Prosthetic valve paravalvular leak repair

Peripheral valve flap leakage is a serious complication after valve replacement. In early years, the incidence of mitral valve replacement was 9%, and aortic valve replacement was 13%. Currently, the incidence of paravalvular leaks has fallen below 1%. The cause of perivascular leakage is mainly due to improper surgical operation techniques, such as excessive needle spacing, poor knotting or detachment of the knot, and suture splitting of the annulus. Invalid clearance of valvular mucosal degeneration or calcification is a factor contributing to the occurrence of paravalvular leakage. In addition, artificial valve endocarditis is also a common cause of paravalvular leaks. Periorbital leakage of the aortic valve region can occur at various locations of the annulus, while the mitral valve is common in the anterior leaflet region. The clinical signs caused by paravalvular leakage are: hemolytic anemia caused by excessive local blood flow shear force and rough surface tissue; secondly, the performance and consequences of valvular insufficiency are similar, and the severity is mainly related to the leakage. The size is related; however, there are differences in the different valve locations. The clinical manifestations of the paravalvular leak in the aortic valve area are the heaviest, followed by the mitral valve area. The tricuspid valve has a small pressure difference due to systolic pressure and mild symptoms. Treating diseases: heart valve disease Indication Patients with small peri-valve leaks, such as no obvious hemodynamic changes and blood component damage, can be temporarily not operated, and closely observed. If serious hemolytic anemia or hemodynamic disorder is caused, surgery should be performed. Surgical methods include paravalvular repair and re-valvular replacement. If the leak is small, repair can be considered. If there is multiple leakage, the annulus tissue is large, the perivascular leakage is accompanied by endocarditis, or the patient with a longer life of the bioprosthesis should undergo a valve replacement surgery. Surgical procedure 1. Mitral valve repair After the mitral valve is exposed, the peripheral leakage of the valve is characterized by endocardial growth in the defect and intimal hyperplasia around the leak. First, the range of the leak should be explored, and the residual suture in the notch should be removed to confirm that the artificial valve is functioning well. There are two ways to fix it: (1) Direct suture suture method: use the atraumatic forceps to gently pull the artificial valve slit ring of the leaking part, use the needle suture to insert the needle from the side of the annulus, and take the needle from the artificial valve suture ring to make the intermittent suture type. Stitching and knotting. If the first operation uses continuous suture suture technique, the two needles should be fixed over the two sides of the leak when repairing. (2) Improved repair method: This method is based on the location of the leak, and is applied with a gasket-type suture from the outside of the heart to reinforce the closure of the peri-valve leak. Periorbital leakage in the anterior mitral valve, the suture with a septum can be sutured from the right atrium, and the posterior mitral valve leaks. It is very difficult to repair from the outside through the left atrium and cannot damage the adjacent coronary artery. The circumflex artery and the coronary sinus. After the repair is completed, the active state of the artificial valve disc is checked again, whether there is structural weakness or whether the slat is fixed, and the artificial valve is confirmed to be in a normal state, and then the heart incision is closed. 2. Aortic valve leakage repair method Check the size of the aortic valve leakage, remove residual sutures and excessively growing fibrous tissue, and then apply a sputum with a gasket for leak repair. Because the aortic valve flap is closely attached to the aortic wall, and most of the artificial valve sutures are located above the annulus, it is difficult to use the direct tamper repair method of the mitral valve. Commonly used aortic wall suture method: suture the needle from the artificial valve suture ring with suture line, at the level of the aortic valve annulus, through the aortic wall out of the needle for intermittent suture suture, add a gasket on the aortic wall Knot. This method is more convenient for the non-crown valve area and part of the left coronary valve, but other areas need to expose the adjacent part of the right ventricular outflow tract, right atrium or pulmonary artery. Therefore, it should be cut open and padded. In order to avoid damage to the coronary artery opening, it is advisable to repair the coronary artery in the left and right coronary artery. In particular, the left coronary artery opening is lower than the right side, and the aortic wall is repaired easily. The aortic sinus is pulled to block the coronary opening. It should be noted.