test 5 surgical valve procedures

Question 1

Valvuloplasty

Answer 1

 Transcatheter balloon valvuloplasty
 Results equal to open surgical valvotomy
 Careful determination of anatomy via Transthoracic echo and angiograms.

Question 2

PERCUTANEOUS VALVES procedure: Melody Valve

Answer 2

 Medtronic transcatheter pulmonary valve
 For patients with failed RV to PA conduits (Rastelli)
 Stenosis or regurgitation
 Transcatheter-delivered valve that has been mounted within a balloon-expandable stent

Question 3

Percutaneous Pulmonary Valve Insertion: Palliative procedure

Answer 3

 Extends life of RV to PA conduit

 High long term failure rate of valves in the pulmonary position

Question 4

Transcatheter Aortic Valve Replacement (TAVR)

Answer 4

 For patients with calcific aortic stenosis
 Bioprosthetic valves sewn within a balloon-expanded or self-expanding stent
 Insertion Methods
 Retrograde transarterial insertion
 Requires femoral-iliac arteries to accommodate a 18-24fr delivery system
 Direct transapical insertion
 Ventricle is paced rapidly to limit cardiac output for device positioning and expansion
 Position too high or too low
 Paravalvular leaks
 Embolization
 Occlusion of coronaries

Question 5

Percutaneous Mitral Valve Repair

Answer 5

 Multiple different types of devices
 MitraClip
 Only device to complete enrollment in randomized clinical trials
 Designed to perform edge to edge repair of the mitral valve.
 Other devices attempt to create an annuloplasty
 Have not reached randomized trial phase yet
 Technical issues
 Delivered by a transvenous, transseptal approach
 Guided by TEE
 Implanted on the valve
 Grabs middle portions of the anterior and posterior mitral leaflets
 Creating edge to edge repair
 Has been used on MV prolapse, flail leaflets, annular dilation, mitral regurgitation secondary to cardiomyopathy

Question 6

Mitral and Tricuspid Valve Repair CPB considerations

Answer 6

 Cannulation
         Arterial: Aorta
         Venous: Bicaval
 Cardioplegia
         Antegrade
 Hypothermia
         Mild – Moderate depending on surgeon