardo C, Pita A, Perez-Caballero R. Journal: Multimed Man Cardiothorac Surg. 2023 Dec 18;2023. doi: 10.1510/mmcts.2023.096. PMID: 38108603