Our Summary

A 14-year-old girl needed a new pulmonary valve, which helps control the flow of blood from the heart to the lungs. Doctors found that she also had a larger than normal pulmonary artery, which is the main blood vessel carrying blood from the heart to the lungs. Instead of a traditional open-heart surgery, the doctors decided to perform a less invasive procedure through the left armpit area.

The girl was positioned on her side with a roll under her left shoulder and her left arm over her head. The doctors made a 2-inch cut along the side of her chest and entered her chest cavity between the fourth ribs. They then connected her to a heart-lung bypass machine through a cut in her right groin. This machine temporarily takes over the heart and lung functions during surgery, allowing the heart to be stopped and the surgery to be performed.

The doctors then connected the machine to the major blood vessels in her heart and opened the pulmonary artery. They replaced the faulty valve with a biological valve made from animal tissue. They used a special technique to close the artery, reducing its size.

After 64 minutes, they stopped using the heart-lung machine and removed the tubes connected to it. They checked that the new valve was working properly and that the pulmonary artery was smaller. The girl was sent home 12 days after the surgery with medication to prevent blood clots. This research demonstrates that less invasive procedures can be successfully used in pediatric heart surgery.

FAQs

  1. What type of valve was used for the pulmonary valve replacement in the 14-year-old girl?
  2. What approach was used for the pulmonary valve replacement surgery in this case?
  3. What was the patient’s condition post-surgery and what treatment was she discharged with?

Doctor’s Tip

A helpful tip a doctor might tell a patient about valve replacement is to follow postoperative care instructions closely to ensure proper healing and optimal recovery. This may include taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities as advised by the healthcare team. It is important to communicate any concerns or symptoms to the doctor promptly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended valve replacement include those with congenital heart defects, such as in the case of the 14-year-old girl with an aneurysmal pulmonary artery. Other patients who may be recommended valve replacement include those with valve stenosis or regurgitation, valve damage due to infection or degeneration, and those with valve dysfunction that is causing symptoms such as shortness of breath, chest pain, or fatigue. Valve replacement may also be recommended for patients who have had previous valve repair procedures that have not been successful.

Timeline

Before valve replacement:

  • Patient is scheduled for pulmonary valve replacement
  • Computed tomography scan shows enlarged cardiac silhouette with an aneurysmal pulmonary artery
  • Less-invasive approach through left axilla with peripheral cannulation is selected

During valve replacement:

  • Patient is draped in decubitus position with roll under left shoulder and left arm over head
  • 5-cm vertical incision in mid-axillary line is performed
  • Thorax is entered through fourth intercostal space
  • Peripheral cannulation for cardiopulmonary bypass is achieved through right groin dissection
  • Pulmonary artery is opened and 25-mm biological valve is chosen
  • Arteriotomy is closed with double row of large bites
  • Cardiopulmonary bypass is discontinued after 64 minutes
  • Echocardiography shows good result with proper valve function and reduced pulmonary artery

After valve replacement:

  • Patient is discharged on postoperative day 12 on antiplatelet therapy

What to Ask Your Doctor

  1. What are the risks and benefits of valve replacement surgery in my specific case?
  2. What type of valve will be used for the replacement and why?
  3. What is the expected recovery time after the surgery?
  4. Will I need to take any medications after the surgery, and if so, for how long?
  5. What kind of follow-up care will be necessary after the surgery?
  6. Are there any restrictions on physical activity or diet that I should follow post-surgery?
  7. What signs or symptoms should I watch out for that may indicate a complication after the surgery?
  8. How long will the valve replacement last, and will I need additional surgeries in the future?
  9. Are there any alternative treatments to valve replacement that I should consider?
  10. What is the success rate of valve replacement surgery in patients with a similar condition to mine?

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